This document provides an introduction to the Plan-Do-Study-Act (PDSA) cycle for quality improvement. It explains that PDSA cycles allow for testing changes on a small scale through iterative learning. Changes are implemented in controlled steps to identify problems early before full implementation. The document prompts the reader to think of an accreditation standard they want to improve and develop a PDSA cycle to test changes toward meeting that standard. It emphasizes that PDSA cycles incorporate documentation and data over time to support local learning and sharing of lessons with others.

1. PDSA – tell me
more!
Presented by:
Adjunct Prof Paresh Dawda
https://prestantiahealth.com/home/aapm_pdsa

2. Some questions for you?
Who knows what the quadruple aim is?
Heard of PDSA
If you have done a PDSA in
last 12 months
Last 6 months
Last month
Last week
Last day

4. The quadruple aim
Patient
Experience
Staff and
Provider
Experience
Effectiveness
of Care
Efficiency of
care

5. Appreciation of a
system
Understanding
variation
Theory of
knowledge
Knowledge of
Psychology
“Knowledgeisabigsubject.Ignoranceis
Bigger”
Source:FiresteinS.Ignorance:how it drivesscience.Oxford:
Oxford UniversityPress,2012.

6. Let’s start with a game?

7. Theory of knowledge
Theory of knowledge is based on
the premise that management is
prediction and knowledge acquired
as a rational prediction based on a
theory of what may happen
This is then revised based on
comparison of prediction with
actual observation
The new knowledge is then
reflected in the new theory of what
action is needed to effect change
“The goal of these
methods is not to test
a hypothesis but
rather to gain insight
into the workings of a
system and improve
that system.”Source: Ogrinc G, Shojania KG. BMJ
Qual Saf 2014;23:265–267.

9. The usual approach

10. The usual approach
Design Design Design Approve
Implement
MeetingRoomsRealWorld
Test +
refine
Test +
refine
Test +
refine
Test +
refine
Test +
refine

11. The usual approach
• Not clear or agreed what we want to achieve (aim for nothing and you'll hit it)
• We make lots of assumptions but rarely test them
IDEAS
• Half the team don't see the need for change
• (but we're still surprised when guidelines/protocols aren't followed consistently)
WILL
• Big exhausting changes
• Don't know when we've arrived
• Don't look for unintended consequences
• Don't iron out little niggles
EXECUTION

12. The learning cycle

13. Plan, Do, Act, Study

14. Plan, Do, Act, Study

15. Plan, Do, Act, Study

16. Plan, Do, Act, Study

17. Applying it to an
accreditation
standard

18. A short exercise
Think about one accreditation standard or criteria
that you would like to improve (one that’s
challenging or you think you will have difficulty with)
• How will you go about it?
• What will you do next?
• How will you know whether it will work or not?
• Now write a PDSA

19. Source: Greg Ogrinc, and Kaveh G Shojania BMJ Qual Saf 2014;23:265-267
“false starts, miss firings, plateaus, regroupings, backsliding,
feedback, and overlapping scenarios within the process”

20. Plan-Do-Study-Act
• progress is achieved in small, controlled, manageable steps
• problems can be identified early & ironed out before moving
on
Time
Complexity

21. Key features of PDSA cycles
Iterative cycles To achieve an iterative approach, multiple PDSA cycles must occur.
Lessons learned from one cycle link and inform cycles that follow.
Depending on the knowledge gained from a PDSA cycle, the following
cycle may seek to modify, expand, adopt or abandon a change that was
tested
Prediction-based test
of change
A prediction of the outcome of a change is developed in the
‘plan’ stage of a cycle. This change is then tested and examined by
comparison of results with the prediction
Small-scale testing As certainty of success of a test of change is not guaranteed, PDSAs
start small in scale and build in scale as confidence grows. This allows
the change to be adapted according to feedback, minimises risk and
facilitates rapid change and learning
Use of data over time Data over time increases understanding regarding the variation
Documentation Documentation is crucial to support local learning and transferability of
learning to other settings
Source: Taylor MJ, et al. BMJ Qual Saf 2014;23:290–298. doi:10.1136/bmjqs-2013-001862

22. Questions
https://prestantiahealth.com/portal/aapm_pdsa
What can you do by next
Tuesday?