Becoming an Advanced Practitioner Using PDSA cycles to implement change Catherine Lynch Becoming an Advanced Practitioner - Slough March 2010

PDSA Cycle

PDSA Improvement Model Cycle 1Cycle 3Cycle 2 What are we trying to accomplish? How will we know that a change is an improvement? What changes can we make that will result in an improvement?

The Plan-Do-Study-Act (PDSA) Worksheet is a useful tool for documenting a test of change. The PDSA cycle is shorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing and learning from the consequences (Study), and determining what modifications should be made to the test (Act).PDSA cycle

Background Used in the Institute for Healthcare Improvement’s "Methods and Tools for Breakthrough Improvement" course, the PDSA Worksheet has been used by hundreds of health care organizations.

Directions Use the Plan-Do-Study-Act (PDSA) Worksheet to help your team document a test of change. Fill out one PDSA Worksheet for each test you conduct. Your team will test several different changes, and each change will go through several PDSA cycles. Keep a file (either electronic or hard copy) of all PDSA Worksheets for all changes your team tests.

PDSA Cycles ActPlan DoStudy

PDSA Cycles Involves testing ideas on a small scale before making changes Involves learning from the test in order to improve, in a structured way Barriers to change often reduced when many people are involved in this process.

PDSA Rules Keep it simpleKeep it simple Keep it manageableKeep it manageable Address single issues – for a number of issues use a number of PDSA cyclesAddress single issues – for a number of issues use a number of PDSA cycles Short timescaleShort timescale If ideas do not work then stopIf ideas do not work then stop

RAID Review – look at current situation and prepare for change Agree – ensure staff are signed up to the process Implement – put the planned changes into action Demonstrate – show that your change has resulted in improvement

Which framework to use… If high awareness of change options and impact of these – complexity of challenge low – use PDSA cycle If there is low level of agreement about change and what can be achieved and comlexity of challenge is high – use RAID (Rogers 2006)

References Langley, G., Nolan K., Nolan, T., Norman, C. & Provost, L. (1996) The Improvement Guide: a practical approach to enhancing organisational performance. San Francisco: Jossey Bass. Rogers, P. (2006) RAID methodology: the NHS Clinical Governance Team’s approach to service improvement. Clinical Governance: An International Journal. 11(1) p