Systematic review of the application of the plan–do–study–act method to improve quality in healthcare
Top Cited Papers
Open Access
- 11 September 2013
- journal article
- review article
- Published by BMJ in BMJ Quality & Safety
- Vol. 23 (4), 290-298
- https://doi.org/10.1136/bmjqs-2013-001862
Abstract
Background Plan–do–study–act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems. The method is widely accepted in healthcare improvement; however there is little overarching evaluation of how the method is applied. This paper proposes a theoretical framework for assessing the quality of application of PDSA cycles and explores the consistency with which the method has been applied in peer-reviewed literature against this framework. Methods NHS Evidence and Cochrane databases were searched by three independent reviewers. Empirical studies were included that reported application of the PDSA method in healthcare. Application of PDSA cycles was assessed against key features of the method, including documentation characteristics, use of iterative cycles, prediction-based testing of change, initial small-scale testing and use of data over time. Results 73 of 409 individual articles identified met the inclusion criteria. Of the 73 articles, 47 documented PDSA cycles in sufficient detail for full analysis against the whole framework. Many of these studies reported application of the PDSA method that failed to accord with primary features of the method. Less than 20% (14/73) fully documented the application of a sequence of iterative cycles. Furthermore, a lack of adherence to the notion of small-scale change is apparent and only 15% (7/47) reported the use of quantitative data at monthly or more frequent data intervals to inform progression of cycles. Discussion To progress the development of the science of improvement, a greater understanding of the use of improvement methods, including PDSA, is essential to draw reliable conclusions about their effectiveness. This would be supported by the development of systematic and rigorous standards for the application and reporting of PDSAs.Keywords
This publication has 34 references indexed in Scilit:
- Large scale organisational intervention to improve patient safety in four UK hospitals: mixed method evaluationBMJ, 2011
- Medical engagement in organisation-wide safety and quality-improvement programmes: experience in the UK Safer Patients InitiativeBMJ Quality & Safety, 2010
- A case study of translating ACGME practice-based learning and improvement requirements into reality: systems quality improvement projects as the key component to a comprehensive curriculumHeart, 2009
- Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation scienceImplementation Science, 2009
- Pseudoinnovation: the development and spread of healthcare quality improvement methodologiesInternational Journal for Quality in Health Care, 2009
- Evidence-Based Quality Improvement: The State Of The ScienceHealth Affairs, 2005
- Effects of a Quality Improvement Collaborative on the Outcome of Care of Patients with HIV Infection: The EQHIV StudyAnnals of Internal Medicine, 2004
- Guidelines for Appraisal and Publication of PDSA Quality ImprovementQuality Management in Health Care, 2004
- Getting evidence into practice: the meaning of `context'Journal of Advanced Nursing, 2002
- Complexity science: Complexity, leadership, and management in healthcare organisationsBMJ, 2001