PDSA for Dummies

Clinics like mine are supposed to do lots of PDSAs, rapid quality improvement projects. It’s part of our agreement with Uncle Sam. We keep starting them, but many of them fizzle. Our Federal Project Officer told us (again) at his last inspection to do more of them.

We have gone through multiple forms and formats, one more complicated than the other. But simple folks like me can’t wrap our heads around them. It should be simple: P stands for Plan, D for Do, S for Study and A for Act. Four short words, fourteen characters and, in our case, years of confusion.

Every PDSA form creator has his or her own idea. In some iterations, Plan means a detailed description of multi step processes, without declaring the overarching idea or purpose behind the project in the first place. In some, Do is where you enter your measurements and Study is where you analyze the results, while in others Do is the experimental workflows and Study is where you put the measurements.

So, as one to often reduce complicated things to their bare essence, here’s what I’ll be presenting my boss with. I’ll call it “PDSA for Dummies, v. 1”. My secret weapon is that each word, Plan, Do, Study and Act, is followed by a sentence that spells out my interpretation of what it stands for. It may not be the best, and is certainly not the only, way to do it but at least I think it’s clear:

P – Plan: In one sentence, what will you try to do?

(Example: Decrease the number of patients who leave the clinic without making a followup appointment)

D – Do: What steps or workflows will you carry out and how will you measure what works?

(Example: Give the first ten of my patients a numbered, sealed envelope and ask them to drop it off at the reception and have me or my medical assistant give everyone else just a friendly reminder to stop there on their way out. Keep a log of who got an envelope, a nurse reminder or a doctor reminder.)

S – Study: What results did you record?

(Example: Did more envelope carrying patients make followup appointments than reminder-only ones? Was there a difference between doctor and nurse reminders?)

A – Act: Given what we observed, should we adopt one of these new workflows or do we need to try something else?

(Example: Nothing seemed to work very well, maybe we should relocate the checkout station in another PDSA.)

Four boxes, each with a definition of exactly what we mean with Plan, Do, Study and Act and, in small print, simple examples.

That’s my opinion, we welcome yours…

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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