Improvement Method Olympics Quarter Final 1

Posted by: NHS Horizons - Posted on:

Today’s first quarter final vote is between PDSA cycles and the 5 Whys

  1. PDSA cycle (tool)

We can use PDSA cycles to test an idea for change by temporarily trialling a change and assessing its impact. There are four distinct stages to the PDSA cycle:

  • Plan – the change that needs to be tested or implemented
  • Do – carry out or test the change
  • Study – data before and after the change and reflect on what is learned
  • Act – plan the next change cycle or full implementation

We may not get the results you expect when making changes to our processes, so it is safer, and more effective to test out improvements on a small scale before implementing them across the board. As with any change, ownership is key to implementing the improvement successfully. If we involve a range of colleagues and service users in trying something out on a small scale before it is fully operational, we will reduce the barriers to change.

PDSA cycle - circle with four sections Act What's next? 
Plan What will happen if we try something different?
Study - did it work?
Do - let's try it!

View a PDSA worksheet from the IHI.

Some additional resources for PDSA cycles The PDSA cycle 101: video from BMJ Quality

What’s in a name: PDSA or PDCA? by @JoyFurnival

Plan, do, study, act (PDSA) cycles and the Model for Improvement by NHS England and NHS Improvement, suggested by @HassanmahmoodDr

Benefits of PDSA cycles by Jason Williams in LifeQI

An example of using a PDSA process to improve the quality of pledges that people made following a training programme by @NikkiDQIC

Evolving quality improvement support strategies to improve Plan–Do–Study–Act cycle fidelity: a retrospective mixed-methods study: BMJ Quality and Safety article suggested by @julie4clahrc

A systematic review of the application of the plan–do–study–act method to improve quality in healthcare: BMJ Quality and Safety article suggested by @julie4clahrc

Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects: article from BMC

2. Five Whys (tool)

By repeatedly asking the question ‘why?’ (using five as a rule of thumb), we can peel away the layers of an issue, which can lead us to the root cause of a problem. The reason for a problem can often lead into another question; we may need to ask the question fewer or more than five times before we get to the origin of a problem. The real key is to avoid assumptions and logic traps and encourage the team to keep drilling down to the real root cause.

See root cause analysis from NHS Elect.

This example from Lothian Quality gives an example of 5 whys.

Example of 5 whys - Mrs X fell when entering the building Why? the floor was wet as it was raining outside. Why? The wet mat hadn't been put out when the rain started. Why? Only mat was still wet from yesterday. Why? There is only one wet mat.

Some additional resources for 5 Whys

A step-by-step guide for running a 5 Whys exercise by Buffer

5 Whys: getting to the root of a problem quickly by MindTools suggested by @phwandjes

The 5 whys and fishbone diagramming video suggested by @Winn_on_health

Using the 5 whys for life design (using 5 Whys to think about your goals and ambitions in life) by Life Design Log

The problem with ‘5 whys‘ BMJ Quality and Safety article by @AlanJCard, suggested by @JulieEReed