Plan, Do, Study, Act and Repeat

Plan-Study-Do-Act (PSDA) is a key tool to help skilled nursing providers with Quality Assurance Process Improvement (QAPI).

In my last blog, I reviewed the fundamentals of QAPI. The underlining theme being improvement that results in a better outcome. The Centers for Medicare and Medicaid Services recommends PSDA to teams working on performance improvement projects (PIPs).

What is PSDA and how can it help? Let’s review.

What is PSDA?

The philosophy is to design a small test with limited impact. Assess the results. If the desired results are not achieved, design another test. Keep repeating the process until you reach your goal.

Use PSDA with your PIP team to help answer these central questions:

  1. What are we trying to accomplish? Determine the objective.
  2. How will we know that a change is an improvement? Document/record findings to show improvement.
  3. What changes can we make that will result in improvement? Identify specific actions/ideas of change.

Plan it

Plan the changes you want to test or implement. This could be related to staffing, culture, dietary, or anything that the team has identified for improvement. For example, a change to the dining menu.

Be specific about your action steps – who, what, where, when. For example, are you going to study the residents or the staff? In addition, how long will you study?

Set a goal that you can measure. Make sure it’s documented.

Do it

Carry out your plan or change on a small scale, such as one wing/unit. Collect and record feedback/results. Begin analysis of the data.

In the example of changing the dining menu, capture and evaluate resident satisfaction.

Study it

Complete the analysis of data. Did you get the results you wanted? Look for surprises, successes, failures, intended and unintended outcomes.

Because you set measurable goals, you should have clear results to document. For example, 95% of residents liked the change to the dining menu OR only 35% of residents liked the change to the dining menu.

Act on it

If you achieve the desired results (e.g., 95% in the example above), implement the change!

If you don’t get the results you wanted (e.g., 35% in the example above), look at why. Determine what to do differently in your next PSDA cycle. Remember that a PIP will usually involve multiple PDSA cycles.

Keep your PSDA cycles to share with your team, review as needed, or leverage again in the future.

Make PSDA work for you. For more on PSDA, visit the Institute for Healthcare Improvement and download their worksheet on PSDA.

Denise Wassenaar

Denise Wassenaar joined MatrixCare as Chief Clinical Officer in May 2013. A recognized leader in long-term care, Wassenaar brings innovative strategies and solutions to the changing environment of the post-acute provider. She has more than 20 years in the post-acute settings serving as Vice President of Clinical Services for a CCRC organization, President of Alliance Pharmacy Services and other executive positions. Wassenaar holds BS and MS Degrees in Nursing from Purdue University and is a licensed nursing home administrator. She serves on the Board of Directors of a CCRC in Arizona.