Model Pdca Cycle

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?
Detailed prior study?
Chaos
Paralysis
Too much action, not enough

thinking
Too much thinking, not enough

action
Something must be done, this is

something therefore we must do
it
We cant 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 whats 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?
Complete the analysis

of the data
Compare data to
predictions
Summarise what was
learned
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
Defining the problem

Always speak to
someone different
Getting
Information
Didnt specify what

I wanted properly
Set
impossible
timescales
Didnt check
often enough
Am I dealing
with really
urgent work?
Not got an
accurate
brief
Havent planned
time available well
Other
deadlines
Not sharing
the workload
Waiting for line

managers
approval
Didnt give
manager
enough time
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 didnt?
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
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
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

Implementing new
procedures & systems
- sustaining change
Testing and
refining ideas
Bright
idea!
Developing improvement with PDSAs

Improvement
?
Improvement
Improvement
Improvement
Bright
idea!
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 dont forget to
record what happens
Questions
Thank You!

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Tools for Change

Plan, Do, Study, Act

Value the use of tools in changing systems

To make successful changes you must set

Change can be exciting but also threatening

Change means testing things out in the

Three fundamental questions

How will we know that a change is an

What changes can we make that will result

How has it been done so far?

Detailed prior study?

Too much action, not enough

Too much thinking, not enough

Something must be done, this is

We cant do anything until we

Trial & Learning Approach

Trial & Learning component parts

Identifying principles/change ideas

Implementing and sustaining change

What changes are to

Complete the analysis

Carry out the plan

Defining the problem

Didnt specify what

Waiting for line

What should a PDSA look like?

Example PDSA form

Example of a PDSA cycle

Example of a PDSA cycle

Example of a PDSA cycle

Developing improvement with PDSAs

Developing improvement with PDSAs

Advantages of the PDSA approach

Enables testing of ideas to:

Minimise problems with getting started

Promotes bite sized chunks

Task: to complete a PDSA within a week

Remember that you will never know whether

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