Model for Improvement: Plan-Do-Study-Act (PDSA) Cycles
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.
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.
Step 3: Study
- Carry out the test.
- Document problems and unexpected observations.
- Begin analysis of the data.
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.