Are your processes stagnant? Has your external environment shifted on you, requiring a review? Or, are you in need of a mini-process improvement methodology to help refine some of your work processes?  In coaching physician practices on transformation activities, many practices are using a quick and easy process improvement strategy taught by the Institute for Healthcare Improvement (IHI).

This methodology is called PDSA.  PDSA stands for “Plan, Do, Study, Act”. When using this simple methodology, your team will:

  • Plan: Plan to test a single change
  • Do: Conduct the test
  • Study: Study the results of the test
  • Act: Decide what actions should be taken in response to the results of the test

The beauty of this methodology is the simplicity of testing one thing. Remember when your baby started on baby food and the pediatrician had you try only one food at a time so if there were a problem you would be able to identify the one food your child was allergic to?  This is a similar process. Changing one step at a time enables you to see the impact and value more clearly. Identify one thing to change at a time, run through the PDSA cycle, then change one more thing and repeat, until the process has been revamped successfully.

Here is a good example of a PDSA cycle: A practice decided to employ a list of triage questions when patients call in to the office with a goal to improve call back times overall, specifically quicker call backs for sicker patients. They planned what the triage questions would be, determined who would use the questions and under what circumstances, and then trained all appropriate personnel. They put the test into place for one week, counting the number of “call backs” that were remaining at 5PM, as well as looking at the level of acuity of the remaining patients. The practice manager studied the results and decided that the triage questions were indeed a great improvement. For the next PDSA cycle, they modified the questions to enable the appropriate level of detail in determining how quickly the patient needed a response. The team’s next PDSA cycle intended to test allocation of resources who call the patients back.

Another example of a PDSA cycle: A Nephrology clinic that administers a very costly medication has a log by the refrigerator for signing out the medication. However, the log was set up in a way that did not show a running total of medication on hand. It simply documented each dose. They didn’t really need to document each dose, because the actual dose documentation was in the patient record. All they needed was a current inventory at all times so they knew when they needed to re-order and account for all of the medication used. The practice planned the trial of a new log that included medication used and a count of the amount remaining with each entry to enable a current total of medication on hand at all times. They tested the new process for one week, with the charge nurse spot checking the log against actual medication on hand twice daily. The practice studied the results and decided the new format provided the information they needed and improved the accuracy of keeping track of their inventory.

For more information on PDSA cycles or for a copy of the worksheet, follow this link:

About Laura Buchanan MBA, BSN, RN

Ms. Buchanan is a Registered Nurse (RN) with 39 years of professional experience. She serves as a director with a focus on technology projects utilizing her clinical, management, business, and technical consulting experience. She has extensive experience with clinical transformation, workflow analysis, process design, vetting software options, data analysis, and implementing EHR systems.​

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