If you are preparing for - or starting out on - your first quality improvement (QI) project, you might have already come across the Plan-Do-Study-Act (PDSA) cycle as part of your research. In this article, we’re going to take a look at this really effective way to test changes in QI projects.
What is a PDSA?
The PDSA cycle is a structured method which is commonly used to test changes as part of an improvement initiative or project. It enables you to thoroughly and efficiently test and evaluate your ideas for change and involves four steps.
In our blog ‘What is a PDSA cycle?’ we talk through the various stages of a PDSA cycle in detail, but for now here is a quick summary:
Plan – This is the stage when you agree on the change to test and plan your actions for the cycle. You would also agree on and form a team to manage the process and be responsible for the PDSA cycle. At this stage, you need to identify exactly what your objectives are and what you want to achieve. It’s also crucial to work out what measurements you will use to judge the success of your changes, i.e. define the criteria for identifying whether your PDSA cycle has been a success or not.
Do – This stage is when you will carry out the change or test. It may be a very small test, perhaps even completed within a day. But this is when the action takes place. This is also the stage when you will be observing where any problems lie and start collecting data for analysis. In Life QI you can easily record all stages of the cycle within the system and collect data that will be reviewed within the ‘Study’ phase.
Study – You will now need to study the data you have collected, which will be based on the measures that were agreed during the Plan phase. Once you have collected the data, you can review, discuss and reflect with your team about the impact of the change and the test and about what you have learned. Now is the time to agree what needs to be tweaked or whether test needs to be abandoned. Or indeed whether the results mean a positive outcome can be followed through going forward.
Act – At this stage, you will be acting on the data that you have collected. So you may be planning the next change cycle based on the reflection of the test within the Study phase. You may also be planning full implementation based on your results. The results of one cycle are used to inform an enhanced idea, that you can test in a new cycle.
Once you have been through the process, it should be easier to evaluate what has happened. It will give you guidance as to either stop the process or use the information to carry on again, creating a ‘feedback loop of constant learning and improvement.’
The PDSA cycle enables you to test changes on a small scale and quickly. It's designed to be short term but frequent. So, the aim is to iterate on your idea (each iteration being a new cycle) until you are able to implement a successful improvement.
Great names in healthcare improvement, such as the Institute for Healthcare Improvement (IHI) use the Model for Improvement, which incorporates the PDSA cycle as a key tenet of its model. NHS Education for Scotland also provide more detail about the PDSA process their Quality Improvement Zone.
While you start thinking about kicking off your first PDSA, you may consider using tried and tested solutions to help you in your endeavour. Solutions such as Life QI provide a range of QI tools which enable you to ‘run and ramp’ PDSA cycles quickly and easily.
Why should I use the PDSA method?
PDSAs are based on scientific method and are a rapid way for organisations to easily test changes in QI projects. They give teams and stakeholders the chance to see if proposed changes can work before wider rollout and commitment. They can also be a really powerful learning tool for teams.
NHS Education for Scotland cite three different reasons to use the PDSA cycle within your QI effort, thus:
- Build knowledge to help answer any of the three questions in the Model for Improvement
- Test changes
- Implement a change
The methodology behind PDSAs helps to support an organisation-wide approach to culture change and you should definitely consider using a PDSA if you want to make quality changes within your organisation.
How to write and design a PDSA cycle (as a team)
So, you are ready to plan your first PDSA cycle - it’s time to get your team together and get creative! There are plenty of helpful resources to help you plan and design your PDSA.
We’ve written in detail about this in our ‘How to plan your PDSA cycle as a team’ article. This article sets out a five step approach to planning your PDSA cycles which you might find helpful. From the kick off meeting, to delegating tasks and setting deadlines, you should be able to find everything you need to get started.
As PDSA is a ‘trial-and-learning’ method which allows you to thoroughly and efficiently test and evaluate your change ideas, the first thing you need to do, is to identify what you want to achieve. You could start with brainstorming a list of tests to work out how easy or difficult they will be.
At this stage you can also look at using a software solution, such as Life QI. It enables you to assign team members to tasks and set a deadline for each task in the 'Plan' section. Life QI will then automatically list the tasks in order of the date that they need to be completed by.
Measuring the success of your PDSA cycle
A very important part of the PDSA cycle is how you evaluate the results – as this will shape your quality decisions going forward.
You will have already decided how and when you are going to evaluate with your team as part of your PDSA planning schedule. The ‘Study’ phase of your PDSA is the time to discuss the data you have collected, to complete your analysis and to compare predictions. This is when you need to think about whether you are going to adopt, adapt or abandon your change idea. This should be a data-driven decision so review your SPC charts as part of the study stage to ensure your decisions are based on objective results.
In the BMJ Open Quality Paper ‘Quality Improvement Project Guide’ the writers explain that you are likely to collect a range of measurements during your PDSA cycle and say: ‘At the very least we would expect data collection at baseline, during every PDSA cycle and after your final PDSA cycle.' They give examples of projects with multiple measurement points and say that ‘Successful and sustainable changes are more likely the more times an intervention has been tested and improved.’
They also talk about what ‘balancing measures’ to collect during the project. Balancing measures are used to try to assess the impact of your improvement elsewhere in the system with the aim of avoiding improvement in one area at the expense of another area.
We’ve also looked at this in our article ‘How to decide whether to adopt, adapt or abandon’ which helps you identify whether you adopt your project going forward:
When to Adopt - If you got the results that you had planned for – then this is the time to adopt them going forward!
When to Adapt - If your results are not quite what you wanted – but could be tweaked.
When to Abandon - You’ve tested several times – but it’s just not working out.
PDSAs should be rapid and the changes simple, but you may be running several at a time. So it is worth using tools that can help you with this. Platforms such as Life QI enable you to effectively organise and track your PDSAs all in one place to streamline the coordination of project activities.
As you will no doubt agree, PDSAs can be a really helpful method to support your improvement efforts. We hope that you will come up with some of your own ideas to help you test your changes, which will in turn support you on your journey to implement and sustain transformational change.