Principles for Tests of Change

The Goal:
Test potential improvements to the unit's care processes that have the potential to transform care in large and small ways.

Why It's Important:
Small-scale tests of change help determine whether an idea could result in sustainable improvement. Changes should be tested under multiple conditions and with a variety of staff before being implemented.

How To Do It:

1. Understand the testing process.
The Plan-Do-Study-Act (PDSA) cycle presents a simple mechanism for testing changes that can lead to improvement. PDSA is at the core of the model for improvement used by the Institute for Healthcare Improvement. The cycle involves all four elements of testing—planning the test, trying it out on a small scale, analyzing the results, and then acting on what is learned. When conducting a test of change, four actions can help guide the process:

  • Plan: Plan the test or observation, including a plan for collecting data. State the objective of the test. Make predications about what will happen and why. Develop a plan to test the change. (Who? What? When? Where? What data need to be collected?)
  • Do: Try out the test on a small scale. Carry out the test as designed. After completing the test, record what actually happened.
  • Study: Analyze the data. Determine what you learned. Ask what the results show compared to your prediction. Assess if there are any surprises.
  • Act: Using learning from the test, refine the test of change. Determine the next step.

2. Determine which staff will be involved. Engage staff most interested in the test of change. It's also helpful to engage staff most frustrated by the current problem who may be most interested in finding a new solution.

Tip: It's important to make sure tests of change are very defined and limited in scope, particularly when first implementing TCAB. One patient, one nurse, one day is an acceptable way to begin a test of change.

3. Predict the outcome. It is important for the group developing the test to predict a quantifiable outcome before beginning the test so that the actual outcome can be gauged against expectations. Using an "Evolving Your Idea Worksheet" will help guide the team's learning throughout the process.

4. Be specific. Before implementing the test of change, outline:

  • What will be done
  • Where will it occur
  • How the test will be run
  • What the expected outcome will be.

5. Be forward thinking and flexible. When planning a test, consider how the next few cycles of the test may evolve and change based on the initial results and response to the intervention. Also, keep in mind that you may need to end the test of change. After making variations on the idea and trying new cycles of tests, if data and feedback show that the test is not making improvement, the test should be ended.

How to Test Changes

How to Test Changes

How to Test Changes

June 2008. Interview with Mary Kay Wisniewski, Improvement Specialist, University of Pittsburgh Medical Center Shadyside. Small-scale tests of change help determine whether an idea could result in sustainable improvement. Changes should be tested under multiple conditions and with a variety of staff before being implemented.

June 2008. Interview with Mary Kay Wisniewski, Improvement Specialist, University of Pittsburgh Medical Center Shadyside. Small-scale tests of change help determine whether an idea could result in sustainable improvement. Changes should be tested under multiple conditions and with a variety of staff before being implemented.

How to Test Changes

June 2008. Interview with Mary Kay Wisniewski, Improvement Specialist, University of Pittsburgh Medical Center Shadyside. Small-scale tests of change help determine whether an idea could result in sustainable improvement. Changes should be tested under multiple conditions and with a variety of staff before being implemented.

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