What can you change in two weeks?

Submitted by: 08/04/2015 by Maureen Fitzgerald

The NIATx model relies on using rapid-cycle testing to make effective, lasting changes. Structured around what’s known as the PDSA (Plan-Do-Study-Act) Cycle, rapid-cycle testing is used to quickly evaluate the impact of potential changes on a specific aim.

What’s great about rapid-cycle testing is it keeps change projects short and to the point. A change team can test an improvement and decide whether it’s working or not within just a couple of weeks.

Rapid-cycle testing: Why “Rapid” is Key

When doing rapid-cycle testing, it’s critical that you limit the time you spend planning, executing, and analyzing a given change, for a number of reasons:

  • Deadlines: Setting specific, concrete deadlines forces the team to act and to get things done. By allotting only a couple of days for the entire test process, including planning, you avoid the trap of getting so hung up in the planning stage that you never end up making the change. Without a solid timeframe and deadlines, it’s easy to let a project drag on and on, particularly when the planning phase of a project seems to be easier than the “doing” phase.
  • Risk reduction: Short tests minimize the chances of spending lots of time, energy, and money on testing a change that turns out to be ineffective. By testing changes rapidly, you are able to quickly ascertain whether you are headed in the right direction or whether you should choose a new direction entirely. And the stakes are lower: if one direction turns out to be fruitless, that’s all right, and you can move on knowing that you haven’t wasted much time. Tests that last longer than a month tend to become the new way of doing things even if they have proven unsuccessful.
  • Experimentation: Short testing cycles allow the team to be more experimental with the changes they decide to test, which often produce surprising results. When you’re only committing a couple weeks to a change, you are more willing to think outside the box and test some of the more off-the-wall ideas you’ve come up with. On the other hand, if the test period was to last for two months, you might be less inclined to take risks because the stakes would be higher.
  • Staff support: Short tests are less overwhelming for staff, and will produce less resistance and skepticism. Staff are more likely to have an open mind about trying out a new procedure with the knowledge that it is short term. Furthermore, once you decide to institutionalize a change on a full scale, staff may be more enthusiastic because they have seen for themselves how well it worked during testing.
  • Knowledge: You’ll learn from the tests, even if they are not successful, and you can put that knowledge to use in subsequent tests. Shorter tests mean more tests, and more tests means evolution of ideas and refinement of methods. You’ll also become better at conducting the tests in the future.
  • Less disruption: Everyone has had the experience at least once of a large-scale organizational change being implemented without adequate testing (new information systems are the quintessential example). A lot of money, time, and energy has been spent on planning and implementing, but not on testing; staff are dragged away from their normal duties to assist in implementation; efficiency is reduced during implementation, so the organization and clients all suffer. If staff and clients had been more engaged in planning and testing, the process might not have had to be so large and disruptive. A small change, tested in a small area, or even with one staff person and with a few clients, can identify changes that work will before they are expanded to the whole organization, causing minimal disruption until the change is proven to work.

Excerpted from Gustafson, D.H., Johnson, K., et al. (2011). Rapid-Cycle Testing. In The NIATx Model: Process Improvement in Behavioral Health (pp. 73-75). Madison, WI: University of Wisconsin-Madison.

What’s the most off-the-wall change that your change team has tested—that proved to be successful? What’s the shortest rapid change cycle you’ve run?  Share your story in the NIATx E-news! Contact: maureen.fitzgerald@wisc.edu

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