How do you use PDSA cycles to test and implement changes?

In my experience, using a small test of change allows one to establish measurable goals, assess the effects of the change and if necessary, make adjustments and do another PDSA. Additionally, while tracking process and outcome measures, one can assess the balance measures which can result in positive or negative unexpected outcomes.

Utilizo os ciclos PDSA para testar e implementar alterações começando pelo "Plan", onde defino a mudança e os objetivos. Em "Do", aplico a mudança em um ambiente controlado ou em pequena escala. No "Study", avalio os resultados, comparando com as expectativas e coletando feedback. Finalmente, em "Act", ajusto a abordagem com base nos resultados e preparo a implementação em maior escala, se bem-sucedida.

A systematic and iterative approach to testing and implementing changes in various processes. PDSA allows teams to experiment with changes on a small scale, assess the impact and then decide whether to adopt adapt or abandon the changes. Plan: The team identifies the problem or opportunity for improvement, sets specific objectives, and designs a plan to test a change. Do: This phase involves implementing the planned change on a small scale. Study: Evaluate and analyze the data collected during the "Do" phase to understand the impact of the change. Compare the results against the objectives set in the planning phase. Act: Based on the findings from the study phase, decide whether to adopt the change, adapt it further, or abandon it.

A PDSA cycle is a method for implementing and testing changes in a systematic manner. It stands for Plan, Do, Study, Act, and involves: Planning the change. Implementing or doing the change on a small scale. Studying the results and analyzing data. Acting on what was learned, whether to adopt, adapt, or abandon the change.

So as leaders, we throw everything we think of at the problem randomly. If it improves, we don't actually know what helped and what didn't. Whatever we already believed would work is determined to be the solution.. If it fails to work the next time, we blame those it is not working for. In general, whoever has the highest salary or friends gets to decide. We all want them on our side, so we don't question them. They have more experience, notably with whatever is not working. We expect them to solve the problem, and blame them when they can't. Thus, wasting the wonderful talent and intelligence of most of us, including those familiar with the problem at close range, who could solve it, with a freedom and a few tools, and are even a bargain!

Always important to include other stakeholders in measure development as they will bring different perspectives and experiences. In addition to gaining different perspectives with stakeholders, it is an ideal way to create a consensus approach with buy in from stakeholders. I have found that most initial PDSA cycles struggle with creating a measurable aim as it is difficult to quantify some goals and establish a targeted goal, not just show improvement.

I have seen PDSA projects fail right from the start because they do not address an answerable question. A clear, answerable question is the first step. A reliable metric is the second, preferably one whose results can be directly tied to the trial, although it can work with metrics that indirectly impact, if the initial question is clear.

Define the Problem: Clearly articulate the problem or opportunity for improvement. Be specific about what needs to change and why. Set Objectives: Establish clear and measurable objectives for the change. What are you trying to achieve, and how will you know if the change is successful? Identify Changes to Test: Determine the specific changes you plan to test. These changes should be based on informed hypotheses about what might improve the current situation. Develop a Plan: Outline the steps involved in implementing the change. Consider who will be involved, what resources are needed, and the timeline for testing the change.

Define the aim. Specify the question. Choose measurable indicators. Allocate resources. Establish a timeline. Determine data collection methods. Use existing knowledge. Involve stakeholders.

PDSAs do not have to be rapid or small in scale, but they work best if they are. We usually think about PDSAs as small tests of change to be scaled up, and the same approach can be used in the scaled up version, or even a larger project.

Small Scale: Start by implementing the change on a small scale or in a limited setting. This allows for easier monitoring and reduces the potential impact if the change is unsuccessful. Document the Process: Clearly document how the change is being implemented. This documentation is crucial for analyzing the results and replicating successful changes in the future. Collect Data: Use relevant metrics and data collection methods to assess the impact of the change. Ensure that the data aligns with the objectives set during the planning phase.

Implement the change on a small scale. Collect data before, during, and after the test. Document the process, challenges, and observations. Communicate the test to stakeholders.

Compare Data: Analyze the data collected during the test phase. Compare the results against the objectives to determine the effectiveness of the change. Identify Patterns or Trends: Look for patterns or trends in the data. Understand whether the change had the desired effect, and consider any unexpected consequences. Engage Stakeholders: Involve relevant stakeholders in the analysis process. Their insights may provide valuable perspectives on the impact of the change.

Analyze collected data and compare with expected outcomes. Answer the initial question and evaluate the change's impact. Reflect on lessons learned, successes, and failures. Share results with stakeholders involved or interested in the change.

In my experience, if you have a clear and concise AIM, you will know if your intervention worked. If you exceed the goal, definitely move to spread but also take time to assess if the goal was too conservative or other unintended consequences helped to drive exceeding the goal. If you meet the AIM, develop plans for spread. If you did not meet the AIM, but the AIM is important, go back and re-assess the interventions. If the intervention showed measurable improvement, perhaps add on another intervention and start the PDSA cycle over again. Irrespective of the PDSA cycle success of lack of success, keep the participants and stakeholders informed of the results and next steps in the process. on other PDSA cycles.

Decision Time: Based on the analysis, make a decision about whether to adopt, adapt, or abandon the change. Document Lessons Learned: Document lessons learned from the test. What worked well? What could be improved? Communicate Findings: Share the findings with the broader team or organization. Effective communication ensures that everyone is informed about the results and the decision made based on those results. Iterative Process: Understand that the PDSA cycle is iterative. If the change was successful, consider additional refinements to further improve outcomes. If the change was not successful, use the lessons learned to design a new test or adjust the change for another iteration.

Decide to adopt, adapt, or abandon the tested change. Adopt successful changes and scale them up. Adapt partially successful or unsuccessful changes based on feedback. Abandon ineffective or harmful changes. Document decisions and plan next steps accordingly.

As important as the PDSA cycle itself, also place value and support of the participants and stakeholders. By fully engaging them, they will be more likely to participate in future PDSA inititaives.

PDSA cycles help with transient goal setting really well too. So, define the larger aim/vision, plan the first measurable aim/step that progresses you towards that change and use PDSA cycles to test and achieve this new state and use learning from this to plan the next step and so on to progressively achieve milestones towards the larger aim, remembering to celebrate success at achievement of each step along the journey.