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Completed PDSA Worksheet (NC Program on Health Literacy)PDSA Directions and ExamplesThe Plan-Do-Study-Act method is a way to test a change that isimplemented. By going through the prescribed four steps, it guides thethinking process into breaking down the task into steps and thenevaluating the outcome, improving on it, and testing again. Most of usgo through some or all of these steps when we implement change inour lives, and we don’t even think about it. Having them written downoften helps people focus and learn more.For more information on the Plan-Do-Study-Act, go to the IHI (Institutefor Healthcare Improvement) Web site or this PowerPoint presentationon Model for Improvement.Keep the following in mind when using the PDSA cycles to implementthe health literacy tools: Single Step – Each PDSA often contains only a segment orsingle step of the entire tool implementation. Short Duration – Each PDSA cycle should be as brief aspossible for you to gain knowledge that it is working or not(some can be as short as 1 hour). Small Sample Size – A PDSA will likely involve only a portion ofthe practice (maybe 1 or 2 doctors). Once that feedback isobtained and the process refined, the implementation can bebroadened to include the whole practice.Filling out the worksheetTool: Fill in the tool name you are implementing.Step: Fill in the smaller step within that tool you are trying to implement.Cycle: Fill in the cycle number of this PDSA. As you work though a strategy for implementation,you will often go back and adjust something and want to test if the change you made is better ornot. Each time you make an adjustment and test it again, you will do another cycle.PLANI plan to: Here you will write a concise statement of what you plan to do in this testing. This will bemuch more focused and smaller than the implementation of the tool. It will be a small portion of theimplementation of the tool.I hope this produces: Here you can put a measurement or an outcome that you hope to achieve.You may have quantitative data like a certain number of doctors performed teach-back, orqualitative data such as nurses noticed less congestion in the lobby.Steps to execute: Here is where you will write the steps that you are going to take in this cycle.You will want to include the following:Completed PDSA Worksheet (NC Program on Health Literacy) The population you are working with – are you going to study the doctors’ behavior or thepatients’ or the nurses’? The time limit that you are going to do this study – remember, it does not have to be long,just long enough to get your results. And, you may set a time limit of 1 week but find outafter 4 hours that it doesn’t work. You can terminate the cycle at that point because you gotyour results.DOAfter you have your plan, you will execute it or set it in motion. During this implementation, you willbe keen to watch what happens once you do this.What did you observe? Here you will write down observations you have during yourimplementation. This may include how the patients react, how the doctors react, how the nursesreact, how it fit in with your system or flow of the patient visit. You will ask, “Did everything go asplanned?” “Did I have to modify the plan?”STUDYAfter implementation you will study the results.What did you learn? Did you meet your measurement goal? Here you will record how well itworked, if you meet your goal.ACTWhat did you conclude from this cycle? Here you will write what you came away with for thisimplementation, if it worked or not. And if it did not work, what can you do differently in your nextcycle to address that. If it did work, are you ready to spread it across your entire practice?ExamplesBelow are 2 examples of how to fill out the PDSA worksheet for 2 different tools, Tool 17: GetPatient Feedback and Tool 5: The Teach-Back Method. Each contain 3 PDSA cycles. Each onehas short cycles and works through a different option on how to disseminate the survey to patient(Tool 17: Patient Feedback) and how to introduce teach-back and have providers try it. (Tool 5:The Teach-Back Method).Completed PDSA Worksheet (NC Program on Health Literacy)PDSA (plan-do-study-act) worksheetTOOL: Patient Feedback STEP: Dissemination of surveys CYCLE: 1st TryPLANI plan to: We are going to test a process of giving out satisfaction surveys and gettingthem filled out and back to us.I hope this produces: We hope to get at least 25 completed surveys per week during thiscampaign.Steps to execute:1. We will display the surveys at the checkout desk.2. The checkout attendant will encourage the patient to fill out a survey and put it inthe box next to the surveys.3. We will try this for 1 week.DOWhat did you observe?We noticed that patients often had other things to attend to at this time, like makingan appointment or paying for services and did not feel they could take on anothertask at this time.The checkout area can get busy and backed up at times.The checkout attendant often remembered to ask the patient if they would like to fillout a survey.STUDYWhat did you learn? Did you meet your measurement goal?We only had 8 surveys returned at the end of the week. This process did not work well.ACTWhat did you conclude from this cycle?Patients did not want to stay to fill out the survey once their visit was over. We need togive patients a way to fill out the survey when they have time.We will encourage them to fill it out when they get home and offer a stamped envelope tomail the survey back to us.Completed PDSA Worksheet (NC Program on Health Literacy)PDSA (plan-do-study-act) worksheetTOOL: Patient Feedback STEP: Dissemination of surveys CYCLE: 2nd TryPLANI plan to: We are going to test a process of giving out satisfaction surveys and gettingthem filled out and back to us.I hope this produces: We hope to get at least 25 completed surveys per week during thiscampaign.Steps to execute:1. We will display the surveys at the checkout desk.2. The checkout attendant will encourage the patient to take a survey and an envelope.They will be asked to fill the survey out at home and mail it back to us.3. We will try this for 2 weeks.DOWhat did you observe?The checkout attendant successfully worked the request of the survey into thecheckout procedure.We noticed that the patient had other papers to manage at this time as well.Per Checkout attendant only about 30% actually took a survey and envelope.STUDYWhat did you learn? Did you meet your measurement goal?We only had 3 surveys returned at the end of 2 weeks. This process did not work well.ACTWhat did you conclude from this cycle?Some patients did not want to be bothered at this point in the visit – they were moreinterested in getting checked out and on their way.Once the patient steps out of the building they will likely not remember to do the survey.We need to approach them at a different point in their visit when they are still with us –maybe at a point where they are waiting for the doctor and have nothing to do.Completed PDSA Worksheet (NC Program on Health Literacy)PDSA (plan-do-study-act) worksheetTOOL: Patient Feedback STEP: Dissemination of surveys CYCLE: 3rd TryPLANI plan to: We are going to test a process of giving out satisfaction surveys and gettingthem filled out and back to us.I hope this produces: We hope to get at least 25 completed surveys per week during thiscampaign.Steps to execute:1. We will leave the surveys in the exam room next to a survey box with pens/pencils.2. We will ask the nurse to point the surveys out/hand then out after vitals andsuggest that while they are waiting they could fill out our survey and put it in box.3. We will see after 1 week how many surveys we collected.DOWhat did you observe?Upon self report, most nurses reported they were good with pointing out or handingthe patient the survey.Some patients may need help reading survey but nurses are too busy to help.On a few occasions the doctor came in while patient filling out survey so survey wasnot complete.STUDYWhat did you learn? Did you meet your measurement goal?We had 24 surveys in the boxes at the end of 1 week. This process worked better.ACTWhat did you conclude from this cycle?Approaching patients while they are still in the clinic was more successful.Most patients had time while waiting for the doctor to fill out the survey.We need to figure out how to help people who may need help reading the survey.Completed PDSA Worksheet (NC Program on Health Literacy)PDSA (plan-do-study-act) worksheetTOOL: Teach-back STEP: MDs initially performing Teach-back CYCLE: 1st TryPLANI plan to: We will ask the physicians in Wednesday PM to perform teach-back with thelast person they see that day.I hope this produces: We hope that all the physicians will perform teach-back and findthat it was useful, did not take that much more time, and they will continue the practice.Steps to execute:1. We will ask the 5 physicians who hold clinic on Wednesday PM to perform teachback with their last patient of the day.2. We will show these physicians the teach-back video.3. After their last patient checks out, we will ask the physicians if they felta. it was useful?b. it was time consuming?c. they will do it again?DOWhat did you observe?All physicians found the teach-back video informative and seemed eager to try thisnew tool.STUDYWhat did you learn? Did you meet your measurement goal?4 out of 5 physicians performed teach-back on at least one patient in the afternoon. The 1physician who did not indicated she did not quite know how to integrate it into her visit.ACTWhat did you conclude from this cycle?4 out of 5 felt comfortable with it and said they would continue using it.For the 1 who was not sure how to integrate it, we will look for other teach-back resources tohelp address this.Ready to introduce to entire clinical staff.Completed PDSA Worksheet (NC Program on Health Literacy)PDSA (plan-do-study-act) worksheet TOOL: Teach-backSTEP: MDs continuing to perform Teach-back CYCLE: modified2nd try PLANI plan to: We will see if the physicians in Wednesday PM clinic are still performingteach-back by asking them after their last patient leaves. (3 weeks have gone by sinceinitial introduction.)I hope this produces: We hope that each of the physicians will have performed teach-backon at least 3 of their afternoon patients.Steps to execute:1. We will approach the 5 physicians on Wednesday PM after their last patient leavesand ask them to count the number of patients they performed teach-back on thisafternoon.2. We will ask the physicians if they still feela. it was useful?b. it was time consuming?c. they will do it again?DOWhat did you observe?Some physicians could not find appropriate situations for teach-back.All still felt it was a worthy tool during their patient visits but feel they need toremember it and practice it more.STUDYWhat did you learn? Did you meet your measurement goal?3 out of 5 physicians said they did perform teach-back on 3 of their patients.1 performed it in one instance.1 did not perform it at all (same one as before).ACTWhat did you conclude from this cycle?Teach-back is being used, maybe not as readily as I had anticipated.Maybe the goals of ‘3 out of 6 patient encounters should contain teach-back’ isunrealistic. We may put a sign in the clinic rooms, in view of the physicians, to remindthem about teach-back.Will measure again in 6 months.Completed PDSA Worksheet (NC Program on Health Literacy)PDSA (plan-do-study-act) worksheetTOOL: Teach-back STEP: MDs continuing performing Teach-back CYCLE: 3rd TryPLANI plan to: We want to see if the signs put up in the exam rooms help physicians rememberto do teach-back and increased its utilization.I hope this produces: We hope that all the physicians will perform teach-back 3 out of 6times.Steps to execute:1. We will put signs reading “Teach it Back” taped on the exam room desk/work areato remind physicians to use the technique.2. We will ask physicians if they notice the signs and if they reminded them toperform teach-back.3. We will see if Wednesday PM clinic had increased use of teach-back.DOWhat did you observe?Nurses felt the sign will get in the way.STUDYWhat did you learn? Did you meet your measurement goal?4 out of 5 physicians did teach-back on 3 patients Wednesday afternoon. 1 did it on 1patient.4 out of 5 said they did see the sign and that it was a reminder to do teach-back.ACTWhat did you conclude from this cycle?That a reminder is needed (especially initially) to help physicians use this tool in theirvisit.No further intervention needed at this point.PDSA Worksheet Template Project LeadTitleTeamChangeDate RangeCycle #Key Words BACKGROUND: What led you to start this project? Is this cycle a continuation of another cycle? Why isthis topic relevant? Include any baseline data that has already been collected. Include relevantinformation from literature.______________________________________________________________________________PLAN:Aim/Objective Statement for this cycle What do you hope to learn? What are you trying to improve (aim),by how much (goal) and by when (timeframe)?Specific questions to address in this cycle:1.2.3.Predictions/Hypotheses (What do you think will happen?)Plan for change/test/interventionWho (target population):What (change/test):When (dates of test):Where (location):How (description of plan):Measures (What will you measure in order to meet your aims? How will know that a change is animprovement? Will you use outcome or process measures?)Plan for data collectionWho (will collect):What (measures):When (time period):Where (location):How (method):_____________________________________________________________________________DO: Carry out the change/test. Collect data.Note when completed, observations, problems encountered, and special circumstances. Include namesand details.PDSA Worksheet Template______________________________________________________________________________STUDY: Summarize and Analyze data (quantitative and qualitative). Include charts, graphs.______________________________________________________________________________ACT: Document/summarize what was learned. Did you meet your aims and goals? Did you answer thequestions you wanted to address? List major conclusions from this cycle.1.2.3.Define next steps. Are you confident that you should expand size/scope of test or implement? Whatchanges are needed for the next cycle?1.2.3.PDSA Worksheet TemplatePDSA WORKSHEETTeam Name: ____Date of test: ___________Test Completion Date: ________Overall team/project aim: _________________________________________________________What is the objective of the test? ___________________________________________________PLAN:Briefly describe the test:How will you know that the change is an improvement?What driver does the change impact?What do you predict will happen? List the tasks necessary to complete this test (what)Person responsible (who)WhenWhere1.2.3.4.5.6. DoPlanActStudy PDSA Worksheet TemplatePlan for collection of data:DO: Test the changes.Was the cycle carried out as planned? YES ____ NO _____Record data and observations.What did you observe that was not part of our plan?STUDY:Did the results match your predictions? YES ____ NO _____Compare the result of your test to your previous performance.What did you learn?ACT: Decide to Adopt, Adapt, or Abandon.ADAPT: Improve the change and continue testing plan.Plans/Changes for next test:Adopt: Select changes to implement on a larger scale and develop an implementation plan and plan forsustainabilityAbandon: Discard this change idea and try a different onePDSA Worksheet for Testing Change—Option 2Institute for Healthcare ImprovementAim: (overall goal you wish to achieve):Every goal will require multiple smaller tests of change Describe your first (or next) test of change:PersonresponsibleWhen tobe doneWhere tobe done Plan: List the tasks needed to set up this test ofchangePersonresponsibleWhen tobe doneWhere tobe done. Predict what will happen when the test is carriedoutMeasures to determine if prediction succeeds Do: Describe what actually happened when you ran the testStudy: Describe the measured results and how they compared to the predictionsAct: Describe what modifications to the plan will be made for the next cycle from what you learnedPDSA Worksheet for Testing Change—Option 2Institute for Healthcare ImprovementPDSA Worksheet for Testing ChangeAchieving our goal will require multiple small tests of change to reach an efficient process and the desired results.Date: Cycle:Change Champion:3 Fundamental Questions for Improvement1. What are we trying to accomplish (Aim or long-range goal)?2. How will we know that a change is an improvement/how will we measure the test?3. What changes can we make that will lead to improvement?PLAN (short-range goal)We plan to (include anticipated date of completion):We hope this produces: Steps to execute the plan:Assigned to:Date to be completed: 1.2.3. DOWhat happened when we ran the test? What did we observe?PDSA Worksheet for Testing Change—Option 2Institute for Healthcare ImprovementPDSA Worksheet for Testing Change—Option 2Institute for Healthcare ImprovementSTUDYWhat did we learn/conclude from this cycle? Why was/was not the test successful?  ACTDate:What are our next steps?  We are going to adopt this test and We are going to adapt this test and repeat PDSA for another cycleWe are going to abandon this test and start a new PDSAPDSA Worksheet for Testing Change—Option 2Institute for Healthcare ImprovementPDSA Worksheet for Testing ChangeInstructionsThe Plan-Do-Study-Act (PDSA) Worksheet is a useful tool for documenting a test of change. The PDSA cycle isshorthand for testing a change by developing a plan to test the change (Plan), carrying out the test (Do), observing andlearning from the consequences (Study), and determining what modifications should be made to the test (Act).PDSA is the “action” portion of the Model for Improvement shown at right.DirectionsUse the PDSA Worksheet to help your team document a test of change. Fill out one Worksheet for each test youconduct.Your team will test several different changes, and each changewill go through several PDSA cycles. Keep a file (electronic orhard copy) of all PDSA Worksheets for all changes your team tests.Step 1—Respond to the 3 fundamental questions for improvement1. What are we trying to accomplish (aim)?2. How will we know that change is an improvement (measures)?3. What change can we make that will result in an improvement (ideas, hunches, theories)?Step 2—Fill in your plan What is your hunch that you would like to test? What do you expect to happen? Who will it involve (e.g. one resident, one unit, one floor, one department)?How long will the change take to implement?Step 3—Do Implement the change. Try out the test on a small scale.Document problems and unexpected observations.PDSA Worksheet for Testing Change—Option 2Institute for Healthcare ImprovementStep 4—Study Set aside time to study the results and determine if the change resulted in the expected outcome. Reflect on what happened and what was learned.Look for unintended consequences, surprises, successes, failures.Step 5—Act Adopt—If your test was successful, consider expanding the changes to additional residents, staff, units.Adapt—If your test was moderately successful, but did not produce the desired results, refine the changes based on what was learned from the test, and do another round of PDSA.Abandon—If the results were not what you wanted and you feel you have tried every change possible, abandon this test and consider a newapproach.  What changes are to be Objectivemade? Predictions Next Cycle? Plan to carry out the cycle(who what, where, when)ActPlan Plan for data collection  Analyze dataStudyDo Carry out the plan Compare results to Document observationspredictions Record data  Summarize whatwas learnedAdapted from content developed by the Institute for Healthcare Improvement and the North Carolina Program on Health Literacy

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