Video Transcript: The PDSA Cycle (Part 2)

So let’s apply the PDSA cycle to an actual example. Let’s take, for example, discharge planning. That is getting a patient out of the hospital on time—when they were told they’d be discharged—which pleases the patient, the family, and the next set of patients that need to come in.

So, what is our plan? The first aspect that we’re going to do is that we’ve worked with the team to develop a new discharge planning form. Now this form is a task that has to be done in order to achieve a test. (Often times, people get confused between a task and a test. The test is going to be taking the form and applying it to a patient.) So now, this form has check boxes, it has pharmacy, it has discharge planning instructions, education, and other things that are needed. Now we’re going to do it. This is, on next Monday, we’re going to get one of the discharge planning nurses, Tom, to take this form and apply it to three patients. We’re not going to do it on all 50 patients, we’re not going to do it on the whole hospital, but we’re going to start out with a small test—3 patients. Tom’s going to take the form and use it with these three patients. We’re going to get feedback then, we’re going to study, and Tom is going to come back and we’re going to get feedback from Tom on whether or not the form worked: Were things easy to fill out? Did he have to look all over the place? Did the flow of information work well? So Tom’s going to give us feedback. Then we’re also going to get feedback by keeping track of the percent of patients discharged by 11 o’clock. And we’re going to keep this little run chart to look at our progress over time. As we do more tests, we’re going to accumulate more data and eventually we’ll be able to see if in fact this form, and what goes with it, is actually improving the percent of patients that get discharged before11 AM.

Then we’re going to act. We’re going to take the feedback from Tom and from our data, and then we’re going to think about the next test with more patients—maybe on a different unit, maybe now we’re going to take it instead just on 3 West, we’re going to take it and we’re going to apply it to all med surg floors. Now when we’ve tested under different conditions and we’re now accumulating—we’ve tested it with 3, 5, 10, 15 patients—at some point after we’ve tested under different conditions, we’re going to be ready to move to the next phase, which is to implement. That is implementation of the test (in this case, the form) to all units. But we wouldn’t want to do that until we’ve tested—especially under different conditions.

And finally, once we’ve implemented, we’ll be ready to engage ourselves in some spread. Let’s say that we are part of a system and that system has three hospitals. So we’ve been testing it starting on one unit, Tom’s unit. Then we’re going to go to this hospital. Then we’re going to move to the next two hospitals and spread what has been tested and documented.

But it all starts with our PDSA cycle that gives a framework for testing one idea against a group of patients that eventually will be allowed to implement and spread on a regular basis. It all starts with the testing of PDSA.