Plan-Do-Study-Act (PDSA)

Plan-Do-Study-Act is an iterative, four-stage problem-solving model used for improving a process or carrying out change.

Step 1 Step 6 Step 7 Step 8

Step-by-Step Walkthrough

detail of PDSA model

Plan

In Step 1, you will identify an opportunity for improvement for your PDSA cycle. Let data guide your selection of a topic. Data can be both numerical (like client or program records) and descriptive (like results from customer satisfaction surveys or general staff feedback). Also, you can start thinking about and securing the resources you will need for your PDSA cycle and getting any necessary approval to start the CQI project.

Ask yourself: What are some areas the program can improve on? What do the data tell us about how well we are doing in those areas?

In Step 2, you will  identify staff, program participants, community members, and partners who have knowledge of the targeted area so you can assemble your CQI team. The team should further discuss the opportunity for improvement and draft an initial SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) aim/goal statement. Teams often find it helpful at this point to assign roles to members (including leader/facilitator, note taker, document manager, and meeting scheduler), create a project timeline, and organize project plans into a summary document, called a team charter.

Ask Yourself: Who can contribute to our team’s PDSA cycle, and what will their role in our CQI work be? What is the goal of the PDSA cycle?

In Step 3, clarify how the program is currently operating in the area you have identified to improve with your PDSA cycle. Consider creating a process map or flow chart to examine how the program operates and look for data and information you can use to establish a baseline (i.e., starting point) to compare to when your PDSA cycle is complete. Before coming up with a solution, ask your team to first think about what is causing the problem to exist. You may find it helpful to create a cause and effect diagram (e.g. fishbone diagram) to explore the root cause of the problem. After creating a list of all the possible reasons the problem exists, ask the team to pick just one that you will try to change with your CQI work.

Ask Yourself: What do we know about the area we have chosen to improve? What is the main reason this problem exists?

Step 4 is when the team will brainstorm and collectively think about all the possible solutions to the root cause of the problem. Teams should look to their program model or existing best practices when possible. The team should select a potential solution within its scope of control that could best address the problem.

Ask Yourself: What could we do to improve the challenge we are experiencing?

In Step 5, your team should develop a theory for improvement, which is a prediction of what will happen when your team tests the potential solution on a small scale. Your team will also develop a strategy for how you will test your theory for improvement (e.g., who will help, what materials are needed, when it will occur).

Ask Yourself: What do we think will happen if we try out a specific potential solution? What do we need to do to get ready for our test?

detail of PDSA model

Do

In Step 6, your team will test the improvement theory on a small scale. Remember to document how the test unfolds.

Ask Yourself: Are we carrying out the test as we planned?

detail of PDSA model

Study

In Step 7, your team will use the data collected during the “Do” stage to study the results of your test. This process will include comparing results against your baseline data and discussing the team’s overall experience with the project.

Ask Yourself: Did the change we tested result in an improvement?

detail of PDSA model

Act

In Step 8, your team will decide what to do with the lessons learned through this PDSA cycle. The team can (1) adopt the change as a standard of practice, (2) test the change under different circumstances through a new PDSA cycle, or (3) abandon the change and try a new solution to the problem.

Ask Yourself: Should we keep the change and apply it more broadly, or do we need more information?

In Step 9, your team will work to build on the progress made by this PDSA cycle and make plans for additional cycles.

Ask Yourself: What did we accomplish in this PDSA cycle and how can we keep moving forward?