Model for Improvement - Testing Interventions

Three teams tested change interventions using the Plan-Do-Study-Act (PDSA) cycle. The PDSA Worksheet helped organize the process for testing change interventions.

Examples of completed PDSA Worksheets: Example 1 (pdf, 1 page), Example 2 (pdf, 1 page)

In 2009, the New York State Department of Health received a one-time state action grant to test the Healthy People 2020 Action Model in a local setting. As part of this grant, the Model for Improvement by the Institute of Healthcare Improvement was adapted to pilot projects in three counties. The three projects addressed specific improvement opportunities in nutrition or physical activity within a school setting.

Advisory team, made up of faculty and students from Cornell University's Food and Brand Lab, visited the school cafeterias in Clinton and Franklin counties. They identified a menu of change options for the school lunch rooms and asked the teams in Clinton and Franklin counties to pick two to three changes to test in the school cafeteria. The Yale-Griffin Prevention Resource Center suggested ideas for changes with the Schenectady County team and provided survey tools that could be adapted for local use.

County Team Change Interventions Selected and Tested Results
  • Identified and worked with students to name new menu items
  • Students completed a "Tell us what you think??" survey after tasting new menu items and made recommendations
  • Improved signage with catchy slogans
    • 'Take an apple for later'
    • 'Fruit free with lunch'
  • Placed fruits in attractive bowls
  • Placed fruits at eye level
  • Added spinach to the salads
  • Promoted vegetable pizza in place of pepperoni pizza and garden burger in place of the traditional burger
The Clinton County Team learned valuable lessons from the PDSA cycle, and found:
  • Based on student opinion, new menu items "Vegetable burger" and "Mexican pasta" were were promoted to the menu. Sales of these and other vegetarian items should be tracked regularly to understand the true impact of adding the new items.
  • Menu items were re-named "Macaroni Veggie Mania"and "Vegilicious Burger" based on winning student menu contest entrees
  • Based on placement of the fruit baskets and signage, consumption of fresh fruit increased (see graph of impact of fresh fruit placement on sales) steadily from January to March and surpassed canned fruit sales. The drop in fresh fruit sales and increase in canned fruit sales in June may be attributed to using up the canned fruit inventory before schools close.
  • Anectodal stories were reported about the adults who bought lunches and liked the addition of spinach in the salad. Students were not surveyed for their feedback.
  • There was no increase in sales of vegetable burgers, while consumption of traditional burgers increased. This was an unintended consequence. Vegetable pizza consumption increased over two months that it was offered.
  • Made skim milk the default choice by locating skim milk in front of the cooler, and placing chocolate milk in the back
  • Worked with students in health class to taste test new menu items
  • Offered orange sections in addition to whole fruit
  • Data not available. Placement of skim and chocolate milk was tested in April, and the final data were collected in March. Data were not collected on a weekly or monthly basis.
  • Students participated in taste tests for healthier recipes of meatballs, breaded pork and fishsticks. Sales result were mixed.
  • Sales of total lunches and sales of free and reduced lunches, and sales of adults lunches were tracked. None changed significantly.
  • Developed and set up an indoor physical activity track
  • Planned and implemented exercise stations or activities for students
  • Designed and negotiated a schedule for a three-week exercise intervention for 10 minutes, two days per week with three fourth-grade classes outside the regular classroom hours during the school day
  • Identified exercises to increase cardiovascular endurance and to develop upper and lower body strength