# Plan–Do–Study–Act

## How to use

Sometimes it is hard to know whether a change designed to improve quality will have the desired effect; the Plan–Do–Study–Act (PDSA) tool is useful here. PDSA allows you to make small-scale focused changes, assess their impact and then decide what to do next. In this way, managers can test a new initiative to see if it works and whether it creates unintended problems. The cycle can be rerun several times to improve understanding, so you can think of it as moving in an upwards spiral of learning.

The precise origins of the PDSA cycle used today are vague, but it developed from the ideas of American physicist and engineer Walter A. Shewhart and statistician William Edwards Deming (Moen and Norman, 2010). Based on the idea that continual minor adjustments, properly assessed, will lead to improved performance, the model can be used for implementing ongoing quality improvement in any context. It is widely used in health and social care where it allows the testing of ideas before introducing large-scale change.

The four stages of each PDSA cycle are as follows.

#### 1 Plan

Be clear about your objective, specify what needs to be done and who will be involved. Make predictions for the likely impact of the change, decide what data needs to be collected, and plan how to measure the outcomes.

#### 2 Do

Carry out the plan, and document your observations about what happens. Record the expected and the unexpected, the positive and the negative outcomes.

#### 3 Study

Assess the impact, looking carefully at what worked, what didn't, and why. Consider this against your initial predictions. Evaluate your findings to confirm or adjust your plan and identify ideas for improvement.

#### 4 Act

Based on what you have learned, what should you do? Implement the full plan? Make more minor revisions and begin the PDSA cycle again?

Because PDSA forces you to analyse and reflect on plans, processes and procedures, it also encourages active engagement with the four building blocks of the fully rounded caring manager. Using PDSA particularly helps to improve goal awareness and contextual awareness and can therefore support a wider quality improvement culture. You need to be very clear about your goals and understand the variables you are working with. It also helps to highlight unintended consequences which may impact on other goals and contexts. All too often in health and social care, we hear about the ‘unintended consequences’ of change. There is little point in implementing a change if it inadvertently causes major problems for another part of the service.

PDSA is about testing small-scale ideas initially. Often there are numerous major changes that are required to improve quality in a service and this may feel like a slow process. To accommodate this, you can run several different PDSA cycles simultaneously, but you then need to be particularly attentive to how different initiatives interact, and to be careful about assumptions around cause and effect.

#### Using the interactive tool

Use the segmented circle in the centre of the tool to begin a PDSA cycle. When a phase is selected, it will appear highlighted, and you can type notes in the corresponding text box. Select the next stage represented on the circle to continue on to each step in the cycle. Once you have completed the ‘Act’ stage of the first cycle, you can continue using the tool to compete a total of four cycles. All the complete cycles are represented along the ‘Cycle bar’ at the top of the tool. Click on the PDSA letters that appear on the bar to access the information you have entered. The ‘text view’ button will show you a text view of all four cycles.

#### References

Moen, R.D. and Norman, C.L. (2010) ‘Circling back: clearing up myths about the Deming cycle’, Quality Progress, November, pp. 23–28. Available online at www.apiweb.org/circling-back.pdf (Accessed 18 January 2013).

Tip Start small – think one patient, one team, one provider; think hours and days, rather than months or years.