WBB's Thought Leadership

Executing Plan–Do–Study–Act Cycles in Healthcare

January 17

PDSA cycles are the building blocks of healthcare improvement, but need to be embraced as a scientific method that includes a prediction and test of outcome.

Each PDSA cycle combines a prediction of outcome and a hypothesis test, and should be used to modify the prediction after every cycle.


Excerpt: “Plan-do–study–act (PDSA) cycles are the building blocks of iterative healthcare improvement. Although frequently regarded as separate from research, this quality improvement method remains rooted in the scientific method. The P in PDSA usually stands for ‘plan’ but could just as easily refer to ‘predict’. Each cycle combines prediction with a test of change (in effect, hypothesis testing), analysis and a conclusion regarding the best step forward—usually a prediction of what to do for the next PDSA cycle.
“Too often, however, improvement teams go through the motions of PDSA cycles without really embracing its spirit or applying its scientific method. For example, an improvement team might talk about having used PDSA when in reality the original change idea remained roughly unchanged throughout the project, with no refinements to the intervention or the plan to implement it. Quality improvement rarely works out so smoothly. Even among published studies, which presumably include better than average projects, the application of PDSA falls short, with less than half of studies meeting minimum characteristics of PDSA. Sometimes PDSA seems more like a quality improvement catch phrase than it does a recognisable scientific process.”
“PDSA cycles constitute the cornerstone of the model of improvement and this method has obvious advantages when put into practice. The key to successfully harnessing this approach lies in making sure each cycle includes an explicitly stated prediction (or ‘plan’) and a test of change to answer the question.”
“Benefits from the authentic application of plan–do–study–act cycles
• Efficient use of data—collecting just enough to inform the best action forward
• Refine measures and data collection method
• High ‘return on failure ratio
• Recognise necessary refinements to the intervention
• Identify missing ingredients for the intervention
• Anticipate what might go wrong during implementation
• Increases confidence that the change under consideration will produce improvement
• Engages stakeholders in development of the intervention
• Minimises resistance when change is implemented”

Source: BMJ Journals


WBB Take: Although there has been moderately high adoption of formal quality improvement (QI) approaches in healthcare, there has not been the same level of success as in other industries such as aircraft maintenance, discrete manufacturing, and chemical production. One of the obstacles to effective adoption, is the lack of dynamic linking of specific PDSA outcomes to strategic healthcare goals. Many PDSA initiatives have goals that are more “feel good” than are specific elements in the value chain. Failure to adjust the plan in each cycle reduces the potential to achieve strategic goals in the value chain. Tying PDSA outcomes to the value chain helps to ensure that the sum total of QI initiatives is achievement of strategic goals.


Matthew Loxton

Matthew Loxton

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