PDSA Cycle

A PDSA cycle is a tool used in the workplace to help implement change. The initials are an acronym that stand for Plan, Do, Study, Act. Each word in the tool signifies a different stage in the cycle; where you would move on to the next step in the process.

Its purpose allows changes to business operation to be tested on a small scale, giving time for any amendments to be made, before implementing the tested change across wider departments. This helps organisations to improve their products, processes, or services and learn knowledge and insights about particular stages of their work to improve efficiencies. Like many other organisational tools, such as a PESTLE Analysis, its purpose is to avoid organisational error by ensuring that new ideas are fit for purpose, rather than a hinderance to the business.

The PDSA cycle forms part of an improvement framework, particularly in the healthcare sector. It is based on scientific methods for measuring chances of success. Its science particularly lends itself to the healthcare sector because it promotes evidence-based practice to inform change. Evidence-based practice ensures that the best practice and clinical expertise is always used to ensure that patients’ needs are met and valued. The best quality information can be derived from testing something in a real-life setting, making sure that your proposed changes will promote good quality work.

Who created the PDSA cycle?

The PDSA cycle was influenced by Walter Sherwart. Sherwart was an American psychologist, engineer and statistician who worked on improving processes and productivity. Using scientific methods, Sherwart introduced concepts that supported hypothesising by using specification, production and inspection as a cycle to acquire knowledge.

The whole concept of the PDSA cycle is based on scientific methods using analysis to draw conclusions and evaluations. It was first called the Sherwart cycle, until an American doctor called Dr Edward Deeming, later used Sherwart’s research to create a new version of the cycle. His newer version emphasised interaction between four stages (which are plan, do, study, act), and it was initially known as the Demming cycle. This was used in problem solving and quality control to create better outcomes.

Interaction between the four stages is key because once a hypothesis was tested, the cycle could be repeated to generate more findings and extent knowledge further. It is thought that the more repetition you do of the cycle, the closer you will get towards your goal, desired outcome, or knowledge acquisition.

Initially Deeming created the cycle using the acronym “plan, do, check, act (PDCA)”. However, he noted that the word “check” suggested that you should hesitate or take no further action afterwards, which he disliked in the cycle. Due to this, he changed the word “check” with the word “study”, to provide a more motivating and analytical action.

What happens at each stage of the PDSA cycle?

Plan

Plan the change that is forming the basis of your hypothesis (the thing you want to test). Plan what changes you think will improve your workplace and explain how you will test these clearly so that you remain focussed.

Do

Carry out your study (test the change) on a sample of participants internally, and then externally. Ensure to keep your “do” stage time limited so that you can move on in the cycle.

Study

Collect and analyse your data to determine the success of the change. Identify what worked well and what didn’t work so well, to inform your next actions.

Act

Use your analysis from the previous stage to start a new cycle (if required) or implement your change fully if there were no errors.

How does the PDSA cycle work?

The plan, do, study, act cycle works by creating a series of stages for you to work through in the same order as the acronym presents:

• Plan
• Do.
• Study.
• Act.

However, instead of stopping at step four, you go back to step one at the beginning, and repeat the stages. This allows you to make the necessary changes to your testing depending on your findings. This is why the PDSA model is called a cycle.

Working through the cycle can be likened to completing a small experiment; whereby you test a hypothesis that you have. This is due to its scientific foundations explained earlier. In science, you create a hypothesis, identify a sample and control group, and conduct the experiment – which is not too dissimilar to what happens during a PDSA cycle.

The PDSA model appears to be a simple process, with it only having four stages in the cycle. However, it is important to be disciplined during the work so that you or other team members do not make assumptions about your results. Doing so would compromise the projected changes that you are looking to make, or cause people to have subjective opinions about the prospective changes. This could alter your results, due do the workforce being resistant to change as opposed to the change not being right for the business.

It can be common for people to resist change in the workplace due to the impact it has on the culture, anxiety and morale. By setting clear goals, defining why change needs to happen, and involving colleagues in the testing process, you can help your workforce to feel more positive and valued. Gartner (2020) found that when employees were included in the implementation process, the probability of success was boosted at least 12%.

Creating a PDSA cycle

Before starting a PDSA cycle, it is important to have clear goals established to base your PDSA cycle on. This will help you to stay focussed on the problems of concern during your whole cycle; keeping your testing targeted. There is no size limit to the changes that you may want to test, so even the smallest process tweaks can be tested using this method.

Often the small-scale changes lead to the better PDSA cycles taking place, as you don’t have the levels of bureaucracy or costs to content with. Testing small workplace changes can often be better received by colleagues and customers because they are not as overwhelming to take on board.

There is no formal paperwork that you have to complete to do a PDSA cycle. However, we advise recording information so that you have an audit record of how change has been implemented (this may be particularly important to the nursing sector). That way if you ever want to build on your changes in the future, you can continue from your last PDSA cycle.

The general themes of a PDSA cycle are common in many forms of natural problem solving. You may already be familiar with the methodology or critical thinking required – or perhaps you have previously completed the steps informally in your head without realising. Continue below where we break down the steps in a PDSA cycle.

In a work setting, it is common for managers to use a small sample of participants to test the PDSA cycle on (such as one patient, or one particular team for a select period of time). This ensures that any unexpected results are not widespread due to your small sample size.

When doing a PDSA cycle, it is a good idea to first test your hypothesis on internal customers or colleagues before venturing out to test on real life (or external customers). This adds another layer of protection to your organisation so that any major errors can be kept internal to learn from in your next PDSA cycle. The customers that you conduct your PDSA cycle on can provide you with feedback about your proposed change to help make further improvements.

We have included some simple tips below to help you when doing your own PDSA cycle:

• The PDSA cycle does not have to be a long process. Often a short test can help you to gain a snapshot of how your hypothesis is working. Keeping things short can also encourage you to continue the cycle, instead of getting stuck in one stage.
• Keep in mind that when doing a PDSA cycle, each letter in the acronym stands for a separate task; so there are four separate tasks that follow on from one another in the cycle.
• Remember what you are trying to accomplish. It is important to keep your hypothesis in mind when completing the cycle so that you can gather relevant information to study your findings and inform your next actions.
• Before beginning the PDSA cycle, have a clear understanding of “what good looks like”. It is important that you know what improvements to your processes or services look like (otherwise your PDSA cycle will have no direction).
• Consider different options that you can use your PDSA cycle to test. It is good to understand why a change needs to happen, but progress cannot be made without knowing what changes to test.

How to do a PDSA cycle in nursing?

The nursing sector relies on using evidence-based practice as a problem-solving approach to combine clinical expertise and patient views to improve practice. In the UK, the Nursing and Midwifery Council include evidence-based practice in their code of practice, which means that it is mandatory for all practising nurses in the UK to work in this way.

Evidence-based practice has a host of benefits for the sector including improving patient satisfaction, improving efficiencies, quality of service, and saving money once the right changes have been made. The healthcare sector has been known to battle with austerity whilst in an era of increased demand, with IPPR reporting that the UK spend £27.7 billion less on health annually than its G7 counterparts. So, the chance to provide a better more streamlined service is welcomed by staff and patients. The PDSA cycle matches well to creating positive change in the nursing sector because it provides a safe and managed path for implementation. It helps the nursing profession make service improvements using a structured format where learning can clearly be identified and tested safely. The PDSA model ensures that the whole team in a healthcare setting can learn from the cycle findings, making it an essential part of the service upgrade process.

In the nursing sector, the PDSA cycle is most commonly used during pilot projects, to test the impact of a new idea and how this would work in practice.

For example, in nursing the PDSA cycle would be used in the following way:

• Plan – Identify areas for improvement before auditing the state of current care. You can use this to create a baseline in which you can compare your results later on. Also gain stakeholder opinions at this stage to encourage richer ideas and ensure you are working within agreed boundaries.
  – For example: “Our goal is to improve patient waiting times. This can be achieved by allowing patients to book online, and reducing the patient transfer time from GP to hospital.”
• Do – Implement your intervention pilot study to your agreed time parameters.
  –For example: “Allow patients from one GP surgery to book their own appointments online on Thursday afternoon.”
  – For example: “Ask one GP to complete telephone referrals, followed up with an email, instead of paper-based form referrals”.

Please note that there are two examples included above because you can have more than one PDSA cycle running simultaneously. This may be beneficial when involving different departments but it can make it harder to manage. Ensuring that you have appropriate reporting channels and highlighting any interactions can help to manage simultaneous PDSA cycles.

• Study – After your pilot is complete, determine whether or not your changes added any benefit to nursing care.
  – You can capture the learning from your PDSA cycles and use this to inform your next PDSA cycle. Recording this information is helpful for if you ever need to return to it in the future.
• Act – Evaluate your study and separate your results. You can group them into results that require no change, and results to inform your next PDSA cycle.

Can anyone use a PDSA cycle?

A PDSA cycle is used by many businesses across the world and can help in a range of industries, such as automotive, manufacturing, marketing, sales and retail. The model is so transferable due to its speed and simplicity in testing changes to build on success. Most organisations in the public and private sector have stakeholders, so the PDSA model also provides early insight to them of your proposed changes succeeding.

Its versatility means that it can support the following business functions:

• Project management.
• Product development.
• Resource allocation.
• Change control.
• Quality improvement.

The PDSA cycle can be used for any type of problem solving across all teams in an organisation. Due to its evidence-based practice, it produces high quality, reliable results, which is why it is a trusted source of change in the nursing and healthcare sector. These sectors work with vulnerable patients on a daily basis, so they require a reliable business model that will promote patient safety and reduce challenges.

So, by using an evidence-based tool to promote change, professionals can see from early on what does and doesn’t work, enhance team collaboration, and meet requirements for continuous learning and development.