Plan-Do-Study-Act | Quality 101 | SHM's Quality & Innovation Initiatives

No plan survives its first contact with reality, particularly those that aim high. There will always be unforeseen glitches when trying something new, especially in a complex environment such as a hospital. Start small and scale quickly utilizing rapid cycles of action-oriented learning. The "popular–do–study–act (PDSA)" model is successful in this scenario.

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.It is important to 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. This process will enable you to learn 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).

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 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; 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 doctors; and finally units.
  • Balance changes within the overall system to ensure other processes are not adversely stressed.
  • Pay special attention to preserving productivity and work flow.

The team member(s) who observe and study the test should record lessons and the suggested tweaks and share them at the next multidisciplinary team meeting.

If you need additional support in leading a quality improvement effort, SHM’s signature programs can guide your team through each phase and provide individual mentoring in areas such as care transitions (Project BOOST®), Glycemic Control (GC), Medication Reconciliation (MARQUIS), Atrial Fibrillation (AFIB) and Venous Thromboembolism (VTE). We also provide resources by clinical topic to help you find exactly what you need.

No matter where you are in the spectrum, SHM can assist you in your efforts. SHM encourages you to join the QI community and view the calendar for up to date information on key events and discussions around the quality and innovation movement.

Questions or Comments, please email thecenter@hospitalmedicine.org.