NHS Plan, Do, Study, Act Cycle 

 April 6, 2022

By  Dave Litten

Plan, Do, Study, Act (PDSA) cycles and the model for improvement

The Plan, Do, Study, Act (PDSA) cycle started out as the Plan, Do, Check, Act cycle and was introduced by Walter Shewhart in the 1920s. It formed the basis of Dr. WE Deming’s approach to organizational development and leadership.

What is it?

Nhs Plan

The model for improvement provides a framework for developing, testing and implementing changes leading to improvement. It is based on the scientific method and moderates the impulse to take immediate action with the wisdom of careful study.

Using PDSA cycles enables you to test out changes on a small scale, building on the learning from these test cycles in a structured way before wholesale implementation. This gives stakeholders the opportunity to see if the proposed change will succeed and is a powerful tool for learning from ideas that do and don’t work.

This way, the process of change is safer and less disruptive for patients and staff.

When to use it

Nhs Plan

When planning any improvement or change to work processes, it is essential to know what you want to achieve, how you will measure improvement, and be explicit about the idea to be tested.

You may not get the results you expect so it is safer and more effective to test out improvements on a small scale before implementing them across the board.

How to use it

The framework includes three key questions to answer before testing an improvement concept and a process for testing change ideas:

  1. What are we trying to accomplish? (The aims statement)
  2. How will we know if the change is an improvement? What measures of success will we use?
  3. What changes can we make that will result in improvement? (The change concepts to be tested).

    The model for improvement
Nhs Plan

This approach has been unusual in a healthcare setting because traditionally, new ideas are often introduced without sufficient testing.

The four stages of the PDSA cycle are:

Nhs Plan

Plan – the change to be tested or implemented
Do – carry out the test or change
Study – based on the measurable outcomes agreed upon before starting out, collect data before and after the change and reflect on the impact of the change and what was learned
Act – plan the next change cycle or full implementation

As with any change, ownership is key to implementing the improvement successfully. If you involve a range of colleagues in trying something out on a small scale before it is fully operational, you will reduce the barriers to change.

Step 1

Nhs Plan

Start by answering the three essential questions.

  1. What are we trying to accomplish?
    Teams need to set clear and focused goals with measurable targets. These goals require clinical leadership and should focus on problems that cause concern, as well as on patients and staff. They should be relevant to the length of the project and be bold in aspiration.

    An example of an aims statement from cancer services:
    To improve access, speed of diagnosis, speed of starting treatment and patient care for people who are suspected of having bowel cancer. This will be achieved by:
    • Introducing booked admissions and appointments. Target: more than 95% of patients
    • Reducing the time from GP referral to first definitive treatment to less than 15 weeks
    • Ensuring that over 80% of patients are discussed by the multidisciplinary team.

  2. How do we know if the change is an improvement?
    In order to answer this question, you will need to measure outcomes such as a reduction in waiting time. If we make a change, this should affect the measures and demonstrate over time whether the change has led to sustainable improvement.
Nhs Plan

The measures in this model are tools for learning and demonstrating improvement, not for judgment.
Each project team should collect data to demonstrate whether changes result in improvement, reporting progress monthly on time series graphs known as run charts or statistical process control (SPC) charts.
You may also want to undertake a qualitative analysis through patient questionnaires.
(See gaining insights from/working in partnership with health service users)

  1. What changes can we make that will result in improvement?
    There are many potential changes your team could make. However, evidence from scientific literature and previous improvement programs suggests that a small number of changes are most likely to result in improvement.

Nhs Plan

The Cancer Service Collaborative identified twenty-eight change principles grouped into four areas.

  1. Connect up the patient journey.
  2. Develop the team around the patient journey.
  3. Make the patient and care experience central to every stage of the journey.
  4. Make sure there is the capacity to meet patients’ needs at every stage of the journey.

Step 2
You should now start the PDSA cycle. There may be several PDSA cycles running sequentially, or even simultaneously. Sequential cycles are common when the study reveals results that suggest a different approach is needed.

Nhs Plan

Simultaneous cycles may occur when the changes are more complex, possibly involving several departments. It is important that you identify any interactions between simultaneous cycles, as a change in method in one cycle, may alter the impact of another somewhere else.

Step 3
Record your PDSA’s over time, to capture the learning and to demonstrate the improvement journey, which is often lost or not recorded. You could use the template below.

Nhs Plan
Nhs Plan


• Plan multiple cycles to test ideas.
• Test on a really small scale. For example, start with one patient or one clinician at one-afternoon clinic and increase the numbers as you refine the ideas.
• Test the proposed change with people who believe in the improvement. Don’t try to convert people into accepting the change at this stage.
• Only implement the idea when you’re confident you have considered and tested all the possible ways of achieving the change.

Nhs Plan

What next?

Continue with new PDSA cycles and continuous service improvement.

Having identified the changes with the greatest benefits, the next stage is to fully implement the change. This will require a stakeholder analysis. You will possibly need to use aspects of project management and benefits realization.


Fully compliant with PRINCE2 2017+

Prince2 Practitioner Masterclass

Your Route To PRINCE2 Practitioner

Prepare for your PRINCE2 Foundation and Practitioner Exams with our famous on-line course with streaming HD Video Lessons, study guides and mock exams. In the last fifteen years we have had 6,000+ Academy students successfully transform their careers as PRINCE2 Practitioners.

  • Bite Sized Lessons  The sheer size of PRINCE2 can be daunting. The Masterclass will guide you through the syllabus in easy to consume bite sized lessons
  • Be prepared and confident for the exams  Test your knowledge in a fun, entertaining environment with the PRINCE2 Foundation & practitioner exam revision tools
  • Enjoy yourself!  This PRINCE2 Foundation & Practitioner online course is broken into bite-size lessons, combining leading edge multimedia and interactive exercises for optimum enjoyment and knowledge retention
  • Feel confident with full tutorial support  Benefit from fast access to experienced, one-to-one learning support as you study via email and phone, so there is no need to feel isolated while you are learning
  • Take your time  Study at your own pace by bookmarking your progress and picking up where you left off at a speed that suits you

Do you want NHS-relevant PRINCE2 Practitioner personal Coaching?

Dave Litten Projex Academy

Dave Litten

Get PRINCE2 Coaching From An Insider Examiner!

“Hi, I’m Dave Litten and have been a PRINCE2 Coach and Accredited Trainer since 1997, and an official examiner since 2000. I know the PRINCE2 Method at a deep level and I know how to coach you through to a PRINCE2 Practitioner Pass. As CEO and Founder of Projex Academy, I launched this benchmark video training PRINCE2 Masterclass over two decades ago and this has been responsible for transforming literally thousands of our students into PRINCE2 Practitioners.”

You Do The Work.

I Speed You To PRINCE2 Practitioner.

Typically, each student will get over 22 hours of one-to-one coaching from me – Dave Litten!

In addition, I will be sending you regular assignments, exercises and PRINCE2 Exam coaching practice and techniques.

Prior to each coaching session, you get a detailed Personal Coaching Handbook to prepare, this ensures you get the most value each time we connect.

At each coaching session, you and I rigorously review your progress thus far, and I drill down to ensure you have fully mastered each PRINCE2 topic, and have a resilient defence against any exam question the examiner throws at you!

Providing you act, and put in the work I prescribe (using my unique Coaching System) – I will coach you through to exam success

After our first skype call — You pay just a one-time fee. That’s all! No other hidden exam preparation charges.

Here’s Who I Can Help:

I DO understand that if you are like me, then taking an exam is not something folks look forward to – unless they need therapy! – and you will be a little anxious. Nervous Is Good. It Demonstrates Your Desire to Win. I Can Help You Pass.

  • You need to have a basic knowledge of project management (You do NOT need to be a project manager right now)
  • You *must* want to become PRINCE2 Qualified, and be prepared to put in the preparation work effort (against an agreed schedule plan developed between us)
  • You must be able to afford my one-off coaching fee. I do not wish you to get in debt or take out loans – this is vital for you and I to develop a great student/coach relationship
  • You must be able to afford my one-off coaching fee. I do not wish you to get in debt or take out loans – this is vital for you and I to develop a great student/coach relationship
  • you will need to set aside regular quality study/coaching time with you and I – this may be in your personal/family time
  • I won’t work with students who take the approach of “you’re the coach – get me through the exam” You pull your weight – No shenanigans!


If this applies to you, it is therefore vital that you talk this through with your partner/family and gain agreement for our study time – I am available 7 days a week so the choice is yours….
If you want to fast-track my PRINCE2 Exam Coaching and work 100% of your time for say, 14 or 21 days flat out, then I can put you on my accelerated coaching at no extra cost.

Here’s What I Want You To Do Next

If you meet the criteria above and would like to talk to me personally about getting you incredible PRINCE2 Foundation and Practitioner results, then I’ll happily set aside regular coaching time for you.

Your first call is FREE and does not commit you in any way

Sign Up for PRINCE2 Coaching

Please be aware that I can only take on FIVE Students right now, so if personal PRINCE2 Exam Study Coaching is for you, you need to apply and invest without delay – Register below to fill out your contact form ready for our first FREE chat …

Dave Litten

David spent 25 years as a senior project manager for USA multinationals, and has deep experience in project management. He now develops a wide range of Project Management Masterclasses, under the Projex Academy brand name. In addition, David runs project management training seminars across the world, and is a prolific writer on the many topics of project management.

The Projex Academy

related posts:

{"email":"Email address invalid","url":"Website address invalid","required":"Required field missing"}

Project Management Masterclasses