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Applying the PDSA cycles for quality improvement

The essential components of the Plan Do Study and Act components of testing quality improvement interventions for healthcare services.

The video on this step describes each of the PDSA components and how they can be applied, illustrated by a practical example from ROP screening. The importance of observing and monitoring improvements during the process is highlighted throughout.

As you watch the video, reflect on how different members of the QI team take responsibility for the various PDSA components.

Successfully applying PDSA cycles

The strength of the Plan-Do-Study-Act approach is in enabling healthcare teams to learn quickly whether a quality improvement (QI) intervention can work in their particular health setting.

By making adjustments in small steps healthcare teams increase the chances of delivering and sustaining a desired improvement to their process. It is important to remember that PDSA does not always lead to quality improvement. Some QI interventions will be adapted or adopted after PDSA testing but some will have to be abandoned.

The structured, reflective practice that PDSA requires can seem very counterintuitive to healthcare providers who are used to focusing on ‘doing’. This can make the time required for planning and reflection seem like a luxury rather than a necessity. As a result, QI teams often get stuck in the ‘Do’ phase and don’t spend enough time on the ‘Study’ phase. QI teams must be careful to avoid this trap when undertaking PDSA. It is the ‘Study’ phase and the iterative design of the PDSA cycles that will allow for the discovery of the unexpected and enable the team to make their QI intervention more successful.

Key success factors for any QI intervention

  • Strong leadership on performance improvement
  • Active staff involvement (buy-in and accountability) at all connected levels
  • Effective use of data for decision-making and an effective communication strategy
  • A positive culture in the organisation towards practice changes.

Common challenges

  • Convincing people that there is a problem that is relevant to them
  • Convincing them that the chosen solution is the right one
  • Getting the data collection and monitoring systems right
  • Excessive ambitions or lack of staff engagement
  • Clashes in organisational cultures, capacities and contexts
  • Weak leadership
  • Securing sustainability
  • Risk of unintended consequences.
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