PDSA blank form

Using PDSA cycles enables you to test changes on a small scale, building on the learning from these test cycles in a structured way before wholesale implementation. This gives stakeholders the opportunity to see if the proposed change will succeed and is a powerful tool for learning from ideas that do and don't work. This way, the process of change is safer and less disruptive for patients and staff.
  • Written documentation of a PDSA cycle helps keep a team aligned, with a common purpose.
  • A written plan (who, what, when, where, why, how) gives you a chance to give a common message to people affected by the change.

Blank form with instructions for use in recording PDSA cycles

Background of the problem:

[This does not change throughout the entire project]
Example scenario:
The outpatient head nurse was concerned at the number of patients who failed to attend their appointments. Over the years the hospital had tried to decrease the failure-to-attend rate, but none of the changes had been sustained.
The main impact was that failed appointments waste time and cost the hospital financially. They also mean that other patients can’t be offered appointments as quickly as they want, and double booking can mean stress for staff.

What is the problem to be solved?

What is the project aim?

[This does not change throughout the entire project]
An example of an aims statement for this example:
To reduce the number of patients who fail to keep their OPD appointments without notifying the hospital.

What is the problem to be solved?

What is the change strategy to test?

[This does not change if strategy does not change, but is edited for each new strategy]
Example (continued):
For 2 weeks, an OPD nurse (participating in the project) will phone all patients who fail-to-attend and ask them whether there was a particular reason for the failure.

What is the change strategy to test?

Why What is the goal of this PDSA cycle?

[This is edited for each new cycle]
Example (continued):
Collect data for 2 weeks and analyse the causes for common factors or trends.

What is the goal of this PDSA cycle?

Cycle#:

Date start:

Date stop

PLAN the change, prediction(s) and data collection

THE CHANGE

Example (continued):
The OPD QIP team decided to measure the extent of the problem. They agreed it feels like a problem but didn’t know the exact extent of it. They started by agreeing what constitutes a failed appointment and then decided to keep a simple paper record of failed appointments. The data was to be collected for 2 weeks and then analysed.

What are we testing?

 

Who are we testing the change on?

 

When are we testing?

 

Where are we testing?

 

How will we measure the result?

 

 

 

PREDICTION(s)

Prediction is a key parameter in your planning. In your plan, state explicitly what you expect to happen as a result of the change you induce; then in the Study section, reply to this prediction by using the results of this cycle to evaluate whether the prediction was achieved.
An explicit prediction increases the likelihood that you will really learn from your cycle — either from the success of a prediction that matches actual outcomes or from your failure to predict correctly!

What do we expect to happen?

 

 

 

DATA

The plan should be time-specific and measurable [2] ; it should also define the specific population of patients that will be affected.
Example (continued):
The OPD QIP team decided to measure the extent of the problem by keeping a simple paper record of failed appointments including:
  • the patient’s demographic details
  • are they new patients to the hospital
  • what treatment they were due to have
  • time of failed appointment
  • any previous failed appointments
The data was to be collected for 2 weeks and then analysed.

What data do we need to collect?

 

 

 

Who will collect the data?

 

When will the data be collected?

 

Where will the data be collected?

 

DO:

Example (continued):
The QIP team nurse phoned the patients to ask them whether there was a particular reason they had not attended. The data was collected for 2 weeks and then analysed. 15 patients failed-to-attend.
Observations: In some cases, the patients were grateful to be reminded. The caller asked patients if they would prefer a reminder text or phone call.
Problems: In some cases, the patients were busy when the call was made.

What was actually tested?

 

 

 

What happened?

 

 

 

Observations:

 

 

 

Problems:

 

 

 

STUDY

Example (continued):
During the 2 weeks, 15 patients failed-to-attend but there were no apparent trends or common factors. The biggest impact was when patients had long appointments or — in one case — when a family of 4 failed-to-attend. The phone calls showed:
  • 5 patients had forgotten they had an appointment, of which 3 were new to the hospital
  • 4 had transport problems
  • 2 were not well at the time of their appointment
  • 4 could not be contacted because the phone numbers on file were incorrect.

Complete analysis of data

 

 

 

Summarize what was learned

 

 

 

Compare to prediction

 

 

 

ACT

Example (continued):
The team decided to implement changes and continue to keep data so they could see whether the changes had improved the situation. Changes suggested: ?>
  • phone patients with appointment length 30 minutes or over
  • phone new patients to remind them of their appointment
  • To ask all new or recall patients for their phone number to ensure correct number in the notes
  • to put a reminder notice by reception to ask patients to tell receptionist if their number had changed

Are we ready to implement the change we tested?





Summarize what was learned

 

 

 

What will the next cycle be?

 

 

 

What adjustments to the change or method of test should we make before the next cycle?

 

 

 

References

  1. Institute for Healthcare Improvement. Science of Improvement: How to improve. [www.ihi.org]
  2. SMART Objectives and Goals: Definition, Characteristics and Examples [www.questionpro.com]