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The PDSA Cycle or "plan-do-study-act" is a method for testing and implementing continuous improvements in quality control. Although it was developed for use by manufacturers, it is often used in health care contexts and is endorsed by the Institute for Healthcare Improvement. However, it is not as easy to use as it may seem to be.
How PDSA Works
PDSA is intended as an uncomplicated way to test and implement quality improvement changes using the scientific method. In the "plan" stage you decide on a change you would like to try, such as a new scheduling system for the nurses. In the "do" stage you implement the change on a limited scale, such as a single department. In the "study" stage you analyze the results of the experiment. For instance, you may find that the new scheduling system made it easier to match nurse availability to peak needs. In the "act" stage you implement the new system on a larger scale. Although the concept is simple, the application is not. The Agency for Healthcare Research and Quality website suggests that the PDSA Cycle requires a major commitment of time and effort.
What's In a Name
The PDSA Cycle is often referred to as PDCA or plan-do-check-act. Both acronyms are used as synonyms for the Deming Cycle or Shewhart Cycle even though the Cycle's creator Edward Deming rejected the idea that PDCA and PDSA were the same thing. Deming argued that PDCA was intended as a method for finding problems in a system while PDSA was a method for creating continuous improvements in a process. This confusion in terminology seems to be reflected in application. According to a 2013 article in "BMJ Quality and Safety," health care facilities using the term PDCA instead of PDSA also tended to misinterpret the Cycle.
Failure to Repeat
In theory, you would never use the PDSA Cycle just once, because it is supposed to be a continuous improvement tool. As soon as you complete one PDSA Cycle you start another one, using whatever you learned from the previous cycle as a starting point. The "BMJ Quality and Safety" study analyzed 73 peer-reviewed articles about PDSA Cycles in health care facilities and found that only 20 percent repeated the PDSA Cycle as intended. Most facilities would perform a single PDSA Cycle and never repeat it, or would fail to use data from previous PDSA Cycles when beginning a new one.
Mixed-Up Steps
The other problem identified in the "BMJ Quality and Safety" study was a failure to perform the four PDSA steps in the correct order. One health care facility skipped the study stage by implementing the full plan without first analyzing the results of the trial run. A facility using the term PDCA did the same thing but then checked the results after implementing the full-scale plan. The facility then changed the plan, checked the results again and changed the plan again -- a PDACACA Cycle instead of a PDCA Cycle. The Agency for Healthcare Research and Quality website states "This tool is easy to use and requires little or no training," but the "BMJ Quality and Safety" study suggests the opposite.
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