PDSA cycle
The PDSA cycle, which stands for Plan, Do, Study, and Act, is a management practice designed for process improvement within organizations, particularly in healthcare settings. Developed by W. Edwards Deming and adapted by the Institute for Healthcare Improvement (IHI), this cycle emphasizes iterative testing and small-scale implementation to facilitate change. It begins with identifying an area for improvement, setting measurable goals, and executing a planned change. After the initial implementation, results are studied to assess effectiveness, leading to decisions on whether to expand, modify, or abandon the change.
This approach is favored for its simplicity, flexibility, and minimal resource requirements, allowing organizations to experiment without significant disruption. Each cycle builds on the previous one, fostering continuous improvement through short testing phases that engage the staff directly involved in the changes. However, the PDSA cycle has limitations; it may struggle with complex issues requiring interconnected changes across multiple departments. Success also depends on alignment and support from both management and the involved teams. Overall, the PDSA cycle serves as a practical tool for organizations aiming to enhance their processes incrementally and effectively.
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PDSA cycle
PDSA cycle is a management practice for improving processes. The name stands for Plan, Do, Study, and Act. The cycle focuses on small tests and short time frames for implementation of plans to help drive process improvement. In some cases, PDSA results in immediate improvement, while in others the plan is amended and the process repeated several times before the desired results are achieved. The cycle has proven popular with many organizations because it is simple, does not require the commitment of large amounts of time or resources, and is flexible.
Background
The PDSA cycle was designed by the US Institute for Healthcare Improvement (IHI) as a way to improve healthcare outcomes. It was based on the work of W. Edwards Deming (1900 – 1993), an American engineer, statistician, and management consultant. Deming in turn based his work on the scientific method of formulating and testing a hypothesis.
During the 1950s, he introduced what was known as the Deming wheel, which was intended for the manufacturing industry. It built on a three-step process advocated by Walter A. Shewhart (1891– 1967), an American statistician who is sometimes known as the father of statistical quality control. In 1939, Shewhart developed a circular approach to quality that started with specification of the project, followed by production, and finally inspection. Deming used Shewhart's cycle approach to develop a plan in which manufacturers would design a product, make the product, do in-house testing, sell the product, and then test the product while in use. The final step was asking buyers what they liked and asking those who did not buy it why they made their decision.
Shortly after Deming introduced the wheel, Japanese companies adapted his process into a Plan-Do-Check-Act (PDCA) process. Under this model, a design is planned, the plan is done or the item produced, and the success is checked by reviewing sales figures and any complaints. Finally, those figures and complaints are acted upon by preparing to create a new plan.
The plan was revised several times over the next several decades. In 1985, the Japanese PDCA cycle was modified to include additional steps for training and goal setting. Around the same time, Deming also modified his cycle to include additional emphasis on the planning stage. Shortly before his death in 1993, he devised the PDSA model that was adapted for use by health care providers by the IHI.
Overview
The PDSA cycle is intended to be used as a tool for improving a process or other aspect of an organization. It starts with the participants asking what they want to improve, determining how they will know if what is being done is an improvement, and then setting a plan for making the improvement and testing it. Once they have developed a plan, they make whatever change has been planned, and then study the results. Finally, they act on what they have discovered. This can mean expanding the action to other areas of the hospital or medical practice, deciding on a new thing to change, or making some adjustments to what they were doing, and beginning the process over.
For example, if a medical practice is trying to streamline how patients are checked in, the planners might decide to have one physician in the practice test the new procedure for a day. If they encounter some difficulties, they can discuss these, figure out a way to adjust the change, and try it again the next day. Once the planners are satisfied with how the process is working with one physician, they can try it again the next day with another physician, or with two physicians, before expanding the change to the whole practice.
The PDSA cycle has been popular due to its ease and practicality. The process is simple and the testing group is usually small, so change limits disruption and risk. The situations being fixed generally have direct impact on the people doing the testing, so they are invested and interested in the outcome. The test cycles are short and the outcome is readily apparent, so participant interest stays high and successful changes can be implemented quickly. Even attempts that fail provide useful information that minimizes the feeling of having made a mistake. Since the group who will use the system is involved in the testing process, they are more likely to be accepting when a larger-scale change is implemented. The process also lends itself to incremental implementation by starting with a small test group and expanding it as part of the ongoing tests.
While the PDSA cycle has been highly touted and has brought about successful improvements in many health care settings, some have pointed out that some health care-related issues are too complicated for the cycle to help. A change that might work well when attempted with a small group of three to five patients in one section of a hospital floor may become too complicated, too costly, or too labor-intensive when expanded to include an entire hospital, for example. It also is less effective when an organization needs to make interconnected changes; for example, a new procedure to curb hospital-acquired infections may work fine when it involves the nurses in one ward, but it may take many more resources to incorporate the team of orderlies that transports patients in and out of that ward.
To make PDSA cycles successful, the organizations above and below the area implementing the cycle must be in agreement and willing to accept the results. PDSA cycles will not work if upper management does not agree with the process. It also requires sufficient leadership within the change group to honestly and effectively access what is and is not working and to take steps to move forward with new changes when necessary.
Bibliography
Hunter, John. "The History and Evolution of the PDSA Cycle." The W. Edwards Deming Institute, 28 May 2015, deming.org/the-history-and-evolution-of-the-pdsa-cycle/. Accessed 8 Aug. 2024.
Moen, Ronald D. and Clifford L. Norman. "Circling Back: Clearing Up Myths about the Deming Cycle and Seeing How It Keeps Evolving." Associates in Process Improvement, 2010, www.apiweb.org/circling-back.pdf. Accessed 8 Aug. 2024.
"PDSA Cycle." W. Edwards Deming Institute, deming.org/explore/pdsa/. Accessed 8 Aug. 2024.
"PDSA: Plan-Do-Study-Act." Minnesota Department of Health, 3 Oct. 2022, www.health.state.mn.us/communities/practice/resources/phqitoolbox/pdsa.html. Accessed 8 Aug. 2024.
"Plan-Do-Study-Act Worksheet." Institute for Healthcare Improvement, www.ihi.org/resources/tools/plan-do-study-act-pdsa-worksheet. Accessed 8 Aug. 2024.
Reed, Julie E., and Alan J. Card. "The Problem with Plan-Do-Study-Act Cycles." BMJ Quality & Safety, 23 Dec. 2015, doi:10.1136/bmjqs-2015-005076. Accessed 8 Aug. 2024.