The problem with Plan-Do-Study-Act cycles
File(s)
Published version
Author(s)
Reed, JE
Card, AJ
Type
Journal Article
Abstract
Quality improvement (QI) methods have been introduced to healthcare to support the delivery of care that is safe, timely, effective, efficient, equitable and cost effective. Of the many QI tools and methods, the Plan-Do-Study-Act (PDSA) cycle is one of the few that focuses on the crux of change, the translation of ideas and intentions into action. As such, the PDSA cycle and the concept of iterative tests of change are central to many QI approaches, including the model for improvement,1 lean,2 six sigma3 and total quality management.4
PDSA provides a structured experimental learning approach to testing changes. Previously, concerns have been raised regarding the fidelity of application of PDSA method, which may undermine learning efforts,5 the complexity of its use in practice5 ,6 and as to the appropriateness of the PDSA method to address the significant challenges of healthcare improvement.7
This article presents our reflections on the full potential of using PDSA in healthcare, but in doing so we explore the inherent complexity and multiple challenges of executing PDSA well. Ultimately, we argue that the problem with PDSA is the oversimplification of the method as it has been translated into healthcare and the failure to invest in a rigorous and tailored application of the approach.
PDSA provides a structured experimental learning approach to testing changes. Previously, concerns have been raised regarding the fidelity of application of PDSA method, which may undermine learning efforts,5 the complexity of its use in practice5 ,6 and as to the appropriateness of the PDSA method to address the significant challenges of healthcare improvement.7
This article presents our reflections on the full potential of using PDSA in healthcare, but in doing so we explore the inherent complexity and multiple challenges of executing PDSA well. Ultimately, we argue that the problem with PDSA is the oversimplification of the method as it has been translated into healthcare and the failure to invest in a rigorous and tailored application of the approach.
Date Issued
2015-12-23
Date Acceptance
2015-11-23
Citation
BMJ Quality & Safety, 2015, 25, pp.147-152
ISSN
2044-5423
Publisher
BMJ Publishing Group
Start Page
147
End Page
152
Journal / Book Title
BMJ Quality & Safety
Volume
25
Copyright Statement
This is an Open Access article distributed in
accordance with the Creative Commons Attribution Non
Commercial (CC BY-NC 4.0) license, which permits others to
distribute, remix, adapt, build upon this work noncommercially,
and license their derivative works on different
terms, provided the original work is properly cited and the use
is non-commercial. See: http://creativecommons.org/licenses/bync/4.0/
accordance with the Creative Commons Attribution Non
Commercial (CC BY-NC 4.0) license, which permits others to
distribute, remix, adapt, build upon this work noncommercially,
and license their derivative works on different
terms, provided the original work is properly cited and the use
is non-commercial. See: http://creativecommons.org/licenses/bync/4.0/
License URL
Sponsor
Chelsea & Westminster Hospital NHS Foundation Trust
Identifier
PII: bmjqs-2015-005076
Grant Number
N/A
Subjects
Healthcare quality improvement
Quality improvement
Quality measurement
Publication Status
Published