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There is scope for improving the quality of medical care for residents through implementing systems and tools over the short and medium term. Many RACFs use a continuous quality improvement cycle to implement changes.260 The PDSA (plan, do, study, act) cycle is increasingly used for quality improvement in general practice and health service organisations.261
The PDSA method encourages starting with small changes, which can build into larger improvements in practice through successive quick cycles of change, as shown in Table 17.
Table 17. The Plan, Do, Study, Act cycle
Step 1. Plan to test selected improvement or change Once the actual change to be introduced has been agreed, consider the following questions:
- What would we expect to see as a result of this change?
- What data do we need to collect to check the outcome of the change?
- How will we know whether the change has 'worked' or not?
- Who, what, where, when?
Step 2. Do the test and collect data for analysis
Keep the 'do' stage short and record any outcomes, unexpected events, problems and other observations.
Step 3. Study the results
Has there been an improvement? Did your expectations match the reality of what happened? What could be done differently?
Step 4. Act on the result
Do an 'amended' version of what happened during the 'do' stage, measure and study any differences in results. Once you have achieved success in a PDSA cycle, the change can be implemented as part of usual practice and mechanisms established to sustain the improvement. These may include:
- training and education of staff
- standardisation of systems and processes
- documentation of associated policies and guidelines
- measurement and review to ensure that the change is incorporated into routine practice.