The Plan-Do-Study-Act (PDSA) cycle is a "trial-and-learning" method that allows you to thoroughly but efficiently test and evaluate your ideas for change.
All ideas are taken through the circular process of: planning out how the test will be carried out, testing the change and collecting data, evaluating that data, and then either dropping the idea or using the information to run another cycle, thus creating a feedback loop of constant learning and improvement.
A common thought amongst organisations is that big goals inherently lead to bigger and better results. Smaller ideas are put to one side. However, what this assumption doesn't consider is what the accumulation of many small ideas can achieve. The power of incremental marginal gains.
Here are some reasons why the PDSA model is the path towards effective improvement:
The striving for continuous learning is at the heart of the PDSA method.
PDSA cycles are designed to be short, rapid, and frequent. The results of one cycle are used to facilitate and inform a better idea that can then be tested in a new cycle. The process is repeated until you finally implement a successful, sustainable improvement.
Ideas tested through PDSA cycles are always small and take a bottom-up approach; very often they are mere tweaks to the everyday routines and processes.
This in itself has considerable benefits:
- Easier to implement and involve less bureaucracy than large ideas.
- Less disruption to patients and staff. If a big change doesn't work, it is much more likely to have an equally large negative impact on the system. Small ideas carry a much lower risk if they should fail.
- Cost-effective. Small changes are inexpensive to implement, yet the learning payoff can be huge.
- Easier to leave bad ideas behind. The amount of planning and financial - and even emotional - investment involved in big ideas makes them difficult to let go of, even if they prove to be disastrous. Small changes that have been planned and implemented quickly and efficiently are much easier to drop if they don't work out.
- Staff and patients are more receptive to small changes. Big changes can be overwhelming and cause too much conflict, but small alterations to everyday practices are usually well-received, especially as the testing phase in PDSA cycles is so short.
One of the natural outcomes of a bottom-up approach is that it directly involves frontline staff and places the ability to solve problems directly in their hands. This can galvanise staff into proactive involvement. Frontline staff also have the greatest incentive to make the best decisions possible as they are the staff who will be directly impacted by the changes and choices made.
Creates a cohesive culture of learning and change
A frequent concern for members of any QI community is that their ideas for change are stopped short by a resistant culture that favours a static status-quo.
However, non-threatening small changes combined with frequent PDSA cycles fosters a culture of learning and change. It is a good and gentle way to get even the most resistant of teams to become accustomed to change.
Moreover, frequent team-led PDSA cycles and bottom-up improvement strategies go a long way in fostering a team environment.
All projects are conducted in the same uniform manner (Plan-Study-Do-Act), making measuring and drawing comparisons between different projects and change ideas much easier. Providing this standardised improvement strategy also means that it is suitable for any department or organisation.
The PDSA model is efficient and provides clear focus for a project. Moreover, beginning with a thorough planning stage leads to effective action and relevant meaningful data.
Good ideas are adequately tested before being implemented.
It is unlikely that an idea will be implemented perfectly first time: all ideas can be tweaked and checked for sustainability through multiple PDSA cycles before being introduced permanently or rolled out elsewhere. This also ensures that changes always support, rather than hinder, improvement.
So what will your next PDSA be …?