Plan
Planning is a vital part of the process. If you put consideration and time into this stage it will pay dividends later, as you will have considered what the likely impact of the change will be and identified potential problems you may encounter. Once you have decided on;
- what you are planning to do,
- what your objectives are,
- who needs to be involved,
- how you are going to do the work,
- how long will your test of change run last, or how many patients will be involved , and
- identified a method for measuring the outcome, you are now ready to put you plan into action.
It is useful at this stage to make predictions on what impacts you think the change will have. You will be able to compare the actual results to your predictions during the study phase.
Do
This is the stage where the plan is put into action. Remember to keep it small and manageable, eg with one patient, one doctor, one nurse, one day. If the change is having a noticeable positive effect, you may decide to shorten your test of change run and implement the change across all patients in your care. Equally, if the change is not having a noticeable effect, you may accept that this is an ‘honourable failure’ and make the decision not to allocate any more resources to the idea. If this is the case, spend time working out what happened, and why the process didn’t work the way you anticipated. This will be valuable in considering the next steps. Carry out the plan, document the problems you encountered and any unexpected observations.
Study
At this stage, the cycle is reviewed and reflected on by everyone who was involved. Any data collected is examined and compared with the predictions that you made in the planning stage. Any ideas for improvements to the cycle should be raised prior to re-testing. Don’t forget to summarise what was learned.
Act
It may be that you think the cycle should be tested again unchanged under different conditions, i.e. with a different patient, doctor, nurse or day of the week. Alternatively, you may decide to amend your plan to reflect learning from the first cycle and re-test.
Consider Multiple PDSA Cycles
Often you will need to use multiple PDSA cycles. This approach can bring about a lot of small changes at once or in close succession. The use of multiple cycles at the same time for testing and implementation reduces risk, as the change process progresses from hunches, theories and ideas to actual changes that result in improvement. For example, you might like to have one nurse testing the statement on risk assessment within 6 hours of admission on one day and another nurse testing the statement on another patient the next day.
Measurement
Measurement is a fundamental part of answering the question ‘how do we know that a change is an improvement?’
Key points to consider when starting to measure:
- Keep your measurements simple.
- Aim to integrate measurement into your daily routine so that it is part of your daily work.
- You should use measurement to speed up improvement, not to slow things down. Seek usefulness, not perfection. Remember the goal is improvement.
- Identify key measures to clarify your team’s objectives and make them realistic.
- Link the measures for improvement with other initiatives *
- Make sure you involve all relevant stakeholders
* If you work in a hospital you can link this work on pressure ulcers with the work for the Clinical Quality Indicators, and on the Patient Experience work.