Science of Improvement: Testing Changes | IHI

The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change — by planning it, trying it, observing the results, and acting on what is learned. Pleasewaitwhileyouarebeingredirected... ThissiteisbestviewedwithInternetExplorerversion8orgreater.CheckyourbrowsercompatibilitymodeifyouareusingInternetExplorerversion8orgreater. LogIn/Register Extranet EducationPlatform NewsletterSignUp NewsletterSignUp Blog Careers Donate Home AboutUs Topics Education Resources Regions EngagewithIHI MyIHI Home AboutUs Vision,Mission,Values EquityIsOneofIHI'sValues History ScienceofImprovement Innovation People HowtoGetInvolved IntheNews Finances Careers Contact KnowledgeBase Topics AllTopicsA-Z COVID-19 HealthEquity ImprovementCapability JoyinWork Leadership PatientSafety Person-/Family-CenteredCare TripleAimforPopulations ValueManagement Education EducationOverview IHIForum IHIPatientSafetyCongress Conferences In-PersonTraining VirtualTraining CertifiedProfessionalinPatientSafety(CPPS) IHIOpenSchool Resources ResourcesOverview HowtoImprove Measures Changes ImprovementStories Tools Publications IHIWhitePapers AudioandVideo CaseStudies Regions RegionsOverview Africa Asia-Pacific Europe LatinAmerica MiddleEast NorthAmerica EngagewithIHI EngagewithIHIOverview CustomizedServices Initiatives MembershipPrograms FellowshipPrograms StrategicPartnerships IndustryPartnerships Blog UserGroups Home / Resources /HowtoImprove/ ScienceofImprovement:TestingChanges HowtoImprove Resources Resources HowtoImprove Measures Changes ImprovementStories Tools Publications IHIWhitePapers AudioandVideo CaseStudies IHILRWide ScienceofImprovement:TestingChanges PageContentModelforImprovement:Plan-Do-Study-Act(PDSA)Cycles ​Onceateamhassetanaim,establisheditsmembership,anddevelopedmeasurestodeterminewhetherachangeleadstoanimprovement,thenextstepistotestachangeintherealworksetting.ThePlan-Do-Study-Act(PDSA)cycleisshorthandfortestingachange—byplanningit,tryingit,observingtheresults,andactingonwhatislearned.Thisisthescientificmethod,usedforaction-orientedlearning. Seealso: TipsforTestingChanges,LinkingTestsofChange,TestingMultipleChanges,ImplementingChanges,SpreadingChanges.   ReasonstoTestChanges Toincreaseyourbeliefthatthechangewillresultinimprovement. Todecidewhichofseveralproposedchangeswillleadtothedesiredimprovement. Toevaluatehowmuchimprovementcanbeexpectedfromthechange. Todecidewhethertheproposedchangewillworkintheactualenvironmentofinterest. Todecidewhichcombinationsofchangeswillhavethedesiredeffectsontheimportantmeasuresofquality. Toevaluatecosts,socialimpact,andsideeffectsfromaproposedchange. Tominimizeresistanceuponimplementation.   StepsinthePDSACycle Step1:Plan Planthetestorobservation,includingaplanforcollectingdata. Statetheobjectiveofthetest. Makepredictionsaboutwhatwillhappenandwhy. Developaplantotestthechange.(Who?What?When?Where?Whatdataneedtobecollected?)   Step2:Do Tryoutthetestonasmallscale. Carryoutthetest. Documentproblemsandunexpectedobservations. Beginanalysisofthedata. Step3:StudySetasidetimetoanalyzethedataandstudytheresults.Completetheanalysisofthedata. Comparethedatatoyourpredictions. Summarizeandreflectonwhatwaslearned.   Step4:Act Refinethechange,basedonwhatwaslearnedfromthetest. Determinewhatmodificationsshouldbemade. Prepareaplanforthenexttest.   ExampleofaTestofChange(Plan-Do-Study-ActCycle) Dependingontheiraim,teamschoosepromisingchangesandusePlan-Do-Study-Act(PDSA)cyclestotestachangequicklyonasmallscale,seehowitworks,andrefinethechangeasnecessarybeforeimplementingitonabroaderscale.Thefollowingexampleshowshowateamstartedwithasmall-scaletest. Diabetes:Plannedvisitsforbloodsugarmanagement. Plan:Askonepatientifheorshewouldlikemoreinformationonhowtomanagehisorherbloodsugar. Do:Dr.J.askedhisfirstpatientwithdiabetesonTuesday. Study:Patientwasinterested;Dr.J.waspleasedatthepositiveresponse. Act:Dr.J.willcontinuewiththenextfivepatientsandsetupaplannedvisitforthosewhosayyes. AverageContentRating (12users) Pleaseenteracomment. Pleaselogintorateorcommentonthiscontent. UserComments [email protected] 10/28/202012:31:58PM excellentexampleontestchange. loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» [email protected] 9/14/202011:41:41AM veryinformative loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byMuhammadIlyas 7/18/20193:46:09AM byMuhammadIlyas6/19/20198:03:35AM Colleagues,itisverygooddiscussion.PDSAisatoolthatfocusonlearningfromexperience.Ofcourse,whatmostimportantherewithPDSAisthatthelearningdeliberatebasedonwhatisachievedfromwhatweplanned,thewaywedid(act)ourplan,thebestpractices/lessonsidentifiedfromtheprocess,andidentifiedareasofimprovementforwayforward.Hence,PDSAisnotonlyforeducationsectorbutalsoworkforeverysectorasatooltoimprovequality loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byAdesholaQuadri 5/17/201912:56:27PM Simplysimplified. loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byKamthornTantivitayatan 12/31/201810:58:12AM DALI(design,action,learning,improvement) loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byJanetOlabode 8/24/20178:45:37PM Ithinkthisisveryhelpful.Itisverydirectandsimpletounderstand. loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byHeathBloch 5/30/20173:28:49PM WhereisthePDSAWorksheetforTestingChange? loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byBamideleFarinre 10/3/20161:37:28PM verysuccintandhelpful loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» byMaryAnnMecca-Monahan 1/12/201611:26:33AM soundsgood loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» bysachacoodye 5/10/20155:52:24AM Excellenttools-simpletounderstandandfollow,toteachothers,andreallysatisfyingtoseewhenchangeandimprovementshavehappened. loading... Didyoufindthisusercommentuseful? peoplefoundthisusercommentuseful. ReportThis» ShowMoreComments... Loading... YouareabouttoreportaviolationofourTermsofUse.Allreports arestrictlyconfidential. Reason*: SelectOne Containsprofanityorviolence Spam Defamatory Illegal/Unlawful CopyrightViolation Other Pleaseselectareasonforthisreport. AddaNote: Yourcommentsweresubmittedsuccessfully. Therewasanerrorreportingyourcomplaint. HowtoImprove Introduction FormingtheTeam SettingAims EstablishingMeasures SelectingChanges TestingChanges ImplementingChanges SpreadingChanges FeaturedContent first< >last HowCanMr.PotatoHeadHelpTeachPDSA? DavidWilliamsexplainsthegenesisoftheMr.PotatoHeadexercisehecreatedtoteachaudiencesallovertheworldaboutPDSAcycles. MitigatingtheRisksofRunningImprovementTestsWhileMaximizingtheLearning:AnExcerptfromTheImprovementGuide Thescaleofthetestshouldbedecidedaccordingto(1)thedegreeofbeliefthatthechangewillresultinimprovement,and(2)therisksfromafailedtest. PDSACycles(Part1) RobertLloyd,theDirectorofPerformanceImprovementatIHI,useshistrustywhiteboardtodissectthescienceofimprovement.Inshortvideos,hebreaksdowneverythingfromDeming'sSystemofProfoundKnowledge,tothePDSAcycle,toruncharts. Plan-Do-Study-Act(PDSA)Worksheet ThePlan-Do-Study-Act(PDSA)Worksheetisausefultoolfordocumentingatestofchange;developedbytheInstituteforHealthcareImprovement(Cambridge,Massachusetts,USA). ProjectPlanningForm TheProjectPlanningFormisausefultoolforplanninganentireimprovementproject,includingalistingofallofthechangesthattheteamistesting,allofthePlan-Do-Study-Act(PDSA)cyclesforeachchange,thepersonresponsibleforeachtestofchange,andthetimeframeforeachtest. MoreonThisTopic LoadingPages.... first < > last AnEquityAgendafortheFieldofHealthCareQualityImprovement ConvenedbytheNationalAcademyofMedicine,leadersofsevenprominentUShealthcarequalityorganizationsidentifiedequityasthemostimportantpriorityforthehealthcarequalitymovementinthenext20years.Thispapersummarizeskeybarriersandstrategiestoadvancingequityinhealthcarequality. AnIntegratedApproachtoQuality Thisarticledescribeshowwholesystemquality,anintegratedorganization-wideapproachtoquality,canhelphealthcareleadersbuildmoreresponsiveandresilienthealthsystems. BetterMaternalOutcomesQualityImprovementWorkbooks ​DevelopedaspartoftheBetterMaternalOutcomesRapidImprovementNetwork,theworkbookscontaindescriptions,examples,andtemplatesfortoolsthatteamscanusetoguidetheirqualityimprovement(QI)workfocusedonimprovingmaternalhealthoutcomesandequity. TacklingSystemicRacisminMaternityCare ABrazilianhealthcollaborativeusesimprovementscienceandtheconceptof“liberatoryconsciousness”toaddressracisminmaternitycare. AcceleratingPopulationHealthImprovement Thisarticledescribeshowapplyingimprovementmethodstopopulationhealthimprovementefforts​couldhelpcloseequitygaps. ViewAll TakeaFreeQICourse Learnthefundamentalsofimprovementwiththisonlinecourse,freewithregistrationonihi.org: QI102:HowtoImprovewiththeModelforImprovement