PDSA Conference 2023
PDSA is a simple, four-stage, cyclic learning approach to adapt changes aimed at improvement. The Plan step identifies a change that can be tested, the Do step sees this change implemented, the Study step examines the outcome and the Act steps identify adaptations and next steps to inform a new PDSA cycle.
The PDSA Cycle
The PDSA Cycle is an iterative improvement process that aims to develop, test, implement and sustain improvements. This framework can be used to create patient safety changes that last.
During the planning step, teams set expectations for outcomes and tasks that should be accomplished through clearly stated goals and numeric predictions. Using a problem-solving tool called the fishbone diagram (a chart that looks like the bones of a fish) during this phase can help teams identify potential causes and their relationships to each other.
Throughout the Do and Study steps, it is essential to keep team members engaged in the process by providing clear instructions. Keeping the process visible with digital huddle boards and kanban charts can speed results and keep the issue at the forefront of team members’ minds. This is also where leaders can lead by example by bringing attention to their own work and the work of others. Having a consistent methodology for collecting data helps teams avoid confusion between the method of data collection and who collects it.
The PDSA Toolkit
It is critical that leaders of QI initiatives promote the use of data visualization tools to speed up results and keep improvement efforts on the front burner. Examples of these tools include digital huddle boards and kanban charts, which are effective in both the planning and execution stages of the PDSA cycle.
A consistent framework for describing the structure of PDSA cycles would be helpful to support learning from the application of this improvement method and help build knowledge about the characteristics of good implementation and reporting. This could be achieved by separating out the key features of a PDSA: an iterative cyclic approach, continuous data collection, small-scale testing and use of a theoretical rationale.
Providing clear guidance on these key elements during the planning phase of a PDSA would also help teams to successfully execute a test and analyze it for lessons learned that could be applied in future cycles. Numeric predictions and measurable goals are also useful in planning a change and in establishing baselines for comparison with outcome data.
The PDSA Model for Improvement
As a tool for process improvement, the PDSA cycle can be used in any situation where a change is needed. But to maximize the effectiveness of this quality improvement approach, some basic guidelines must be followed.
For example, a PDSA cycle should be short in duration and involve only a small sample of the overall practice population (perhaps just 1 or 2 doctors). Keeping improvement activities visible through tools such as digital huddle boards and kanban charts can speed results and keep improvements on the forefront of staff attention.
In a recent study, 120 QI projects were reviewed to assess their reported effects and use of key PDSA features including the iterative cyclic method, continuous data collection and an explicit theoretical rationale. Despite the widespread adoption of PDSA, only two projects achieved a pre-specified aim set during planning. The authors conclude that guidance for the appraising and publication of PDSA projects is needed to improve scientific rigour, implementation and reporting of this simple but powerful quality improvement methodology.
The PDSA Model for Patient Safety
The PDSA cycle is a useful tool for improving patient safety in healthcare settings. Its cyclic approach to change encourages teams to think critically about current problems and to use data to identify areas for improvement. It is also flexible enough to work in a variety of contexts, from primary care through to surgical services.
A multidisciplinary team is essential for the planning stage (plan). In addition, involving frontline staff from across a department can help break down workflow siloes and facilitate outside-the-box thinking for ideas on how to improve processes. The PDSA method also supports the use of “5 Whys” in the study phase, where each team member states an apparent problem and asks “Why?” as many times as necessary until the root cause is revealed.
Despite a strong theoretical framework, the application of PDSA features was highly variable. Only 47 of 73 projects fully documented PDSA cycles in sufficient detail for analysis and only one project used all five key features.