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Understanding and Implementing the Improvement Cycle

Although QI models vary in approach and methods, a basic underlying principle is that QI is a continuous activity, not a one-time thing. As you implement changes, there will always be issues to address and challenges to manage; things are never perfect. You can learn from your experiences and then use those lessons to shift strategy and try new interventions, as needed, so you continually move incrementally toward your improvement goals.

The fundamental approach that serves as the basis for most process improvement models is known as the PDSA cycle, which stands for Plan, Do, Study, Act. As illustrated in Figure 4-1, this cycle is a systematic series of steps for gaining valuable learning and knowledge for the continual improvement of a product or process. Underlying the concept of PDSA is the idea that microsystems and systems are made up of interdependent, interacting elements that are unpredictable and nonlinear in operation. Therefore, small changes can have large effects on the system.

Figure 4-1. Plan-Do-Study-Act Cycle

This image shows the Plan-Do-Study-Act (PDSA) cycle, which illustrates that the effort to improve performance is not a linear process with a beginning and end. It is a cyclical process that leaves room for testing, tweaking, and expanding interventions along the way. The components of the cycle are 1. Plan Strategy, 2. Develop, Test Strategy, 3. Monitor Strategy, and 4. Reassess & Respond.

The cycle has four parts:

Plan. This step involves identifying a goal or purpose, formulating an intervention or theory for change, defining success metrics and putting a plan into action.
Do. This is the step in which the components of the plan are implemented.
Study. This step involves monitoring outcomes to test the validity of the plan for signs of progress and success, or problems and areas for improvement. Short-cycle, small-scale tests, coupled with analysis of test results, are helpful because microsystems or teams can learn from these tests before they implement actions more broadly.7,8
Act. This step closes the cycle, integrating the learning generated by the entire process, which can be used to adjust the goal, change methods, or even reformulate an intervention or improvement initiative altogether.