5 Tips for Testing to Optimize Your Next PDSA

The Plan-Do-Study-Act (PDSA) cycle is a fundamental tool in the quality improvement tool belt. PDSA cycles are used to test, implement and spread change ideas in a systematic way. Regardless of your improvement framework—collective impact, the breakthrough series, etc.—PDSAs can be used. Here are five tips for testing to optimize your next PDSA cycle.

  1. Avoid analysis paralysis. It's easy to get caught up thinking about everything that can go wrong or how difficult it will be to ultimately implement a change idea. Don’t overthink it. PDSAs are about building knowledge by trying small changes. "Failed" cycles are good learning opportunities, particularly when small. Avoid getting stuck in the "what ifs" and instead very quickly run test after test. That is the best way to see what change will result in improvement. 
  2. Start small. Do the initial PDSA on the smallest scale possible—one patient, one staff member. Instead of thinking what test can happen in the next three months, think what can happen in a month, or two weeks, or next Tuesday. Start with volunteers who are interested in change. This will enable your team to move rapidly from cycle to cycle. And successful testing with volunteers can lay the groundwork for involving others later on in the process who may not be as enthusiastic or as committed initially to the change.
  3. Collect data. During each test, collect useful data, not perfect data. The goal is to capture enough information to know what's good and what isn't good so you can modify change over time and get better with sequential tests. Use a measure specific to the PDSA (e.g., how many babies are sleeping on their backs during a shift or how long it takes to complete an assessment). It’s good to think beyond surveys and collect qualitative results too. Data is important because it will help shape the next PDSA cycle.
  4. Understand task versus test. There are many tasks associated with running a PDSA (e.g., scheduling meetings, collecting data, creating supporting materials, etc.) An activity doesn't equal a test of change. A task may be to develop a form or educational resource. The test is going to be taking the form or resource and applying it to a family to see if it results in improvement.
  5. Test under different conditions. It is great when a PDSA cycle result aligns with the prediction. However, don’t be too quick to call the change idea a success and adopt the change system wide. Think about factors that could lead to breakdowns, for example: naysayers, day/night shift, English speaking family/non-English speaking, experienced/inexperienced staff, regular staff/short staffed, cultural differences. Be sure to test under many different conditions to make sure the change has the desired result regardless of conditions. Doing this should lead to more successful implementation. They’ll be fewer surprises when you ask everyone to do the change if you’ve tested over different conditions and identified some of the barriers or problems and come up with solutions.

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