Plan-Do-Study-Act (PDSA)

Definition: The Plan-Do-Study-Act (PDSA) cycle is a continual, four-step model that is used in quality improvement efforts in order to test change.¹

There are four steps to a PDSA cycle:^1,2

1. The first step in the cycle is plan. The plan is determined through outcome predictions and clearly stated tasks.
2. The second step is do. In this step, the plan is implemented to determine if modifications should be made to improve outcomes.
3. The third step is study. Once data and results are collected during the “do” phase, they are analyzed and reviewed. It is important to reflect on the goals of the plan and what was learned during implementation.
4. The final step is act. During this step, it is determined if the plan should be applied in practice, modified, or rejected. If the plan is rejected, it is necessary to reflect on what can be done differently in the future. This can lead to another PDSA cycle, as it is common for the results of one cycle of a project to guide the development of the next.

How it relates to ACO/PCMH and pharmacists in these settings: High-quality patient care is an important aspect of ACOs and PCMH.^3,4 The PDSA cycle is a recognized quality improvement tool that pharmacists can use in collaboration with their practice site to enhance patient-centered care by standardizing processes to reduce discrepancies, achieve calculable results, and improve overall outcomes.⁵ Quality improvement and performance measurement documentation is required for recognition under the Annual Reporting for PCMH process.⁴

The PDSA cycle is an excellent process for showcasing what quality improvement and patient care initiatives have been implemented in a practice or system.

Involved organizations/oversight: Organizations that recognize the value and support the use of PDSAs include, but are not limited to, Agency for Healthcare Research and Quality, Institute for Healthcare Improvement, Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance.

References

1. Christoff P. Running PDSA cycles. Curr Probl Pediatr Adolesc Health Care. 2018;48(8):198–201.
2. Agency for Healthcare Research and Quality. Health Literacy Universal Precautions Toolkit, 2nd Edition: Plan-Do-Study-Act (PDSA) directions and examples. Rockville, MD: Agency for Healthcare Research and Quality. Available at: https://www.ahrq.gov/health-literacy/improve/precautions/tool2b.html. Accessed September 30, 2024.
3. National Committee for Quality Assurance. Annual reporting for PCMH recognition. Washington, DC: National Committee for Quality Assurance. Available at: https://www.ncqa.org/programs/health-care-providers-practices/patient-centered-medical-home-pcmh/current-customers/annual-reporting/. Accessed September 30, 2024.
4. CMS. Accountable care organizations. N.p.: CMS. Available at:  https://www.cms.gov/priorities/innovation/innovation-models/aco. Accessed September 30, 2024.
5. CMS. Quality measurement and quality improvement. N.p.: CMS. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-. Accessed September 30, 2024.

Contributing authors

Courtney Pos, PharmD candidate 2023
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Aurora, CO

Katelyn Currier, PharmD, PGY2 Ambulatory Care Pharmacy Resident
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Aurora, CO

Sara Wettergreen, PharmD, BCACP, BC-ADM
Assistant Professor
University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Aurora, CO

Last Updated 9/30/2024 Sarah M. Aldrich Renner, PharmD, BCACP