Module 6
Once you have identified a promising intervention, the next step is to test it on a small scale. Plan-Do-Study-Act (PDSA) cycles provide a structured approach for learning what works, what doesn't, and how to refine a change before broader implementation.
PDSA is the testing method the Model for Improvement uses to try out change ideas — see Module 2.1 for the full framework and its worksheet. This section focuses on how to run a PDSA cycle.
Phases of the PDSA Cycle
| Phase | What Happens | Key Actions |
|---|---|---|
Plan |
Predict what will happen. Define who, what, when, where. |
Write your prediction. Identify the measure. Assign roles. Set a timeline (days or weeks, not months). |
Do |
Carry out the test on a small scale. |
Document what happens — including surprises, workarounds, and unintended consequences. |
Study |
Compare what happened to your prediction. |
What did you learn? What worked? What didn’t? Did the data support your prediction? |
Act |
Decide: Adopt, Adjust, or Abandon. |
Plan the next cycle based on what you learned. Document your decision and rationale. |
Key Concepts
- Start small: One provider, one shift, one location — then expand as confidence grows.
- Scale gradually: Build ‘PDSA ramps’ — sequences of cycles where each one incorporates what was learned from the last.
- Learn fast: A PDSA cycle can be as short as one day or one week. Speed is a feature, not a shortcut.
- When is enough, enough? When the change works consistently under varied conditions — different staff, different shifts, different volume levels — and confidence is high.
PDSA Cycle Worksheet
Use this worksheet to plan a single test of change. To keep it concrete, the placeholder text below walks through one test on the ED telepsychiatry consult line; replace it with the details of your own project. The questions on the worksheet are adapted from the IHI PDSA Worksheet (QI Essentials Toolkit) for our purposes.
Download: PDSA Cycle Worksheet
Deciding: Adopt, Adapt, or Abandon
The Act phase asks you to make a call: adopt, adapt, or abandon the change you tested. Using the ED telepsychiatry consult line example above, here’s what each decision looks like in practice:
- Adopt: It works consistently and is sustainable. Data show reliable improvement. Staff is confident and engaged. This is your signal to move from small-scale testing into full implementation, embedding the change into standard workflow, policy, and training (see Module 6.4).
- Adapt: It has potential but needs refinement. Some components work, others don’t. Staff has identified barriers. Run another PDSA cycle with modifications.
- Abandon: It consistently fails to improve outcomes, creates more burden than benefit, or is not feasible at scale. Learn from it — document what you learned — and move to the next change idea on your Key Driver Diagram.