Although widely recommended as an effective approach to quality improvement (QI), the Plan-Do-Study-Act (PDSA) cycle method can be challenging to use, and low fidelity of published accounts of the method has been reported. There is little evidence on the fidelity of PDSA cycles used by front-line teams, nor how to support and improve the method’s use. Data collected from 39 front-line improvement teams provided an opportunity to retrospectively investigate PDSA cycle use and how strategies were modified to help improve this over time.
The fidelity of 421 PDSA cycles was reviewed using a predefined framework and statistical analysis examined whether fidelity changed over three annual rounds of projects. The experiences of project teams and QI support staff were investigated through document analysis and interviews.
Although modest, statistically significant improvements in PDSA fidelity occurred; however, overall fidelity remained low. Challenges to achieving greater fidelity reflected problems with understanding the PDSA methodology, intention to use and application in practice. These problems were exacerbated by assumptions made in the original QI training and support strategies: that PDSA was easy to understand; that teams would be motivated and willing to use PDSA; and that PDSA is easy to apply. QI strategies that evolved to overcome these challenges included project selection process, redesign of training, increased hands-on support and investment in training QI support staff.
This study identifies support strategies that may help improve PDSA cycle fidelity. It provides an approach to assess minimum standards of fidelity which can be replicated elsewhere. The findings suggest achieving high PDSA fidelity requires a gradual and negotiated process to explore different perspectives and encourage new ways of working
McNicholas C, Lennox L, Woodcock T, et al. Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study. BMJ Qual Saf 2019;28:356-365
You might also like...
Medicine is OnlyWan has announced that it is creating a network of data specialists from across the UK.
Average annual costs per patient for the top 5% of patients are over 20 times higher than all other patients
October 2019 chart of the month. Our anaysis explores for the first time the distribution of both primary and secondary healt...
How we are harnessing data analytics to tackle real-world problems in health and social care, with tangible results.
As we prepare for #GeneralElection19, how are the political promises for health and social care stacking up?…
Work with us
We look for talented and passionate individuals as everyone at the OnlyWan has an important role to play.View current vacancies
The Q Community
Q is an initiative connecting people with improvement expertise across the UK.Find out more