PDSA: Plan-Do-Study-Act

Also Called: Plan-Do-Check-Act (PDCA), Rapid Cycle Improvement

PDSAPDSA, or Plan-Do-Study-Act, is an iterative, four-stage problem-solving model used for improving a process or carrying out change. (PDSA has also been called PDCA, where 'check' is substituted for 'study.')

When using the PDSA cycle, it's important to include internal and external customers; they can provide feedback about what works and what doesn't. The customer defines quality, so it would make sense to also involve them in the process when appropriate or feasible, to increase acceptance of the end result. (If you're unsure about, who your customers are, you may want to create a customer chain to assist in identification.)

PDSA is a four-stage quality improvement approach:

  • Stage 1: Plan
  • Stage 2: Do
  • Stage 3: Study
  • Stage 4: Act

In applying PDSA, ask yourself three questions:

  • What are we trying to accomplish?
  • How will we know that a change is an Improvement?
  • What changes can we make that will result in an improvement?

How to Use PDSA

PlanStage 1: Plan

Identify an opportunity, and plan for improvement.

A) Assemble the Team

You want to choose people who have knowledge about the problem or opportunity for improvement.

  • It's important to consider the strengths that each team member is bringing to the table. You really don't want prisoners on your team--you want champions, or people who want to be there. Having engaged members will increase productivity by 70% (Source: Passionwerx: Workforce Engagement Solutions).
  • Once team members are selected, identify roles and responsibilities, set a time line, and establish a regular meeting schedule

B) Create an Aim Statement

An aim statement should describe what you want to accomplish, and can change as the process proceeds; the focus of the aim statement can become more specific and will be modified as you learn. An aim statement isn't set in stone.

The aim statement should answer those three fundamental questions:

  1. What are we trying to accomplish?
  2. How will we know that a change is an improvement?
  3. What change can we make that will result in improvement?

C) Examine the Current Approach

Examine your current process or process flow. Start by asking the team these basic questions:

  • What are we doing now?
  • How do we do it?
  • What are the major steps in the process?
  • Who is involved?
  • What do they do?
  • What is done well?
  • What could be done better?

You might have already answered the last two questions if you have performed a SWOT analysis.

Creating a process flow or at least depicting the current process can be very useful. If your team runs into road blocks, you might have found where the problem is occurring--or maybe the right person for identifying a missing step is not at the table.

Once the general structure is completed, these can be some more helpful questions to ask:

  1. How long does the process currently take?
  2. Is it efficient?
  3. Is there a variation of methods of completing the process?
  4. Are we doing the right steps in the right way? What is the cost? (Cost doesn't just include money, but could also include time or resources)
  5. Does someone else do this same process in a better way? Let's not re-create the wheel if we don't need to!
  6. Are we meeting our goals?

This list of questions is by no means complete, but may be a good point at which your team starts. In the end, your team is trying to find the root cause of a problem, and might benefit from assessing the problem with a tool like a fishbone diagram. Once you find the root cause, reexamine your aim statement, and perhaps revise it based on the root cause and/or baseline information.

D) Identify Potential Solutions

Be creative and innovative! If appropriate, spend some time reviewing models or best practices to help identify potential solutions.

This is the area where using your internal and external customers and stakeholders becomes important. The team might have innovative ways to solve the problem. This process really is all about the discussion, so encourage all ideas.

Narrow potential solutions to those within the team's control or influence. Again, ask three fundamental questions:

  • What are we trying to accomplish?
  • How will we know that a change is an Improvement?
  • What changes can we make that will result in an improvement?

If the Aim Statement needs to be refined further, make sure that a numerical measure is listed for the future target. When ready, choose the best solution--that is, the one most likely to fulfill your Aim Statement.

E) Develop an Improvement Theory

Start with a hypothesis:

  • What will the data show?
  • What outcome are we looking for? Can we define the outcome we want?

Try brainstorming with the statement: "If we do _____, then _____ will happen."

Develop a approach to test the theory. The approach you choose should specify what will be tested and how. Ask yourself when the test will occur, and who needs to be involved. What risks could occur during the test, and how can we prevent them from occurring? Again, adjust the aim statement if appropriate.

DoStage 2: Do

Start carrying out your plan:

  • Test the theory for improvement
  • Carry out the plan you've developed
  • Collect, chart, and display data
  • Document problems, unexpected observations, side effects

Some tools that might be useful in this process:

StudyStage 3: Study

Examine your results:

  • Use data to study results of the test
  • Did the results match the theory/predictions?
  • Are there trends? Unintended side effects?
  • Is there an improvement?

You might want to test the improvement under other conditions. You can use visual aids to interpret and understand the data you've collected. Some useful tools to accomplish this include:

  • Pareto Charts: Examine problem frequency to determine places for most potential improvement
  • Control Charts: Determine whether a problem is in a state of statistical control
  • Run Charts: Determine trends by displaying data over time

ActStage 4: Act

Continue to examine and re-examine your process using the PDSA cycle, by standardizing the improvement or developing a new theory, and establishing future plans.

Standardize the Improvement, or Develop a New Theory

If your improvement was successful on a small scale, test it on a wider scale.

  • Continue testing until an acceptable level of improvement is achieved
  • Make plans to standardize the improvements
  • If your change was not an improvement, develop a new theory and test it. Often, several cycles are needed to produce the desired improvement

Establish Future Plans

Celebrate your success!

  • Communicate your accomplishments to internal and external customers
  • Take steps to preserve your gains and sustain your accomplishments
  • Make long term plans for additional improvements
  • Conduct iterative PDSA cycles when needed

Further Reading

More Information

Icon Gorenflo and Moran: PDSA Flowchart (PDF: 349KB / 1 page)
Icon Kaminski & Strom: Getting Started: Using PDSA to Tackle Tough Problems (PDF: 543KB / 5 pages)
Icon Public Health Foundation: The ABCs of PDCA
Icon Michigan Local Public Health Accreditation Program: Embracing Quality in Local Public Health (PDF: 3.3MB / 115 pages)
Icon Baldrige Program: Criteria for Performance Excellence
Icon Balanced Scorecard Institute
Icon PHAB: Proposed Local Standards and Measures
Icon Institute for Healthcare Improvement: PDSA [Note: Video will autoplay]

Examples of PDSA

Icon What is Quality Improvement? PDSA