Managua, Nicaragua

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Plan-Do-Study-Act (PDSA) Cycles

Managua, Nicaragua July, 2007
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What is a PDSA Cycle?

• A PDSA (Plan-Do-Study-Act) cycle is a way of
  determining if a change leads to an improvement.
  It is a method for rapidly testing a change - by
  planning it, trying it, observing the results,
  and acting on what is learned

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Why should we test changes?

• To increase belief that the change will result in
  improvement
• To decide which of several proposed changes will
  lead to the desired improvement
• To evaluate how much improvement can be expected
  from the change

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Why should we test changes?

• To decide whether the proposed change will work
  in the actual environment
• To evaluate costs/impact/side effects from a
  proposed change
• To minimize resistance upon implementation

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Steps in the PDSA Cycle

• Step 1 - Plan
• Plan the test or observation, including a plan
  for collecting data.
• State the objective of the test
• Make predictions about what will happen and why
• Develop a plan to test the change (Who? What?
  When? Where? What data need to be collected?)
• Example
• Ask one patient if he/she would like more
  information on how to manage his/her blood sugar.

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Steps in the PDSA Cycle

• Step 2 Do
• Try out the test on a small scale.
• Carry out the test
• Document problems and unexpected observations
• Begin analysis of the data
• Example
• On Tuesday Dr J asked her first patient with
  diabetes

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Steps in the PDSA Cycle

• Step 3 Study
• Set aside time to analyze the data and study
  the
  results.
• Complete the analysis of the data
• Compare the data to your predictions
• Summarize and reflect on what was learned
• Example
• Patient was interested Dr J. was pleased with
  the positive response.

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Steps in the PDSA Cycle

• Step 4 Act
• Refine the change, based on what was learned
  from the test.
• Determine what modifications should be made
• Prepare a plan for the next test
• Example
• Dr J. will continue with the next five patients
  and set up a planned visit for those who say yes.

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PDSAs versus Traditional QI

• The PDSA philosophy is to design a small test
  with a limited impact that can be conducted
  quickly (days if not hours!) to work out
  unanticipated bugs.
• Traditional quality improvement
• Laborious planning that attempts to account for
  all contingencies.
• Often results in failed or partial implementation
  after months or even years of preparation.
• PDSAs are the scientific method for
  action-oriented learning.

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Linking Tests of Change

• Testing changes is an iterative process.
• Team learns for each test.

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Tips for Testing Changes

• Think a couple of cycles ahead.
• Scale down the size of the test (number of
  patients or locations).
• Test with volunteers or those who want to work
  with you.
• Do not try to get a consensus.
• Dont reinvent the wheel.

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Tips for Testing Changes

• Be innovative to make the test feasible.
• Pick easy changes to try.
• Collect only useful data during each test.
• Avoid technical slowdowns.
• Test over a wide range of conditions.
• Try a a test quickly (e.g. what change can we
  test by Friday?).
• Be prepared to end the test of change.