How will this module help me successfully make changes in my practice?
Describes four STEPS to quality improvement using the PDSA method.
Provides answers to common questions about the PDSA method.
Shares downloadable resources with samples and templates.
The Plan-Do-Study-Act (PDSA) method provides a straightforward, iterative approach to quality improvement in your practice. The PDSA framework is easy to adopt regardless of practice size or resources. As ongoing quality improvement becomes part of your practice's culture, your team will continue to find opportunities to improve existing processes.
Four STEPS to using PDSA within your practice:
Plan: Develop the initiative.
Do: Implement your plan.
Study: Analyze the results.
Act: Adjust the process based on the results found in the Study phase.
Step 1 Plan: Develop the initiative.
The following actions will help you in the “planning” phase of your PDSA initiative:
Select your improvement initiative.
Involve your team in selecting the quality improvement initiative. Most good ideas for improvement come from the people doing the work, so consider the perspectives of everyone on the team, both clinical and non-clinical. Be sure you can answer “What's in it for me?” (WIFM) for everyone you expect will participate. Patient surveys can also be used to identify areas for improvement.
To identify areas for improvement, consider asking these questions:
Where does your practice need to improve patient care?
Your practice may already have performance measure data from a payer (federal, state, and/or private) or a point-of-care registry that can reveal gaps in care processes or patient outcomes.
Where is your practice less efficient than it should be?
Your team may be able to identify bottlenecks in the workflow. Prioritize those areas that you have some control over and that the team thinks will be most impactful. Use a “go and see” approach of respectfully observing the work and then asking “why?”
What about the day is most frustrating for your team and/or patients?
Ask patients and staff. This will generate a list from which you can prioritize areas for improvement.
Reference the module on selecting sustainable change initiatives for more guidance on choosing areas for improvement in your practice.
Quiz Ref IDThe people doing the work should be the ones planning and guiding the process improvement initiative.
Your PDSA team should include representatives from all areas of your practice that will be affected by the improvement. Set expectations for the time commitment to the PDSA team early in the cycle and plan to continue working together through implementation. You may also choose to have a core quality improvement team that rotates in specialized representatives based on the initiative. Most teams work best with a maximum of 10 people. Practice members who are not on your PDSA team should receive regular updates about the initiative's progress.
Your quality improvement team should work together to develop a plan. The plan is a to develop a test to improve the process that you have identified.
Brainstorming to answer the following questions can help you formulate your plan:*
What does my practice want to accomplish?
Why is this a priority? (Of all the possible areas for improvement, why is my practice focused on this one in particular?)
What current process is my practice changing?
What does the new process look like?
Who will enact the changes?
When will the changes be made?
Where will the changes take place?
What team training and preparation are required?
Will patients be affected? How? Which patients will be affected?
What results do you expect?
How will you measure the impact of the changes? What process and outcome measures will you use?
How and when will you inform the team about progress?
The following downloadable tools can help you in your planning phase:
ACP Quality Connect: PDSA planning worksheet (267 KB) Process map toolkit (130 KB)
Step 2 Do: Implement your plan.
With a committed team and a detailed plan, you are ready to implement your quality improvement initiative. Communicate the new process to your team and share inspiring stories to keep everyone excited about the change.
After the change has been implemented, regularly discuss the adoption of the new process at huddles and meetings. This will help you determine if the change had the desired result.
Set SMART goals for your PDSA quality improvement initiative.
Help your team stay focused and efficient through impactful goal setting. For example, one practice goal may be to increase depression screening among patients with a diagnosed substance use disorder. Using the SMART approach, your goal would look like this:
Specific: Your practice will increase depression screening from 20 to 50 percent of patients who are either diagnosed with substance use disorder or prescribed opioids for non-cancer pain.
Measurable: You will use manual or electronic chart audits to document depression screenings.
Achievable: You've set a reasonable goal of 50 percent rather than 100 percent. You want to set an attainable goal; the bar can always be raised if your change is successful.
Relevant: There is a clear gap in care because only 20 percent of your target population is being screened for depression.
Time-bound: The goal will be achieved over the next three months. A reassessment (the “study” step of PDSA) will occur three months from now.
“My practice benefited from making changes, especially in team-based care. I have felt empowered through education and have been able to provide better care through better staff engagement that involves everyone in practice improvement.”
Brenda Vozza-Zeid, MD, FACP, Henderson, TX
Step 3 Study: Analyze the results.
Quiz Ref IDUse the process or outcome measures the PDSA team chose during the planning phase to evaluate the success of the process change. A classic technique to visualize changes over time is a run chart, which can be displayed in a team area or shared regularly at meetings.
Your PDSA team should consider the factors that might have contributed to the findings. You may discover that your change has been very successful or you may find that you are not seeing the improvements you expected. Your team can work together to identify how and why you achieved the observed results.
You can download and customize these tools to align with the measures you have selected for your change initiative.
Simplified practice assessment (34 KB) ACP Advance: setting your QI goals worksheet (267 KB) “I thought I had a good handle on managing my diabetic patients, but I learned about facilitating good decision-making by my patients, coaching behavioral changes, and gaining insight into patient compliance. I also learned about how to engage my office staff into optimizing OUR care of OUR diabetic patients.”
Robert Dobbin Chow MD, MBA, MACP, Baltimore, MD
Step 4 Act: Adjust the process based on the results found in the Study phase.
At this point, you can decide to Adopt, Adapt, or Abandon the process.
The PDSA cycle is meant to be continuous; even your best processes can be improved and become more consistent. You can further refine your processes by repeating the cycle. Celebrate completing your first PDSA cycle even if it didn't result in improvement. View this as a learning opportunity.
During this final stage of the PDSA cycle, your team should determine what action to take next.
Any practice team can complete a quality improvement initiative if they start small and plan ahead. Foster your internal assets to develop more reliable systems to improve care. With careful thought given to each aspect of the PDSA cycle, ongoing communication, and detailed attention to the metrics, your practice can successfully reach its goals.