Title

The problem with Plan-Do-Study-Act cycles

Authors

JE Reed, AJ Card

Published journal

BMJ Quality & Safety

Abstract

Introduction

Quality improvement (QI) methods have been introduced to healthcare to support the delivery of care that is safe, timely, effective, efficient, equitable and cost effective. Of the many QI tools and methods, the Plan-Do-Study-Act (PDSA) cycle is one of the few that focuses on the crux of change, the translation of ideas and intentions into action. As such, the PDSA cycle and the concept of iterative tests of change are central to many QI approaches, including the model for improvement,1 lean,2 six sigma3 and total quality management.4

PDSA provides a structured experimental learning approach to testing changes. Previously, concerns have been raised regarding the fidelity of application of PDSA method, which may undermine learning efforts,5 the complexity of its use in practice5 ,6 and as to the appropriateness of the PDSA method to address the significant challenges of healthcare improvement.7

This article presents our reflections on the full potential of using PDSA in healthcare, but in doing so we explore the inherent complexity and multiple challenges of executing PDSA well. Ultimately, we argue that the problem with PDSA is the oversimplification of the method as it has been translated into healthcare and the failure to invest in a rigorous and tailored application of the approach.

You might also like...

Event

Webinar: Speeding up NHS service transformation – how can we do better?

Event

In this webinar we were joined by Dr Tim Ferris, NHS England’s Director of Transformation, to...

Watch video

Journal article

A systematic review of nudge interventions to optimize medication prescribing

Journal article

 Interventions to optimize medication prescribing

Journal article

Communicating with patients and families about illness progression and end of life

Journal article

A review of studies using direct observation of clinical practice.

Citation

Reed JE, Card AJ.BMJ Qual Saf Published Online First: 12/15 doi:10.1136/bmjqs-2015-005076
Kjell-bubble-diagramArtboard 101 copy

Get social

Last month saw the latest round of NHS reforms — in the Health and Care Bill — become law. However @JenniferTHF w… https://t.co/GDAoGD6rCi

Follow us on Twitter
Kjell-bubble-diagramArtboard 101

Work with us

We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play.

View current vacancies
Artboard 101 copy 2

The Q community

Q is an initiative connecting people with improvement expertise across the UK.

Find out more