Tools for Change

Plan, Do, Study, Act

The PDSA Cycle Explained

Carol Reeve Eastern Wakefield Primary Care Trust

Castleford, Normanton & District Hospital

Lumley Street

High Town

Castleford

West Yorkshire

WF10 5LT

Tel: 01977 665755

Email: carol.reeve@ewpct.nhs.uk

Aims

Understand why we need to research,

analyses, plan and structure change

Appreciate the need for measurement

Value the use of tools in changing systems

Explain the purpose of the PDSA cycles

Understanding systems

We use systems in everything we do

To make successful changes you must set out to change the system

To succeed you must try and try again

Changes should be maintained and monitored

Changing systems

Change can be exciting but also threatening

Change takes time in systems and in people

Change means testing things out in the

reality of their own setting

Three fundamental questions

What are we trying to achieve? Understand the problem. Know what you are trying to achieve. Have clear

and desirable aims and objectives

How will we know that a change is an

improvement? Measure processes and outcomes

What changes can we make that will result

in an improvement? What have others done? What hunches do we have? What can we learn as

we go along and how?

How has it been done so far?

What is the best way to approach change that results in improvement?

Trial & error?

Chaos

Too much action, not enough

thinking

“Something must be done, this is

something therefore we must do

it…”

Detailed prior study?

Paralysis

Too much thinking, not enough

action

“We can’t do anything until we

know exactly what to do…”

‘Trial & Learning’ Approach

‘Trial & Learning’ component parts

Setting challenging aims Is it worth doing? Not “change for change sake”

Identifying principles/change ideas What has worked for someone? What might work for us?

Measuring progress Knowing what’s happening

Testing changes Starting small, reducing risk

Implementing and sustaining change Change in systems and routines. Developing skills and abilities

PDSA

•What changes are to

be made?

•Next cycle?

•Objective

Questions/predictions

Plan to carry out the

cycle (who, what,

where, when?)

Plan for data collection

•Carry out the plan

Document problems

and unexpected

observations

Begin analysis of

•the data

Complete the analysis

of the data

Compare data to

predictions

Summarise what was

learned

Defining the problem

Getting

Information

Set

impossible

timescales

Always speak to

someone different

Didn’t specify what

I wanted properly

Didn’t check

often enough

Not got an

accurate

brief

Didn’t give

manager

enough time

Am I dealing

with really

urgent work?

Not sharing

the workload

Haven’t planned

time available well

Waiting for line

manager’s

approval

Other

deadlines

What should a PDSA look like?

Objective Define the problem

What are you trying to achieve?

Plan Who, what, where, when?

Measurement

Do Just do it

Study What worked? What didn’t?

Act Next steps

Example PDSA form

Example of a PDSA cycle

Objective To improve BP control for patients with CHD in line with the NSF

Plan Practice Manager to identify 5 CHD patients from the

CHD register with BP greater than 140/85 by 24th May

Receptionists to contact patients by telephone to offer

appointments with the Practice Nurse

Measure date of last attendance, BP, medication

compliance

Example of a PDSA cycle

Study Two additional patients were seen opportunistically

Six patients seen and one did not attend

All patients had been seen in previous 4 months

Control of BP had been difficult:

4 patients were overweight, 1 obese

All patients did very little or no physical exercise

All patients except one reported that they comply with

medication

Example of a PDSA cycle

Act Medication compliance is difficult to assess: arrange meeting

with doctors to discuss alternative methods of compliance

Patients to be followed up more frequently by Practice Nurse

Exercise programme aimed at this group to be considered

Doctors to review medication again at the next follow-up visit

Developing improvement with PDSAs

Testing and

refining ideas

Implementing new

procedures & systems

- sustaining change

Bright

idea!

Developing improvement with PDSAs

Bright

idea!

Improvement

Improvement

Improvement

Improvement

?

PDSA cycles

Have a long pedigree

Are similar to techniques such as audit

cycles, ‘plan-do-check’, etc.

‘Natural’ to health care

Small in scope and build incrementally

Have methodological validity

Used and developed by participants in the

Collaborative

Advantages of the PDSA approach

Makes processes and learning explicit ...which is especially useful for team working

Enables testing of ideas to: - customise change for/ to local conditions

- evaluate ‘side-effects’

- improve the idea based on learning

- reduce risks

Minimise problems with getting started - persuading the reluctant

- longest journey/first step stuff

Promotes ‘bite sized chunks’

Task: to complete a PDSA within a week

Work in pairs

Identify and define a shared problem

Start to think about solutions

Develop a ‘Plan’ for a PDSA to be

completed in no more than 1 week

Summary

Improvement requires change to systems

PDSAs are a tool that help you bring about

change in a practical, useful, manageable and

managed way

Starting points: remember the three

fundamental questions to guide change

Remember that you will never know whether

the change is better unless you measure

Keep up the momentum and don’t forget to

record what happens

Questions

Thank You!