Imperial College London
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Dr Thomas Woodcock

Faculty of Medicine, School of Public Health

Senior Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 1838thomas.woodcock99

 
 
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Location

 

328Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{McNicholas:2019:10.1136/bmjqs-2017-007605,
author = {McNicholas, C and Lennox, L and Woodcock, T and Bell, D and Reed, J},
doi = {10.1136/bmjqs-2017-007605},
journal = {BMJ Quality and Safety},
pages = {356--365},
title = {Evolving quality improvement support strategies to improve Plan-Do-Study-Act cycle fidelity: a retrospective mixed methods study},
url = {http://dx.doi.org/10.1136/bmjqs-2017-007605},
volume = {28},
year = {2019}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundThough widely recommended as an effective approach to quality improvement (QI), the Plan-Do-Study-Act (PDSA) cycle method can be challenging to use and low fidelity of published accounts of the method has been reported.  There is little evidence of the fidelity of PDSA cycles used by frontline teams, nor how to support and improve the method’s use. Data collected from 39 frontline improvement teams provided an opportunity to retrospectively investigate PDSA cycle use and how strategies were modified to help improve this overtime.MethodsThe fidelity of 421 PDSA cycles was reviewed using a pre-defined framework, and statistical analysis examined whether fidelity changed over three annual rounds of projects. The experiences of project teams and QI support staff were investigated through document analysis and interviews.ResultsAlthough modest, statistically significant improvements in PDSA fidelity occurred, however, overall fidelity remained low. Challenges to achieving greater fidelity reflected problems with understanding the PDSA methodology, intention to use, and application in practice. These problems were exacerbated by assumptions made in the original QI training and support strategies: that PDSA was easy to understand; that teams would be motivated and willing to use PDSA; and that PDSA is easy to apply. QI strategies that evolved to overcome these challenges included project selection process, redesign of training, increased hands-on support and investment in training QI support staff.ConclusionsThis study identifies support strategies that may help improve PDSA cycle fidelity. It provides an approach to assess minimum standards of fidelity which can be replicated elsewhere. The findings suggest achieving high PDSA fidelity requires a gradual and negotiated process to explore different perspectives and encourage new ways of working.
AU  - McNicholas,C
AU  - Lennox,L
AU  - Woodcock,T
AU  - Bell,D
AU  - Reed,J
DO  - 10.1136/bmjqs-2017-007605
EP  - 365
PY  - 2019///
SN  - 2044-5415
SP  - 356
TI  - Evolving quality improvement support strategies to improve Plan-Do-Study-Act cycle fidelity: a retrospective mixed methods study
T2  - BMJ Quality and Safety
UR  - http://dx.doi.org/10.1136/bmjqs-2017-007605
UR  - http://hdl.handle.net/10044/1/67261
VL  - 28
ER  -
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