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Improvement Planned Stage of PDSA Cycle in Which Progress Was Arrested Participants Involved Symptoms Experienced Design of new DM template for EHR Plan Diabetes improvement team Multiple team members could not agree on the comprehensiveness of final template BP medication compliance Do QI team, residents Could not determine what to do; consensus Pneumovax administration and tracking Plan QI team, one resident Not continued after resident champion graduated Retinal screenings for diabetics Study, Act QI team, nursing Could not determine if first cycle worked or next plan of action BP re-check reminder system Act QI team, one provider-nurse team Could not expand to other providers Advanced Access Scheduling Study Medical director, QI team Could not measure demand data reliably; quit trying after two attempts Self management goal setting Act QI team, nursing Did not spread beyond two physician/nurse teams Microalbumin testing reminders Plan QI team, nursing No agreement on standard protocol A1c testing reminders Study QI team, nursing No follow-up data collection BP Monitoring Standing Orders Plan QI team, administration, nursing Lack of consensus about roles, duties, content Preclinic huddle participation Act QI team, nursing Sustainability was difficult and uneven -
DM, diabetes mellitus; EHR, electronic health record; BP, blood pressure; A1c, hemoglobin; QI, quality improvement.
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- 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 - 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. Inattention Six (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: -
Often introduces a PDSA cycle without adequately collecting baseline data
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Often has difficulty completing a PDSA cycle before beginning an additional PDSA cycle in another area
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Unable to determine which PDSA cycle is being discussed
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Fails to complete PDSA cycles already begun, typically omitting the Study and Act portions.
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Often has difficulty organizing subsequent PDSA cycles
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Is reluctant to engage in tasks that require sustained or long-term change in behaviors or systems
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Frequently unable to remember who is in charge of each PDSA cycle
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Is easily distracted by new QI ideas
2. Hyperactivity/impulsivity Six (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
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j. Often leaves one QI activity to participate in another (“meeting hopping”)
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k. Feels restless during Study and Act phases of PDSA cycles
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l. Every meeting includes at least one new PDSA cycle suggestion
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m. Continuing to actively pursue QI programs and activities, even during periods of rest (eg, holidays)
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n. Often talks excessively about PDSAs and QI, regardless of context
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o. Often determines the results of a PDSA cycle before complete data collection
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p. Interrupting PDSA cycles (eg, a new one begins before the completion of its predecessor)
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q. Introduces interventions that interfere with existing systems and programs
B Some hyperactive-impulsive or inattentive symptoms that caused impairment were present in early stages of organizational change activities. C Some impairment from the symptoms is present in two or more settings (eg, front office clinical operations, direct clinical care areas, administration, education planning). D There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning. -
PDSA, Plan Do Study Act; QI, quality improvement.
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- Table 4.
Treatment Modalities for Plan Do Study Act–Attention Deficit Hyperactivity Disorder
Technique Problem Addressed Example Motivation Lack of participation Active recruitment Champion involvement Enhanced communication Identify benefits Time/resource allocations Positive reinforcement Lack of positive feedback Administrative “coaching” Recognition for efforts Administrative “celebrations” Link efforts to performance reviews/merit increases Inadequate planning Ability to link outcomes to efforts Task prioritization Tracking of tasks and timelines Negative consequences Anonymity/free riding Create specific plans, assign tasks, and publically hold accountable Link efforts to performance reviews/merit increases Inertia/change resistance Encourage leadership to facilitate changes Utilize motivation, positive reinforcement techniques listed above
