Science of Improvement: Testing Changes

Model for Improvement: Plan-Do-Study-Act (PDSA) Cycles

Model for ImprovementOnce 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.


See also: Tips for Testing Changes, Linking Tests of Change, Testing Multiple Changes, Implementing Changes, 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.
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