How to Make Systems Changes
for Improved Care

Plan-Do-Study-Act (PDSA) Cycle

The Institute for Healthcare Improvement has championed the use of rapid cycle improvement for clinical settings. Dr. Donald Berwick, the Institute's founder and president, notes that "Improving the daily practice of medicine requires making changes in processes of care," and describes how to do so as follows:

"In many circumstances, the most powerful way to make such changes is to conduct small, local tests -- Plan-Do-Study-Act (PDSA) cycles - in which one learns from taking action. Learning in these cycles has much in common with learning from prudent clinical work, in which therapies are initiated under close observation and adjustments are made as data and experience accumulate.

Physicians can encourage systemic improvement by endorsing and participating in prudent, local tests of change in their own offices and in the health care organizations in which they work. To do this, they must understand the scientific value and integrity of such small-scale tests." 7 8 9

The model asks three important questions.

1. What are we trying to improve?
2. What change can we make that will result in an improvement?
3. How will we know that a change is an improvement?

Asking the three questions helps bring the problem into "FOCUS."10

Find a process that needs improvement.
Organize a team that knows the process.
Clarify the current knowledge of the process.
Understand the variation in the process.
Select a process for improvement.

Once the three questions have answers and the FOCUS principles have been addressed, the PDSA cycle method is used to test the results of the change that is being evaluated.

Plan the improvement process.

• Determine your objective for conducting the cycle.
• Predict the outcome.

Do the new process and collect data.

• Document any unforeseen problems or other unexpected observations.

Study the results of the new process.

• Analyze the data and compare them to the predicted results.
• Summarize what was learned from performing the cycle.

Act to hold the gains and continue further improvement.

To see an example of how the PDSA process matches the clinical process of care click here

To see examples of PDSA cycles on elements of the Chronic Care Model, click here.

To see the way providers look at the effects of their interventions using run charts and make further decisions about continuing, amending or discontinuing their actions click here.

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