Now that you have engaged with the learning resources in this module, no matter if you are in a primarily direct care or indirect care practice setting, it is time f

Version 3 – June 2022 – CEC REF: D20/25026

Quality Improvement Academy Improvement Science Resource Plan Do Study Act Cycle Form

Improvement Science is a commonly used methodology to address identified problems in healthcare. It involves identifying, defining and diagnosing the causes of a problem, before developing change ideas (interventions / possible solutions) and implementing interventions that may address the identified causes. The change ideas (possible solutions) are tested using small-cycle testing called "Plan, Do, Study, Act" (PDSA) cycles [1]. These tests start very small scale (1 patient, 1 day, 1 team) so we can test safely and learn as we increase test sizes (3 then 7 then all).

The CEC has developed this PDSA form to assist you in planning and documenting how the change ideas will be tested via a PDSA Cycle.

Change Idea being tested:

Name of Test of Change: Cycle / test number:

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Cycle / Instructions: 1. PLAN

Objective of the test:

What is being tested:

Prediction of the test (predict what will happen when the test is carried out):

Who to co-ordinate the test (Who will co-ordinate it? Who else will be involved):

Where will test be performed:

When will test be performed:

Tasks to be done before the test can commence:

What data will we collect and how? Who will collect it?

2. DO Carry out the test and collect data for analysis.

Document the measurable findings and anecdotes (feedback) from relevant staff / consumers.

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3. STUDY Compare data from DO stage / anecdotes to predictions.

Has the test resulted in an improvement? If not, what exactly needs to be changed?

Can this concept be tested on a larger scale next? Does the test need to be adjusted, tried in different conditions or scaled up?

What did we learn?

4. ACT Act on the results.

Review the Study stage and plan for the next PDSA test.

Where can I find more information? Visit the Quality Improvement Tool page on the CEC website.

References: [1] Nolan T, Resar R, Haraden C, Griffi n FA. Improving the Reliability of Health Care. IHI Innovation Series white paper. 2004; Boston: Institute for Healthcare Improvement.

If you have any questions or would like to provide some feedback about this form please email [email protected]

1. Name of change idea from the Driver Diagram:
2. Name of Test of Change:
3. Cycle test number:
4. Objective of the test:
5. What is being tested:
6. Prediction of the test predict what will happen when the test is carried out:
7. Who to coordinate the test Who will coordinate it Who else will be involved:
8. Where will test be performed:
9. When will test be performed:
10. Tasks to be done before the test can commence:
11. What data will we collect and how Who will collect it:
12. What did we learn:
13. Document the measurable findings and anecdotes:
14. Has there been improvement:
15. Can this concept be tested on a larger scale: