Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Ahead of Print
    • Archives
    • Abstracts In Press
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM On Twitter
  • JABFM On YouTube
  • JABFM On Facebook
Case ReportSpecial Communications

“PDSA-ADHD”: A Newly Reported Syndrome

Elizabeth G. Baxley, Kevin J. Bennett, Chaiporn Pumkam, Sam Crutcher and M.Garrett Helms
The Journal of the American Board of Family Medicine November 2011, 24 (6) 752-757; DOI: https://doi.org/10.3122/jabfm.2011.06.100244
Elizabeth G. Baxley
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kevin J. Bennett
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Chaiporn Pumkam
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Sam Crutcher
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
M.Garrett Helms
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

Article Figures & Data

Tables

    • View popup
    Table 1.

    Examples of Abandoned Plan Do Study Act (PDSA) Cycles

    Improvement PlannedStage of PDSA Cycle in Which Progress Was ArrestedParticipants InvolvedSymptoms Experienced
    Design of new DM template for EHRPlanDiabetes improvement teamMultiple team members could not agree on the comprehensiveness of final template
    BP medication complianceDoQI team, residentsCould not determine what to do; consensus
    Pneumovax administration and trackingPlanQI team, one residentNot continued after resident champion graduated
    Retinal screenings for diabeticsStudy, ActQI team, nursingCould not determine if first cycle worked or next plan of action
    BP re-check reminder systemActQI team, one provider-nurse teamCould not expand to other providers
    Advanced Access SchedulingStudyMedical director, QI teamCould not measure demand data reliably; quit trying after two attempts
    Self management goal settingActQI team, nursingDid not spread beyond two physician/nurse teams
    Microalbumin testing remindersPlanQI team, nursingNo agreement on standard protocol
    A1c testing remindersStudyQI team, nursingNo follow-up data collection
    BP Monitoring Standing OrdersPlanQI team, administration, nursingLack of consensus about roles, duties, content
    Preclinic huddle participationActQI team, nursingSustainability was difficult and uneven
    • DM, diabetes mellitus; EHR, electronic health record; BP, blood pressure; A1c, hemoglobin; QI, quality improvement.

    • View popup
    Table 2.

    Baxley Criteria for Plan Do Study Act (PDSA)–Attention Deficit Hyperactivity Disorder

    • Multiple incomplete PDSA cycles ongoing at any one time
    • Doing before planning (cycle dyslexia)
    • Prolonged planning with little doing (more common in academic settings)
    • A paucity of studying, resulting in insufficient acting
    • Inability to complete the study of improvement cycles or tests of change
    • Greater enthusiasm for tests of change than the energy or resources to carry them out
    • High levels of fatigue among improvement team participants and others within the organization
    • View popup
    Table 3.

    Diagnostic and Statistical Manual of Mental Disorders–Like Criteria to Support the Diagnosis of Plan Do Study Act–Attention Deficit Hyperactivity Disorder

    A (either 1 or 2)
        1. InattentionSix (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
    1. Often introduces a PDSA cycle without adequately collecting baseline data

    2. Often has difficulty completing a PDSA cycle before beginning an additional PDSA cycle in another area

    3. Unable to determine which PDSA cycle is being discussed

    4. Fails to complete PDSA cycles already begun, typically omitting the Study and Act portions.

    5. Often has difficulty organizing subsequent PDSA cycles

    6. Is reluctant to engage in tasks that require sustained or long-term change in behaviors or systems

    7. Frequently unable to remember who is in charge of each PDSA cycle

    8. Is easily distracted by new QI ideas

        2. Hyperactivity/impulsivitySix (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
    • i. Often contemplates new PDSA cycles while discussing current PDSA cycles

    • j. Often leaves one QI activity to participate in another (“meeting hopping”)

    • k. Feels restless during Study and Act phases of PDSA cycles

    • l. Every meeting includes at least one new PDSA cycle suggestion

    • m. Continuing to actively pursue QI programs and activities, even during periods of rest (eg, holidays)

    • n. Often talks excessively about PDSAs and QI, regardless of context

    • o. Often determines the results of a PDSA cycle before complete data collection

    • p. Interrupting PDSA cycles (eg, a new one begins before the completion of its predecessor)

    • q. Introduces interventions that interfere with existing systems and programs

    BSome hyperactive-impulsive or inattentive symptoms that caused impairment were present in early stages of organizational change activities.
    CSome impairment from the symptoms is present in two or more settings (eg, front office clinical operations, direct clinical care areas, administration, education planning).
    DThere must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.
    • PDSA, Plan Do Study Act; QI, quality improvement.

    • View popup
    Table 4.

    Treatment Modalities for Plan Do Study Act–Attention Deficit Hyperactivity Disorder

    TechniqueProblem AddressedExample
    MotivationLack of participationActive recruitment
    Champion involvement
    Enhanced communication
    Identify benefits
    Time/resource allocations
    Positive reinforcementLack of positive feedbackAdministrative “coaching”
    Recognition for efforts
    Administrative “celebrations”
    Link efforts to performance reviews/merit increases
    Inadequate planningAbility to link outcomes to efforts
    Task prioritization
    Tracking of tasks and timelines
    Negative consequencesAnonymity/free ridingCreate specific plans, assign tasks, and publically hold accountable
    Link efforts to performance reviews/merit increases
    Inertia/change resistanceEncourage leadership to facilitate changes
    Utilize motivation, positive reinforcement techniques listed above
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 24 (6)
The Journal of the American Board of Family Medicine
Vol. 24, Issue 6
November-December 2011
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
“PDSA-ADHD”: A Newly Reported Syndrome
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
16 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
“PDSA-ADHD”: A Newly Reported Syndrome
Elizabeth G. Baxley, Kevin J. Bennett, Chaiporn Pumkam, Sam Crutcher, M.Garrett Helms
The Journal of the American Board of Family Medicine Nov 2011, 24 (6) 752-757; DOI: 10.3122/jabfm.2011.06.100244

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
“PDSA-ADHD”: A Newly Reported Syndrome
Elizabeth G. Baxley, Kevin J. Bennett, Chaiporn Pumkam, Sam Crutcher, M.Garrett Helms
The Journal of the American Board of Family Medicine Nov 2011, 24 (6) 752-757; DOI: 10.3122/jabfm.2011.06.100244
Reddit logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Case Reports
    • Diagnosis
    • Treatment
    • Conclusion
    • Notes
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Evolving quality improvement support strategies to improve Plan-Do-Study-Act cycle fidelity: a retrospective mixed-methods study
  • Change, Lack of Change, and Creating Optimal Change Out of Chaos
  • Google Scholar

More in this TOC Section

  • Integrating Community and Clinical Data to Assess Patient Risks with A Population Health Assessment Engine (PHATE)
  • Primary Care Is an Essential Ingredient to a Successful Population Health Improvement Strategy
  • Hepatitis C Update and Expanding the Role of Primary Care
Show more Special Communications

Similar Articles

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2023 American Board of Family Medicine

Powered by HighWire