6.7 References

Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. (2009). The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd ed.).

PDSA cycle methodology: Plan, Do, Study, Act phases; ramp sequences; adopt/adjust/abandon decisions

Module 6 is the deepest dive into PDSA methodology in the series. All four phases, the concept of PDSA ramps, and the adopt/adjust/abandon framework come directly from Langley et al. (2009), the primary source for this content.

Taylor MJ, McNicholas C, Nicolay C, Darzi A, Bell D, Reed JE. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290–298.

Evidence base for PDSA as the dominant QI testing method in healthcare; implementation guidance

Taylor et al. (2014) provide a systematic review of PDSA application across healthcare settings — the strongest evidence for why PDSA is the method the modules teach. Module 6 should reference this peer-reviewed evidence as validation that PDSA is not just a best practice but a well-studied method.

Institute for Healthcare Improvement (IHI). (2024). Science of Improvement: Testing Changes.

Small-scale testing before spread; scaling PDSA cycles from one provider to department-wide

The module's guidance to 'start with one provider, one shift, one location' and the audience-specific ramp sequences all reflect IHI's operational guidance on testing changes. This resource is the practical companion to the Langley et al. textbook methodology.

Nolan T, Resar R, Haraden C, Griffin FA. (2004). Improving the Reliability of Health Care. IHI Innovation Series white paper.

Levels of reliability (~80%, ~95%, >99%); moving from memory-based to system-embedded practices

Section 2 of Module 6 reproduces and explains the three reliability tiers — ~80%, ~95%, and >99% — with definitions and examples for each. This framework comes directly from Nolan et al. (2004), cited by the IHI as the foundational source on healthcare reliability.

Deming WE. (2000). Out of the Crisis.

Theoretical foundation of the PDSA cycle (Shewhart/Deming); the philosophical basis for iterative improvement

Section 3's PDSA methodology traces back to Deming's work on statistical process control and iterative cycles. Citing Deming (2000) alongside Langley et al. grounds the module in the intellectual origins of the method, which is appropriate for a training series intended to build genuine QI literacy.

Agency for Healthcare Research and Quality (AHRQ). (2024). Quality Improvement and Patient Safety Resources.

Implementation and embedding of changes into policy, training, and accountability systems

Section 4's guidance on embedding tested changes into policy, onboarding, and accountability structures aligns with AHRQ's implementation science and patient safety systems guidance, providing federal-level validation for the module's sustainability recommendations.

Institute for Healthcare Improvement (IHI). (2017). QI Essentials Toolkit: PDSA Worksheet

Standalone PDSA Cycle Worksheet (fillable): guiding questions for Plan, Do, Study, and Act, adapted to the ED telepsychiatry consult line example

Module 6 now focuses solely on PDSA (the Model for Improvement and its worksheet moved to Module 2.1). This IHI tool is the purpose-built PDSA worksheet whose questions were adapted (not reproduced verbatim) to build the fillable PDSA Cycle Worksheet in Section 6.3.