Plan-Do-Study Act Cycles: A problem-solving tool for improvement work

It’s a fact – change happens.

Sometimes change is forced on us and we need to actively manage the impact (the COVID-19 pandemic is a great example of that). Other times, we make change happen to improve a situation.

As humans, we regularly make changes to our processes. Have you ever:

• Picked a new route to work because you found you’re able to shave five minutes off of your commute?
• Adjusted how you plan your work week to see if it helps with productivity?
• Trialed different recipes before landing on the one you prefer the most?
• Switched brands of a product because you found a different one works better for you?

These are all examples of small changes that you may have made to improve your life. While these examples are all different, they all have one thing in common: you had to work through a process before landing on the best option for your needs.

Within quality improvement work, this process is called the Plan-Do-Study-Act (PDSA) Cycle, which is an approach you can use to make effective change happen.

Read on to learn about PDSA cycles and how you can use them in improvement work.

Table of contents

• What is a PDSA cycle?
• The different steps of a PDSA cycle
• PDSAs in action
• Further PDSA applications
• Tips for successful PDSA cycles
• PDSA Worksheet

What is a PDSA cycle?

The model for improvement offers a framework for developing, testing, and implementing small changes that lead to improvement. This framework – called the PDSA cycle – is a problem-solving approach used to test whether a change is an improvement.

PDSA cycles are meant to help a team quickly learn whether a change results in an improvement or whether it might need some more tweaks

There are four stages to PDSA cycle: Plan, Do, Study, and Act. You can work through these stages by using this PDSA worksheet.

But before you jump into your PDSA cycle, you should first gather the people who will be affected by this change. As a group, you should describe what you are trying to accomplish by setting your aim. You can do this by answering these three questions:

1. What are we trying to accomplish? This is where you think about what you are trying to do and set clear and desirable aims and objectives.
2. How will we know that a change is an improvement? This is where you establish measuring processes and outcomes.
3. What changes can we make that will result in improvement? This is where you generate ideas based on what others have done, what you think could happen, and what can be learned through this process.

Once you have finished the thinking and planning phase, it’s time for action.

The different steps of a PDSA Cycle

Stage 1. Plan

In this stage, you will develop a plan to test the change. To do this, you will need to gather the people who will be affected by this change, make predictions, develop a plan to carry out the cycle (who, what, where, when), and decide what data to gather.

It’s important to use a collaborative approach and have your team clearly define who is doing what, where, and when.

Then, it’s time for your team to examine the current process and set what the goals are for this test of change. You will then create a plan to carry out the PDSA cycle and decide what data to gather.

Keep in mind, you should keep your test of change small. Smaller PDSAs are easier to roll out and you can see the results quicker. They are also more manageable and less daunting than trying to change a whole system.

Once your idea has been thought out and planned, it’s time to carry out the test.

Stage 2: Do

This is the stage where you will carry out your test of change. It’s important that you gather your data as you work through your cycle and document any problems or observations your team may have.

Once you finish the test, it’s time to analyze the data.

Stage 3: Study

Sometimes referred to as the “check” stage, this is where you will analyze the data and compare it to your predictions and aim.

Things you should consider:

• Did your plan result in an improvement? If so, by how much?
• Was the action worth the investment?
• Where there any unintended side effects?

Once the test is complete and your team has reviewed and summarized the results, it’s time to consider what your next step is.

Stage 4: Act

At this point, your team should reflect on the plan and outcomes. One of three things would have happened:

1. The test of change worked great. This idea has legs! In which case, you would probably run the PDSA again but this time for longer, or with more patients, or at a different time, etc. It seems good, but you need to test it again to see if this was just a one-time thing or if it really does seem like an improvement.
2. The test worked OK, but not totally as expected. In this case, you might make some tweaks and then run another PDSA.
3.  It did not work, you had a real stinker on your hands. In this case, you learn from what didn’t work and move on.

As you test ideas, take the ones that work and gradually increase the size and scope until you are ready to implement. It is normal to have to complete multiple rounds of PDSA cycles before finding the best improvement. Conducting many cycles means your team will have a good idea of which ideas will have the greatest impact and which ones won’t.

Once you are ready to implement your change, it’s time to document the improvement. We typically use a tool called a work standard to do this.

PDSAs in action

Now that you have read through what the different stages of a PDSA cycle entail, let’s talk about what this would look like in action. If we use the example of picking a new and shorter route to work, here is what it could look like:

• Plan: Before making a change, you would first measure the time it takes you to get to work using the original route. Then you would pick what you want to try as your new route.
• Do: Try the new route out for five days to see if it’s consistently better. Make sure you track the time it takes you to leave your home until you arrive at work.
• Study: Look at the times from the new route compared to the original route.
• Act: Three days into your test, they begin construction on the new route. Time to test a different route to see if it makes a positive change on your commute times.
   

Further PDSA applications

If you’re looking for more examples of PDSA cycles or are interested in how this framework can be used in a health care setting, check out these videos from the Institute for Healthcare Improvement:

PDSA in Everyday Life

PDSAs in a health care context

Tips for successful PDSAs

There are many ways you can help keep your team on the right track while working through PDSA cycles. Here are some:

• Regularly reflect on what you’re hoping to accomplish and how you will know a change is actually an improvement. 
• Keep track of all the PDSAs your team has conducted.
• Keep your test of change small to begin. Small, incremental PDSAs are easier to roll out and you can get feedback on the changes more quickly. They are also more manageable and less daunting than trying to change a whole system.
• Use a team approach. Have your team clearly define who is doing what, where, and when.  
• Encourage staff to conduct their own PDSAs without requiring approval from higher up. Don’t manage PDSAs from the top down – top-down management inhibits, rather than facilitates, creativity in PDSAs.  

PDSA Worksheet

Now you have an idea of what a PDSA cycle is and how to use it. While it may seem daunting at first, you will soon discover how easy it is to implement improvements into your life by using these small tests of change. Want to try using the PDSA framework with your team? Download HQC’s PDSA worksheet!