Plan-Do-Study-Act
Learning in the clinical setting: Plan-Do-Study-Act
No plan survives its first contact with reality, particularly those that aim high. 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 quickly by using rapid cycles of action-oriented learning. A great way to do this is by using the popular Plan-Do-Study-Act 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, 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).
Reality does have a way of exposing the weaknesses of even the best plans. Especially in a complex environment like a hospital there will always be unforeseen glitches when trying something new. So start small and scale quickly by using rapid cycles of action-oriented learning. A great way to do this is by using the popular Plan-Do-Study-Act model.
Start by planning (Plan) the intervention, and then test (Do) it. In the next step (Study), team members should observe the test first-hand, paying close attention to competing demands and physical space. Listen to individuals involved in the test to hear what worked and what did not. Ask for alternative ideas and discuss them on the spot. The idea, of course, is to understand what could or should be done differently from how the team originally planned it. In the last step (Act), revise the plan and try it again.
The table below highlights the advantages of PDSA as well as principles for doing it well.
Advantages of PDSA and Principles for Success
Advantages of PDSA |
Allows for 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 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 |
Principles for Success |
Start new changes on the smallest possible scale, e.g. 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 doctors, and finally units |
Balance changes within overall system to ensure other processes not adversely stressed |
Pay special attention to preserving productivity and workflow |
Whoever observes and studies the test should record lessons and suggested alternatives. These should be shared at the next multidisciplinary team meeting. The Institute of Healthcare Improvement (IHI) has a pre-printed PDSA Worksheet to download: http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/Tools/Plan-Do-Study-Act%20(PDSA)%20Worksheet
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