Action-Oriented Learning: Plan–Do–Study–Act
No plan survives its first contact with reality, particularly if it aims high. And especially in a complex environment like a hospital, there will always be unforeseen glitches when trying something new. But you can start small and scale up quickly by using rapid cycles of action-oriented learning. A great way to do this is by using the popular plan–do–study–act (PDSA) model.
Start by planning (plan) your intervention and then test (do) it. The next step (study) is critical. Observe the test yourself, paying close attention to competing demands and physical space. Most important, ask those involved in the test what worked and what did not, and listen carefully. Ask them for alternative ideas, pitch your own, and talk it out. The idea is to get a read on what could or should be done differently from how your team originally planned it. The last step is to set things up to do better next time (act).
The following table highlights the advantages of PDSA and provides principles for doing it well.
Advantages of PDSA and Principles for Success
Advantages of PDSA |
- Allows valuable modifications to improve effectiveness or preserve productivity.
- Allows “failures” to come to light without undermining performance and momentum.
- Identifies areas of resistance that might undermine the plan and spread to other units.
- Allows costs and side effects of the change to be assessed.
- Increases certainty that change will result in improvement.
- Allows for detailed documentation of improvement.
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Principles for Success |
- Start new changes on the smallest possible scale, such as one patient, one nurse, one doctor.
- Run just as many PDSA cycles as necessary to gain confidence in a change, then spread incrementally.
- Spread incrementally to more patients, then more nurses, then more doctors, and finally more units.
- Balance changes in the overall system to ensure other processes are not adversely stressed.
- Pay special attention to preserving productivity and work flow.
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Whoever observes and studies the test should record lessons and the suggested tweaks. These should be shared at the next multidisciplinary team meeting.
The IHI has a preprinted PDSA Work Sheet you may find helpful to download.
Plan–Do–Study–Act Work Sheet for Testing Changes
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Aim — Describe the aim of this project.
— Every aim will require multiple smaller tests of change.
— Describe your first (or next) test of change.
— Person responsible.
— When to be done.
— Where to be done.
Plan — List tasks needed to set up this test of change.
— Person responsible.
— When to be done.
— Where to be done.
— Predict what will happen when the test is carried out.
— Measures to determine if prediction succeeds.
Do — Describe what actually happened when you ran the test.
Study — Describe the measured results and how they compared to the predictions.
Act — Describe what modifications to the plan will be made for the next cycle from what you learned. |
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