2025 – PAGE 453 – 454 – PATIENT SAFETY AND QUALITY IMPROVEMENT
CYCLE OF CONTINUOUS IMPROVEMENT
You should know the Plan-Do-Study-Act model for continuous quality improvement. It’s also sometimes called the Plan-Do-Check-Act model. This can show up on the boards, and it plays a part in the MOC Part 4 quality improvement activities.
The four parts of the model are:
- Plan
- Do
- Study/Check
- Act
PLAN: Identify a gap between the current performance and the ideal. For example, let us assume that you have decided that all of the children in your practice should be fully immunized by a certain age. If your practice took on a QI project to improve its immunization rates, then you would start by identifying a quality gap, and make a plan for how to improve it. A very important part of the PDSA model is incremental change. Rather than trying to make a major initiative to correct all of the issues in immunization, you should identify one or two specific problems and then make a plan to improve those problems. A small and highly focused plan has a far greater chance of success than does a large and complicated one. It’s also easier to measure the success of the plan, and to make incremental changes within it for greater impact.
Planning should be a team effort. Consider all of the people who are needed for a successful outcome and bring them on board. Goals should be measurable and specific. Collect baseline data so that you know the starting point. Data collection will also help you frame your goals.
DO: Carry out the planned change on a small number of patients for a limited amount of time. Collect the data needed to evaluate the effects.
STUDY/CHECK: Study (check) the data to determine the effects of the change. Did it work? Did it cause new problems or obstacles? Did it suggest alternatives?
ACT: Based on those conclusions, start the cycle again and decide your next course of action. You might decide to make the initial changes a more permanent part of your process, or you might extend the scope of the project, or you might try something completely different. Once that happens, you’re ready to once again plan for the next change. Remember, PDSA is a cycle and not a one-time event. Quality improvement is supposed to be a continuous part of the health care enterprise.