A Method for Improvement

Having discussed what we mean by “quality,” it’s now time to explore how we approach its improvement. To quote one of the pioneers of quality improvement, Edward Deming, “a goal without a method is nonsense.” A simple, yet effective, method for improvement is the well-known Plan-Do-Study-Act (PDSA) cycle. However, before beginning the cycle, there are a few questions that must be answered.

  1. What are we trying to accomplish? In other words, what is our ultimate goal? This is an essential step in the process wherein we define a clear, concise, and results-oriented aim for a project. For this step, Donald Berwick reminds us that “ ‘some’ is not a number and ‘still’ is not a time.”
  1. How will we know that a change is an improvement? Measures are needed to provide feedback on whether the changes being made are having the desired impact.
  1. What changes can we make that will result in improvements? The entire PDSA process is designed to foster learning. This is the step where we theorize what we can do to create positive change. Once we test these theories, we can then learn from the results. “Without theory, there is no learning. Theory leads to prediction. Without prediction, experience and examples teach nothing” (Edward Deming). Take this examples:

The barnyard rooster Chanticleer had a theory. He crowed every morning, putting forth all his energy, flapped his wings. The sun came up. The connection was clear: His crowing caused the sun to come up; there was no question about his importance. Then came a snag. He forgot one morning to crow. The sun came up anyhow. Crestfallen, he saw his theory in need of revision. Without his theory, he would have had nothing to revise, nothing to learn.

Once these questions have been answered, we test our ideas by performing the PDSA cycle. Based on the tests, we learn what works and what doesn’t work. And we can make improvements based on what we have learned.

  • Plan: We begin the cycle of testing our theories by concretely planning our approach. Who? What? Where? When?
  • Do: Next, we can start carrying out the plan. During this phase, we document our experience and collect data.
  • Study: This is when we start to compare our predictions to the results. What did we learn? What conclusions can be drawn?
  • Act: What refinement or modifications need to be made?

We then start the cycle over again. PDSA is an iterative process that begins on a small scale and gradually grows in size. As the original ideas are refined and adapted, we gain knowledge that results in measurable improvements.


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