Quality Improvement in Healthcare: What is the PDSA Model, and How Well Does it Work for QA/QI? Part 1 of 5

For quality improvement in healthcare, many public health agencies and quality assurance/quality improvement (QA/QI) departments say they use the Plan-Do-Study-Act (PDSA) model. It has also been described as “Rapid Cycle Improvement”.

Is the PDSA Model Really how you do Quality Improvement in Healthcare?

As a spoiler, I have to say “no” – and follow that with my general adage that keeps getting proven over and over, “You can never escape the requirement of a solid study design.”

As an epidemiologist, I was taught a real set of study design approaches – like, the kind I teach in my big data study design courses on LinkedIn Learning. I use these study designs when I do quality improvement in healthcare. And after studying the PDSA and working with real QA/QI departments, I am absolutely convinced that if you want to gather evidence in your setting of whether or not you should make a change, you really need a study design directly from epidemiology (or possibly psychology, depending upon the specific issue). I do not think you can just ignore study design systems in doing research in QA/QI like the PDSA model seems to suggest.

I Didn’t Realize I was Doing Quality Improvement in Healthcare until my Customer Told Me I was

I was not taught this PDSA model – so later, when I was approached by a QA/QI department a few years ago for help, I told them that I didn’t know how to do whatever the PDSA was. But they challenged me, pointing out that I had actually done some high-level QA/QI research (examples here and here).

This led me to actually study the PDSA model. In public health, whenever we implement a model, we have to gather certain data to make sure the model works. As an example, we have the Health Belief Model (HBM) for designing public health interventions, and there are a lot of publications on how well it works in different populations for different interventions. So I figured there would be a lot of data on how well the PDSA worked in different settings, and some sort of metric behind how it improves quality in healthcare.

What is the PDSA Model and Where did it Come From?

Briefly, the PDSA model says that you do QA/QI in a continuous four-stage cycle: Plan-Study-Do-Act. You might notice – as I did – that “Plan” is a way of “Doing” something. “Do” is the same as “Act”. “Study” is also something you can “Do”. So it was not clear to me what each component meant.

That’s the first set of questions I sought to answer when my customer brought up PDSA to me. I was referred to the Institute for Healthcare Improvement (IHI) website, IHI being the healthcare think tank of Harvard University that invented and promotes the PDSA.

At first, I thought that maybe I did not hear about the PDSA until I moved to Massachusetts, because I studied in Minnesota, and Harvard is in Massachusetts. But then I noticed just now that the Minnesota Department of Health also endorses the PDSA model.

This series of blog posts reports on what I found when I looked into the PDSA for quality improvement in healthcare. It answers the following questions:

• Part 2: What are the stages of the PDSA, and what is supposed to happen in each stage?
• Part 3: What is the organizational experience of implementing the PDSA in a healthcare system or facility?
• Part 4: If you don’t want to do the PDSA, what are your alternatives for QA/QI approaches in healthcare?
• Part 5: What do I recommend that healthcare organizations do for QA/QI?

Published June 16, 2021. PDSA graphic by Christoph Roser at AllAboutLean.com, available here. Added blog post menu July 19, 2021.