A primer on PDSA: executing plan–do–study–act cycles in practice, not just in name

Correspondence to Dr Jerome A Leis, Sunnybrook Health Sciences Centre, H463, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5; jerome.leis@sunnybrook.ca Introduction Plan-do–study–act (PDSA) cycles are the building blocks of iterative healthcare improvement.1 Although frequently regarded as sep...

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Bibliographic Details
Published in:BMJ quality & safety Vol. 26; no. 7; pp. 572 - 577
Main Authors: Leis, Jerome A, Shojania, Kaveh G
Format: Journal Article
Language:English
Published: England BMJ Publishing Group Ltd 01.07.2017
BMJ Publishing Group LTD
Subjects:
Accountability
Accreditation
Anaesthesia
Attitudes
Catheters
Data collection
Hospitals
Humans
Hypotheses
Hypothesis testing
Intervention
Medical instruments
Medical Overuse
Medical personnel
Narrative review
Nurses
Organizational Case Studies
Physicians
Program Development - methods
Quality
Quality Improvement - organization & administration
Scientific method
Urinary Catheters
Urinary tract diseases
Urinary tract infections
Urogenital system
Usability
Working conditions
Anaesthesia
Attitudes
Accreditation
ISSN:2044-5415, 2044-5423
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Summary:Correspondence to Dr Jerome A Leis, Sunnybrook Health Sciences Centre, H463, 2075 Bayview Avenue, Toronto, Ontario, Canada M4N 3M5; jerome.leis@sunnybrook.ca Introduction Plan-do–study–act (PDSA) cycles are the building blocks of iterative healthcare improvement.1 Although frequently regarded as separate from research,2 this quality improvement method remains rooted in the scientific method. Each cycle combines prediction with a test of change (in effect, hypothesis testing), analysis and a conclusion regarding the best step forward—usually a prediction of what to do for the next PDSA cycle.3 Too often, however, improvement teams go through the motions of PDSA cycles without really embracing its spirit or applying its scientific method. Illustrative example: project to reduce unnecessary urinary catheters among patients on general medical wards Urinary catheter overuse contributes to unnecessary patient harms including local trauma, decreased mobility, delirium and infection.6 As in many institutions, the practice at our tertiary care hospital in Toronto had been to leave decisions about insertion and removal of urinary catheters to the discretion of individual physicians without any systematic process to reassess them. Emergency staff perceive adding catheter will increase workload. Because of inability to measure fidelity and lack of engagement, this intervention will not successfully address the problem. 2 weeks 4 Admission order sets that promote catheter insertion lead to overuse.
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ISSN:2044-5415
2044-5423
DOI:10.1136/bmjqs-2016-006245