Becoming an Advanced
Practitioner
Using PDSA cycles to
implement change
Catherine Lynch
Becoming an Advanced Practitioner - Slough
March 2010
PDSA Cycle
PDSA Improvement Model
What are we trying to accomplish?
How will we know that a change is an improvement?
What changes can we make that will result in an improvement?
Cycle 1
Cycle 2
Cycle 3
• The Plan-Do-Study-Act (PDSA)
Worksheet is a useful tool for documenting
a test of change. The PDSA cycle is
shorthand for testing a change by
developing a plan to test the change
(Plan), carrying out the test (Do),
observing and learning from the
consequences (Study), and determining
what modifications should be made to the
test (Act).
Background
• Used in the Institute for Healthcare
Improvement’s "Methods and Tools for
Breakthrough Improvement" course, the
PDSA Worksheet has been used by
hundreds of health care organizations.
Directions
• Use the Plan-Do-Study-Act (PDSA)
Worksheet to help your team document a
test of change. Fill out one PDSA
Worksheet for each test you conduct. Your
team will test several different changes,
and each change will go through several
PDSA cycles. Keep a file (either electronic
or hard copy) of all PDSA Worksheets for
all changes your team tests.
PDSA Cycles
Act
Plan
Study
Do
PDSA Cycles
• Involves testing ideas on a small scale
before making changes
• Involves learning from the test in order to
improve, in a structured way
• Barriers to change often reduced when
many people are involved in this process.
PDSA Rules
• Keep it simple
• Keep it manageable
• Address single issues – for a number of
issues use a number of PDSA cycles
• Short timescale
• If ideas do not work then stop
RAID
• Review – look at current situation and
prepare for change
• Agree – ensure staff are signed up to the
process
• Implement – put the planned changes into
action
• Demonstrate – show that your change has
resulted in improvement
Which framework to use…
• If high awareness of change options and
impact of these – complexity of challenge
low – use PDSA cycle
• If there is low level of agreement about
change and what can be achieved and
comlexity of challenge is high – use RAID
(Rogers 2006)
References
• Langley, G., Nolan K., Nolan, T., Norman,
C. & Provost, L. (1996) The Improvement
Guide: a practical approach to
enhancing organisational performance.
San Francisco: Jossey Bass.
• Rogers, P. (2006) RAID methodology: the
NHS Clinical Governance Team’s
approach to service improvement. Clinical
Governance: An International Journal.
11(1) p. 69-80.