The PDSA Cycle: A Step-by-Step Guide for Implementing Change
- Cubiko, Quality Improvement
- Chris Smeed
- October 25, 2022
Most of us go through a process of trial and error when we’re trying to figure out something new. We might try something once, and if it doesn’t work, we’ll try something else. This is often how we learn. The Plan-Do-Study-Act (PDSA) cycle is a way to test changes that you’re thinking about making in a more structured way. This article will walk you through each step of the PDSA cycle so that you can better understand how to use it when implementing change in your life or work.
Within the Standards, QI Standard 1: Quality Improvement asks practices to ‘undertake quality improvement activities to support the quality of care provided to patients’. Additional sections contain further requirements relating to QI however this Standard has a particular emphasis on QI activities within your practice, including the need for a plan.
Keep in mind that this is just a guide – you may need to adapt it depending on the situation. Thanks for reading!
What is a PDSA?
First things first, let’s define what a PDSA is. The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act). This can also be thought of as the “Plan-Do-Study-Act” cycle.
Why use a PDSA?
The PDSA cycle can help bring structure and organisation to testing a change. It’s a way for you to think about all the potential consequences and plan accordingly before implementing the change, rather than diving in without much thought and potentially encountering unexpected roadblocks.
Using a PDSA template
There are many PDSA templates available online that you can use to document your test of change. A common format for the PDSA worksheet includes sections for
- Objective/purpose
- Plan
- Do
- Study
- Act
- Next
We’ve developed a PDSA template to help you with your quality improvement activities.
Put down an objective, measure and ideas for change
Firstly, you want to look at what are you trying to accomplish. What is the point of the PDSA? Think about a quality improvement you want to make in your practice and use the PDSA as a means to work towards that quality improvement.
An objective grounds your QI activity with the PDSA. It provides clear direction to you and your team about what you are setting out to achieve.
The measure is how will we track the achievement of our goal. If you are using Cubiko, this could be a metric that you can view historical data for, and look to improve. If you aren’t using Cubiko, this could be a qualitative or quantitative data source.
Ideas for change, use this to brainstorm with your team some initial ideas that you can apply to the PDSA template. You may already know in your gut about how to action your quality improvement focus area, and so list them here. Remain flexible though as to when you start the PDSA cycle and what recording and analysing the results tell you.
The Plan Phase
In the Plan phase, you decide on a change that you want to test and make a plan for how you will carry it out. This includes identifying your team members, determining what data you will track to measure success, setting a timeline, and creating a plan for communication with stakeholders.
The plan is made up of four key components:
- How are we going to achieve our goal?
- Who will complete these activities?
- When are we going to do it?
- Where will this be actioned?
Remember that your objective is your why.
Do - was the plan executed?
Once you have developed your plan, it’s time for the Do phase. This is where you actually carry out your change and gather data to see if it has the desired effect. Write down the steps you took, and monitor if the plan is actioned. Aim to do on a small scale, to make iterative improvements with the remainder of your PDSA cycle. This allows you to refine the process as you continue.
Study, record, analyse and reflect on results
In the Study phase, you analyse the data that was collected during the Do phase to see if your change had its intended effect on your measure. It’s important to look at all potential factors that could have influenced the results and determine whether or not they were accounted for in your plan.
Review the process of your plan and do phases. A useful tip to study your quality improvement activity is to ask a series of questions. Here are some examples:
- Did everything go to plan?
- What learnings could be made?
- Has the objective of your QI been met?
- Was there any unsuccessful steps in your PDSA?
- What is the data showing? Did you have a hypothesis going into the PDSA, has it been met?
- What feedback do we have from the team, or those involved in the PDSA and QI?
Any improvements that you note for next time, write them down in your study section of the PDSA template.
Act, what are your next steps?
Finally, in the Act phase, you decide whether to continue with the change, modify it, or abandon it altogether and try a different approach. This step also includes sharing your findings with stakeholders and continuously improving upon the process.
Based on the results of your Study phase, you can decide whether to make modifications to your change (Act) or continue with it as is. If modifications are needed, return to the Plan phase and create a new test of change. This PDSA cycle may be ongoing.
PDSA templates available
There are many resources available online that offer PDSA templates to help guide you through each phase. It may also be helpful to involve a coach or mentor in the quality improvement activity. Engage your team along the entire PDSA to provide effective change management.
Cubiko’s PDSA template can be downloaded for free, this article describes how to use our PDSA template for quality improvement activities within your practice.
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