FOCUS + PDSA

Process improvement teams benefit from having a common framework for thinking about the improvement process. One popular approach is the FOCUS-PDSA model, defined as follows:

FOCUS

• Find a process to improve.
• Organize a team that understands the process.
• Clarify what is currently known about the process.
• Understand the causes of variation within the process and what is acceptable variation, and attempt to uncover the root cause of the problem.
• Select the method of improving the process and start the PDSA.

Facilities should first determine what they wish to accomplish, such as improving overall door-to-reperfusion times. The next step is to organize a team that is familiar with the process and supports the need for change. Look at the variation within the selected process and if it is not "normal variation" as previously discussed, attempt to eliminate or incorporate this variation so that the process is being done by everyone in a consistent manner. Try to identify process steps that cause delays, the "root causes" if possible. This is a good time to refer to the flowchart, breaking down the total process into manageable steps with potential for improvement. When a root cause is identified and selected for process improvement, it is time to move to the PDSA cycle and implement the plan.

PDSA (Plan Do Study Act), PDCA (Plan Do Check Act), Shewhart Cycle, Deming Cycle

These titles/acronyms are all synonymous for the four-step model used to bring about process change. It is arguably the most recognized method of identifying an opportunity for change, implementing this change, and then continually monitoring the change for success, thus ensuring continuous improvement. Typically depicted as a circle, it is a recognized method of testing what has been identified as an improvement opportunity.

When the changes are selected, it is time to use the PDSA cycle to "Plan" the change, try it out ("Do"), "Study" the results, and "Act" on what was discovered during the implementation.