Dental Quality Improvement

A PDSA cycle, or Plan-Do-Study-Act, is a model for improvement used to improve a process and to apply changes. By working through the four stages, changes can be developed, tested, and applied to enable the best outcome. PDSA cycles are first used at a small scale, and each cycle builds upon what was learned in the last. Eventually, these cycles can be applied to larger, more extensive settings. Starting at a small scale allows the user to evaluate the outcome before implementing it across a wider setting. In a dental setting, an example would be running PDSA cycles in one surgery with one clinician/staff member, then moving to several surgeries and then onto another practice with more staff, etc.

A previous post discusses how to review problems.

Before starting the first cycle, it is important to answer 3 questions to help guide you through the process:

1. What is the end goal of this improvement project? What do we expect the results to show?
2. How are we going to measure change?
3. How can we be sure that a change is an improvement?

It’s important to establish an end goal; this will keep your team focused on the project and help to alter each cycle to meet your aims. There are measurable outcomes used to analyse how effective the change has been.

Outcome measures show the result of the improvement cycle and any impact that has been made to the patient’s experience. For example, if waiting times at a clinic have gone down then patient satisfaction should go up. Process measures investigate the processes that will impact the aim. For example, the structure in which patients are booked for appointments by the reception staff. Balancing measures show whether a positive change in one part of the system is causing a negative change in another part of the system. For example, if waiting times at a clinic are decreased so patient satisfaction goes up, but staff moral and stress is impacted as they are busier.

Establishing a baseline of how you are operating before starting a PDSA cycle and identifying measurable outcomes means any improvements made will be highlighted. Agreeing on which measurable outcomes will be used beforehand will aid in judging your results.

Plan – put a plan in place for what you are going to do during your first PDSA cycle. Make a clear end goal and write down what changes you are going to make to try and accomplish that goal. Include everyone who will be affected by this change in the process. Ensure to set a timeline for how long you will let this cycle run.

Do – put your plan in motion. Stick to your timeline created in the planning stage.

Study – observe the changes made by the cycle. Compare your results to the baseline data collected before starting the cycle to see if an improvement has occurred. Consult with all staff members involved and get feedback on how the cycle went. Use the measurable outcomes decided before the cycle begun.

Act – if happy with the results, then stop the cycle at this point. If further changes can be made for improvement, start the process again.

Other resources on PDSA Cycles –

How to Improve: Model for Improvement | Institute for Healthcare Improvement

Quality Improvement – NHS Education for Scotland

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