2. What is a PDSA Cycle?
• A PDSA (Plan-Do-Study-Act) cycle is a way of determining if a change
leads to an improvement. It is a method for rapidly testing a change - by
planning it, trying it, observing the results, and acting on what is learned
3. Why should we test changes?
• To increase belief that the change will result in
improvement
• To decide which of several proposed changes
will lead to the desired improvement
• To evaluate how much improvement can be
expected from the change
4. • To decide whether the proposed change will
work in the actual environment
• To evaluate costs/impact/side effects from a
proposed change
• To minimize resistance upon implementation
Why should we test changes?
5. Steps in the PDSA Cycle
Step 1 - Plan
Plan the test or observation, including a plan for
collecting data.
• State the objective of the test
• Make predictions about what will happen and why
• Develop a plan to test the change (Who? What? When? Where?
What data need to be collected?)
Example
Ask one patient if he/she would like more information
on how to manage his/her blood sugar.
6. Steps in the PDSA Cycle
Step 2: Do
Try out the test on a small scale.
• Carry out the test
• Document problems and unexpected observations
• Begin analysis of the data
Example
On Tuesday Dr J asked her first patient with diabetes
7. Steps in the PDSA Cycle
Step 3: Study
Set aside time to analyze the data and study
the results.
• Complete the analysis of the data
• Compare the data to your predictions
• Summarize and reflect on what was learned
Example
Patient was interested; Dr J. was pleased with the
positive response.
8. Steps in the PDSA Cycle
Step 4: Act
Refine the change, based on what was learned
from the test.
• Determine what modifications should be made
• Prepare a plan for the next test
Example
Dr J. will continue with the next five patients and
set up a planned visit for those who say yes.
9. PDSAs versus Traditional QI
• The PDSA philosophy is to design a small test
with a limited impact that can be conducted
quickly (days if not hours!) to work out
unanticipated “bugs.”
• Traditional quality improvement:
• Laborious planning that attempts to account
for all contingencies.
• Often results in failed or partial
implementation after months or even years
of preparation.
PDSAs are the scientific method for action-oriented
learning.
10. Linking Tests of Change
• Testing changes is an iterative process.
• Team learns for each test.
11. Tips for Testing Changes
• Think a couple of cycles ahead.
• Scale down the size of the test (number of
patients or locations).
• Test with volunteers or those who want to work
with you.
• Do not try to get a consensus.
• Don’t reinvent the wheel.
12. • Be innovative to make the test feasible.
• Pick easy changes to try.
• Collect only useful data during each test.
• Avoid technical slowdowns.
• Test over a wide range of conditions.
• Try a a test quickly (e.g. what change can we
test by Friday?).
• Be prepared to end the test of change.
Tips for Testing Changes
