Evolving quality improvement support strategies to improve Plan-Do-Study-Act cycle fidelity: a retrospective...

Area of Science:

• Healthcare Quality Improvement
• Process Improvement Methodologies
• Organizational Learning

Background:

• The Plan-Do-Study-Act (PDSA) cycle is a recommended quality improvement (QI) method.
• Published accounts show low fidelity in PDSA use.
• Evidence on front-line team PDSA fidelity and support is limited.

Purpose of the Study:

• To investigate PDSA cycle use and fidelity among front-line teams.
• To explore how strategies were modified to improve PDSA fidelity over time.
• To identify effective support strategies for enhancing PDSA cycle fidelity.

Main Methods:

• Reviewed fidelity of 421 PDSA cycles using a predefined framework.
• Analyzed changes in fidelity across three annual project rounds.
• Investigated team and QI support staff experiences via document analysis and interviews.

Main Results:

• Modest, statistically significant improvements in PDSA fidelity were observed, but overall fidelity remained low.
• Challenges included understanding, intention, and practical application of PDSA methodology.
• Evolved QI strategies involved project selection, training redesign, and enhanced support.

Conclusions:

• Support strategies can improve PDSA cycle fidelity.
• An assessable standard for minimum fidelity can be replicated.
• High PDSA fidelity requires gradual negotiation, diverse perspectives, and new working methods.