When your healthcare team identifies a change for quality improvement, it’s important to test these predictions with a strong process.

Testing change hypotheses on a large scale at first can cause teams to waste time, money, and efforts. A nimble way to conduct change testing for quality improvement is to work on a small scale before widening your testing range. You can accomplish this with PDSA cycles, a useful, rapid-test tool in the healthcare model for improvement developed by the Associates in Process Improvement.

What are PDSA cycles?

Plan-Do-Study-Act (PDSA) cycles are a method for accelerated quality improvement used in healthcare and other sectors. PDSA cycles guide teams to plan and implement small-scale, rapid cycles of change, analyze the results, and modify plans for future testing with the overall goal of continuous improvement and positive change.

How do I construct PDSA cycles?

The process of PDSA cycles allows for small, manageable cycles of change to be implemented and tested. You can run one PDSA cycle at a time or run multiple cycles concurrently. Regardless of quantity, the process is the same.

PDSA cycles cover four phases: Plan, Do, Study, Act.

Plan.

The first step in the PDSA cycle method is the Plan phase. Here’s where you clearly determine your objectives: the “Who-What-Where-When.” Remember to start small. In this stage, you’ll clearly define the change, predict what might happen, and develop a plan to collect as much data as possible so you can test the change results.

In the Plan phase, you’ll assemble your team, identify each person’s role and responsibilities, and set timelines. Be sure to have a clear definition of your plan in writing and ensure everyone on the team is on board with the goal of the cycle. Note predictions for the cycle’s outcome.

Do.

The second stage is where you implement your plan. During implementation, document any problems you encounter and note any observations, particularly unexpected ones. Collect as much data as possible during this phase.

Study.

Here’s where you take the time to analyze the data you’ve collected and study the results.

Compare the results to your predictions and note learnings and discoveries from this test cycle. Analyze the effectiveness of the change.

Act.

In this final phase, refine your ideas and determine where changes can be made for future testing. What was successful? What modifications are needed for the next test? As you refine your ideas and learn through testing and analysis on a small scale, you can start to widen the cycles of testing to larger groups.

The Carnegie Foundation refers to this part of the process as adopt, adapt, abandon. Based on your results, you can determine whether to adopt the change, adapt and adjust it for a future test, or abandon the test altogether.

Benefits of PDSA cycles

Working in small cycles mitigates the stress and expense of working backward from a large-scale process change that didn’t work out as predicted. PDSA cycles help to save time and resources and help to prevent backtracking or rework while moving toward continuous quality improvement.  

The IHI Open School for Health Professionals created a helpful PDSA template to guide teams to use the PDSA cycles process. Try using this worksheet with your team to record your processes, analyze your results, and determine future testing cycles.