Running PDSA cycles.

The need to change the delivery of healthcare in the United States has been the focus of several recent publications. Quality improvement concepts initially utilized in industry have been applied to healthcare to reduce error and variation in outcomes. The Plan-Do-Study-Act (PDSA) Methodology is one of the most commonly used tools in quality improvement. The PDSA cycle is an iterative, four step model for improving a process. The first step is the development of a plan in which predictions of outcomes are clearly stated and tasks are assigned. It is in this phase that the who, what, when, and where of the plan is decided. In the "do" phase, the plan is implemented. Data and results obtained are then analyzed in the "study" phase. Last, the plan is either adopted, adapted, or abandoned in the "act" phase based on the evaluation of the data in the prior step. The learning from one cycle should guide the cycles that follow. A hypothetical example from an actual Quality Improvement Initiative sponsored by the American Academy of Pediatrics Chapter Quality Networks provides a step by step approach to application of the PDSA model. Changes noted following multiple iterative PDSA cycles resulted in significant improvement in healthcare outcomes.