Institute for Healthcare Improvement: Testing Changes

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Once a team has set an aim, established its membership, and developed measures to determine whether a change leads to an improvement, the next step is to test a change in the real work setting. The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method, used for action-oriented learning.

Linking Tests of Change

Testing Multiple Changes

Tips for Testing Changes

Click here for more information and general tips on Forming the Team, Setting Aims, Establishing Measures, Selecting Changes, Implementing Changes, or Spreading Changes.


	Reasons to Test Changes To increase your 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. To decide whether the proposed change will work in the actual environment of interest. To decide which combinations of changes will have the desired effects on the important measures of quality. To evaluate costs, social impact, and side effects from a proposed change. To minimize resistance upon implementation.

	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?) 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. 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. 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 of a Test of Change (Plan-Do-Study-Act Cycle)

Depending on their aim, teams choose promising changes and use Plan-Do-Study-Act (PDSA) cycles to test a change quickly on a small scale, see how it works, and refine the change as necessary before implementing it on a broader scale. The following example shows how a team started with a small-scale test.

Diabetes: Planned visits for blood sugar management.

Plan:	Ask one patient if he or she would like more information on how to manage his or her blood sugar.
Do:	Dr. J. asked his first patient with diabetes on Tuesday.
Study:	Patient was interested; Dr. J. was pleased at the positive response.
Act:	Dr. J. will continue with the next five patients and set up a planned visit for those who say yes.



How to Improve Forming the Team Setting the Aim Establishing Measures Selecting Changes Implementing Changes Spreading Changes

Download these Tools to help you plan and document your tests of change.

Plan-Do-Study-Act (PDSA) Worksheet Project Planning Form