1. P-D-S-A CyCles the art + Science of improvement
Developing changes that are new, by definition, requires a creative effort = the art of improvement
Studying them forces us to consider the science of improvement
Today I’m presenting a short primer on PDSA Cycles because many people are familiar with the term but it is widely misunderstood and misused. To me, it is probably the most vital part we glass over or rush through with any QI effort. Though its meant to promote rapid cycle testing, sometimes the cycle takes longer than we anticipated.
Diane Liu, MD
Director, UPIQ
Utah Pediatric Partnership to Improve healthcare quality

2. Principles of improvement
Knowing why you need to improve
Having a feedback mechanism to tell you if the improvement is happening
Developing an effective change that will result in improvement
Testing a change before implementation
Knowing when and how to implement change
From The Improvement Guide Langley and Provost page 25 “Key Points from Chapter One)

3. SCIENCE of IMPROVEMENT - Hypothesis
What changes can we make that will result in an improvement? PREDICTIONS!
Once you select a change idea, it is time to turn ideas into action and connect action to learning
Enter the PDSA cycle!
ACTION
IDEAS
LEARNING

4. PDSA shorthand for testing a change
Plan developing a plan to test the change
Do carrying out the test
Study observing and learning from the consequences
Act take action; determining what modifications should be made to the test (source IHI.org)
Using the cycle does take discipline and effort as a method for organizing learning, testing, and implementing during an improvement project.. The cycle is most often used to:
To Build knowledge to help answer any one of the 3 questions
To test a change
To implement a change
The PDSA cycle creates a structure for both testing and implementing change

5. The Improvement Guide Langley/Provost
PDSA project planning forms or rods cycle form with checklist format
SOURCE:
The Improvement Guide Langley/Provost

6. Example of using PDSA worksheet (from IHI) to track change idea

7. Knowledge is gained sequentially
REMEMBER
Improvement is an outcome of the application of (appropriate) knowledge
Knowledge is gained sequentially
All improvement occur due to changes but not all changes lead to an improvement

8. Learning and Improvement Theories, hunches, and best practices
What are we trying to
accomplish?
How will we know that a
change is an improvement?
What change can we make that
will result in improvement?
Model for Improvement
Breakthrough Results A P S D
Evidence & Data D S P A
Wide-scale implementation of change A P S D
This is how we use PDSAs in practice. We start with some hunch or theory (our predictions; the change ideas) and we test on a very small scale. We evaluate the data from that test and plan the next test; and so on. We don’t implement any change until we have done the sequential building of knowledge we get from running PDSA cycles.
Let’s run through an example:
Learning and Improvement
Test new conditions A P S D
Sequential Building of Knowledge with multiple PDSA Test Cycles
Figure 7.2 ‘The Improvement Guide’ Langley, et al. 2009
Follow-up tests
Theories, hunches, and best practices
Small Scale Testing

9. QUESTIONS? Diane.Liu@hsc.utah.edu
THANK YOU!
QUESTIONS?
Diane Liu, MD
Director of The Utah Pediatric Partnership to Improve Healthcare Quality