The Plan-Do-Study-Act (PDSA) Cycle – Type 2 Diabetes
PDSAs are a standard approach to quality improvement that can be applied to nearly every health care process or clinical approach.
The PDSA cycle is one approach to quality improvement (QI) that leverages a structured, straightforward method, which can be applied to a wide variety of care processes. It can be applied in small-to-large practices, regardless of staffing and IT sophistication. It should be very specific and precise, and can become the engine of ongoing improvement. The PDSA form below can help guide Champions in enacting this process.
4 steps to using PDSA:
Plan: Develop the Initiative
Act: Make Further Improvements
Do: Implement Your Plan
Study: Check the Results
3 key questions to ask during a PDSA cycle:
What are we trying to accomplish?
What changes can we make that will result in improvement?
How will we know that a change is an improvement?
Refining a PDSA plan
In order to have a successful DRIVE program, the PDSA plan needs to be carefully crafted and implemented.
The Champion can implement the following elements when presenting the PDSA plan to the practice and/or health system team:
- Seek input from the practice and/or health system team, as some members of the team may have useful insights
- Ensure that every individual from the practice team is informed and agrees on the plan presented
- Use regularly scheduled staff meetings to communicate the status of the DRIVE program and solicit feedback and updates on progress
After a Champion receives buy-in from the practice and/or health system team, the PDSA plan can be put into action.
Different outcomes of the PDSA plan
- If the plan did not achieve the desired results, consider the reasons why and redevelop the plan with those insights in mind. A coaching call with the Center for Sustainable Health Care Quality and Equity (SHC) can also be scheduled for support during this time
- If the plan did achieve or surpass desired results, develop the next cycle to expand its application across more of the practice/health system, or further refine it as needed
Set SMART PDSA goals
When Champions fill out the PDSA form, they need to ensure that the DRIVE program is focused with specific objectives – this can be accomplished by making sure that the goal in the PDSA plan is SMART:
Quantifiable data to show effect
Reasonable to reach
Addresses a current or important issue
Has a specified timeframe in which it needs to be reached
One practice goal could be to prioritize communities of color to improve type 2 diabetes management via telehealth education services. Using the SMART approach, a goal can be specified as follows:
- Specific: Your practice needs to recruit 50% of its Hispanic population of patients with poorly controlled type 2 diabetes with A1c levels over 9 who are also over the age of 50
- Measurable: Through grant funding, you employ a type 2 diabetes educator who is a Certified Health Education Specialist (CHES®) and able to teach sessions to patients on lifestyle changes that include improving physical activity to 150 minutes per week, eating nutrient-dense foods, managing blood sugar, and medication adherence
- Attainable: Since the COVID-19 pandemic began, you have implemented telehealth appointments for chronic disease management. You decide to use the telehealth services you’ve been providing to provide the educational sessions
- Relevant: This intervention would be relevant to communities of color, older patients, patients with comorbidities, such as obesity, and patients with poorly controlled type 2 diabetes
- Time-based: This goal will be reached by November 20, 2021
Starting Small with the PDSA Plan
It is recommended to start a PDSA plan at a smaller scale by piloting it with one physician or in one care team first.
Then, leaders from the practice or health systems can communicate with the rest of the DRIVE team about the initiative’s progress, encourage more widespread adoption of the PDSA plan, and promote its importance and value on a larger scale.
“Quality improvement begins with love and vision. Love of your patients. Love of your work.”Dr. Avedis Donabedian