Selected Quality Improvement Tools

PDSA, or Plan-Do-Study-Act, is an iterative, four-stage problem solving model used for improving a process or carrying out change. The completion of each PDSA cycle leads directly into the start of the next cycle. This allows you to use the knowledge gained to plan the next test. The team continues with this iterative process, refining the change until it is ready for broader implementation.

Before implementing each PDSA cycle, work with your team to answer the following questions:

• What are we trying to accomplish?
• How will we know that a change is an improvement?
• What changes can we make that will result in an improvement?

The PDSA cycle begins with the Plan phase. This involves identifying setting an aim or identifying a goal, gathering baseline data, selecting an intervention to help achieve that goal, and defining measures of success. This is followed by the Do phase, in which the selected intervention is implemented.

In the Study phase, you will: review and analyze the data collected, determine if the test of change resulted in the expected outcome, discuss any implementation lessons from the Do phase, and summarize what was learned which includes identifying unintended consequences, surprises, successes, failures. During the Act phase, reflect on the PDSA cycle and decide if your next step is to: adopt, adjust, or abandon.

A process map is a planning and management tool that visually describes the flow of work. Process Mapping is the technique of using flowcharts to illustrate the flow of a process, proceeding from the most macro perspective to the level of detail required to identify opportunities for improvement. Process mapping focuses on the work rather than on job titles or hierarchy.

Improvement is a gradual, ongoing process that requires sustained effort and patience, as meaningful progress often unfolds over time. To accurately determine if genuine improvement is taking place, it is essential to monitor and analyze data in a structured way. Graphical representations, such as run charts, play a crucial role in this analysis. Run charts are a type of graph that display data points over a set period, allowing patterns, trends, and variations to become visible. These charts are indispensable in Quality Improvement efforts, serving as a visual tool to help teams track performance over time and assess the impact of specific changes.

Run charts provide multiple benefits that make them particularly valuable for teams. First, they function as an effective communication tool, enabling everyone involved to understand the current state of a process at a glance. This visibility helps ensure that all team members are on the same page, facilitating collaboration and aligning efforts toward shared goals. Secondly, run charts allow teams to compare performance before and after implementing a change. This comparison is vital, as it provides insight into whether the change is producing a noticeable impact or if further adjustments are needed. Finally, run charts guide the direction of improvement efforts by revealing trends that indicate if a change is moving a process toward the desired outcome. This directional feedback is essential for making informed decisions, as it helps teams quickly identify whether they are achieving the intended improvements or if additional interventions are necessary.

A Pareto chart is a bar graph that is useful for identifying the most frequent cause of a variable(s) which can help teams prioritize their quality improvement efforts.

See below for Resource 1, an Excel template to help you create a Pareto chart. It contains a prepopulated example of causes for no shows for medical appointments, but it can be edited to use for your quality improvement project.

Resource 2 (video clip) provides an overview of using Pareto charts.

Resource 3 provides a link to a more detailed explanation of using Pareto charts.