Evolving quality improvement support strategies to improve Plan-Do-Study-Act cycle fidelity A retrospective mixed-methods study

Funded by

The Health Foundation Logo

17 April 2019

Published journal: BMJ Quality and Safety

Abstract

Background

Although widely recommended as an effective approach to quality improvement (QI), the Plan-Do-Study-Act (PDSA) cycle method can be challenging to use, and low fidelity of published accounts of the method has been reported. There is little evidence on the fidelity of PDSA cycles used by front-line teams, nor how to support and improve the method’s use. Data collected from 39 front-line improvement teams provided an opportunity to retrospectively investigate PDSA cycle use and how strategies were modified to help improve this over time.

Methods

The fidelity of 421 PDSA cycles was reviewed using a predefined framework and statistical analysis examined whether fidelity changed over three annual rounds of projects. The experiences of project teams and QI support staff were investigated through document analysis and interviews.

Results

Although modest, statistically significant improvements in PDSA fidelity occurred; however, overall fidelity remained low. Challenges to achieving greater fidelity reflected problems with understanding the PDSA methodology, intention to use and application in practice. These problems were exacerbated by assumptions made in the original QI training and support strategies: that PDSA was easy to understand; that teams would be motivated and willing to use PDSA; and that PDSA is easy to apply. QI strategies that evolved to overcome these challenges included project selection process, redesign of training, increased hands-on support and investment in training QI support staff.

Conclusion

This study identifies support strategies that may help improve PDSA cycle fidelity. It provides an approach to assess minimum standards of fidelity which can be replicated elsewhere. The findings suggest achieving high PDSA fidelity requires a gradual and negotiated process to explore different perspectives and encourage new ways of working

Citation 

McNicholas C, Lennox L, Woodcock T, et al. Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. BMJ Qual Saf 2019;28:356-365

You might also like...

Blog

Strengthening social care analytics in the wake of COVID-19: initial findings

The Health Foundation and Future Care Capital have teamed up to explore the key data challenges the...

Blog

How the NHS can use anchor strategies to build a healthy and sustainable post-COVID-19 recovery

We look at how the NHS as an anchor institution has an essential role to play in recovering from the...

Chart

How has NHS 111 shaped public demand for the NHS in England during the pandemic?

Emma Vestesson and Tim Gardner look at what recent changes in patient interaction with NHS services...

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