PDSA cycles

What is PDSA?

Plan-Do-Study-Act (PDSA) is a structured, straightforward approach to implementing quality improvement projects/initiatives in services. This approach works on many changes from improving a patient care process to executing a new system in services of all sizes.

Source : Institute for Healthcare Improvement. Science of Improvement: How to Improve. 2016.

Source : Institute for Healthcare Improvement. Science of Improvement: How to Improve. 2016.


Four steps to using Plan-Do-Study-Act

1. Plan: develop the project

Select your quality improvement project

Involve your team in selecting the quality improvement project. Most good ideas for improvement come from the people doing the work, so consider the perspectives of the clinical team members as well as the clerical staff and service users and carers. Patient surveys can also be used to identify areas for improvement. To identify areas for improvement, consider asking these questions:

  • Where does your practice need to improve patient care?
  • Where is your service less efficient than it should be?
  • What about the day is most frustrating for your team and/or patients?
  • Identify your PDSA team The people doing the work should be the ones planning and guiding the process improvement initiative.
  • Your PDSA team should therefore include representatives from all areas of your service that will be affected by the improvement. Set expectations for the time commitment to the PDSA team early in the cycle and plan to continue working together through implementation.

Develop your plan

Your quality improvement team should work together to develop a plan. The following questions can help you formulate your plan:

  • What do we want to accomplish?
  • Why is this a priority?
  • What does the new process look like?
  • How will the new process become hardwired into the practice?
  • Who will enact the changes?
  • Where will the changes take place?
  • Will patients be affected? How? Which patients will be affected?
  • What results do you expect?
  • How will you know your change is an improvement
  • How will you measure the impact of the changes?
  • How and when will you inform the team about progress?

2. Do: implement your plan

Communicate with the team about the new process to keep your project on track, and share any inspiring stories to keep the team excited about the change. You can do this by running a pdf report on Life QI. Conduct regular checks to ensure the new process is hardwired into the service by the team. Discuss adoption of the new process regularly at huddles and meetings.

3. Study: check the results

This step may also be referred to as “Check.” Use the process or outcome measures the PDSA team chose during the planning phase to evaluate the success of the process change. A classic technique to visualise changes over time is a run chart, which can be displayed in a team area or shared regularly at meetings.

4. Act: make further improvements

This phase may also be referred to as “Adjust.” During this final stage of the PDSA cycle, your team can take the following courses of action:

  • Review the results of your study
  • Restart the cycle at the planning phase

Discontinue the plan

The PDSA cycle is meant to be continuous; even your best processes can be improved and become more consistent. You can further refine your processes by repeating the cycle.

This video from the IHI gives you an introduction to PDSA cycles.

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