The quality improvement model making positive changes in health care

The Plan-Do-Check-Act (PDSA Cycle) is a Quality Improvement model aimed at making positive changes in health care processes to achieve favourable outcomes and has been used widely by the Institute for Healthcare Improvement for rapid cycle improvement.

It can be difficult to establish a programme in an institution and ensure that tasks are prioritised and carried through with. Using a Quality Improvement Project Tool such as PDSA can help you start an antimicrobial stewardship programme (ASP) and improve antibiotic use in specific areas of your institution.

One of the unique features of the PDSA cycle is the cyclical nature of impacting and assessing change, accomplished through small and frequent PDSAs rather than big and slow ones.

How to do it

Before starting, it is important to answer three questions:

• What is the goal? (Make sure it is a SMART goal)
• How will we know when the goal is reached? You need to have a metric/measurement in mind)
• What will be done to reach the goal?

You can then apply FOCUS-PDSA

• Find a problem/process to improve
• Organise team that knows the process
• Clarify how the process works (map it)
• Understand the root cause of the problem
• Select an improvement strategy

Then do PDSA

• Plan
• Do
• Study/Check
• Act (sustain or adjust and go again)

Map your process

It is important to have a good team organised to carry out this improvement. Then you must map your own process which you want to improve (from patient entry to leaving) and identify gaps in procedure or areas of poor compliance. The improvement strategy will depend on what problems were identified.

Once you have established an improvement strategy, to ensure it is sustainable you must:

• Strictly monitor compliance and adherence
• Make it an institutional KPI (key performance indicator) – ensure the policy is adjusted
• Continue education and awareness – teams constantly change (share data)
• Carry out continuous audit and feedback
• Scale it up across all surgeries in the hospital