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.

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

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

	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.



How to Improve Forming the Team Setting Aims Establishing Measures Selecting Changes

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

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