Video Transcript: PDSA in Everyday Life

Bob Lloyd, PhD, IHI Director of Process Improvement

Believe it or not, every day you go through a PDSA cycle.

For example, every day when you get in your car and start to go to work, you go through a PDSA cycle. You get in the car, you listen to the radio, you’ve planned your trip, you’re heading down the road, and then you’re told that, in fact, there is a wreck on a road that you typically use. So you planned your journey, you’re doing it, you’re studying it now (because you’re getting feedback off the radio), and then you discover that this road is closed. So what do you do? You take that information, you put it into your brain, and then you say “Ah, I’m going to get off this road and I’m going to take a different route to avoid that accident.” You’ve just gone through a PDSA cycle.

Similarly, let’s say that you had a sick house plant. And this plant was not doing too well. You could try a number of things: You could try more water. You could try fertilizer. You could try a bigger pot, because it’s root-bound. You could try a variety of things, but again, you would be doing plan, do, study, act. So as we think about the PDSA cycle, it is a very simple thing. Yet many people can describe it, but they’ve had trouble carrying them out.

Historically, the PDSA cycle was developed by a gentleman by the name of Walter Shewhart. Walter Shewhart, back in the 1920s—working at Western Electric in Cicero, Illinois, and in New Jersey—took the scientific method that is inductive and deductive thinking—where you go from the specific to the general, from the general to the specific—with hypothesis testing. He took that scientific method and turned it into a very simple notion that when we’re going to do something, we’re going to plan it, do it, study, and act. Now remember Shewhart and his students—Deming and Juran—were working on the shop floor at Western Electric. They could not as, PhDs trained in physics, engineering, and statistics, take the academic scientific method and apply it to the shop floor where people were working making old-fashioned telephones. Those people, many of which did not read and could not explain the scientific method, were very, very engaged because Shewart was able to take the complexity of this (the scientific method) and turn it into a very simple thing that we do every day: Plan, do, study, act.

This, then, becomes the way that we carry out a test. Every day you’re doing something—whether you think about it or not—you’re actually doing a PDSA. What we’re trying to do is when we give you a PDSA form, and you’re going to fill out the PDSA form, you’re actually going to say, “Here’s my plan, here’s how we’re going to do it, and here are the people. Mary’s going to do this, Bill’s going to do that, Tom’s going to do this. We’re going to study it, we’re going to get some data, we’re going to collect it, were going to track it, and see how the process performed against that test. And then we’re going to act by modifying it, and come back up and plan our next cycle.”

PDSA is not a one-time event where you do it once and then go away. What you do is actually link them sequentially and they move forward—test 1, test 2, test 3. And so we’re going to link the PDSAs, starting out in small tests. You’re going to start with one patient—on one day possibly. Then you might move to three patients. Then you might move to five patients. Then eventually you can apply it to all, but it requires testing under a variety of conditions. So we start small with small a test of change and then we start testing them under different conditions—it worked well in this unit, but then when you went over to the next unit and tested that same notion, it didn’t work too well. Why? Different conditions, different people, different variation in the process. So every day, you’re going to have the opportunity to think about applying these things in a very, very practical yet concerted way.