The Plan, Do, Study, Act (PDSA) cycle is a way of testing changes in real-life settings. It is likely that implementation of any system or practice change will involve a number of PDSA cycles. The key steps in the cycle are outlined below. (Taken from Institute for Healthcare Improvement http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/testingchanges.htm)

Step 1: Plan
Plan the test or observation, including a plan for collecting data.

• State the objective of the test.
• Make predictions about what will happen and why.
• Develop a plan to test the change. (Who? What? When? Where? What data need to be collected?)

Step 2: Do
Try out the test on a small scale.

• Carry out the test.
• Document problems and unexpected observations.
• Begin analysis of the data.

Step 3: Study
Set aside time to analyse the data and study the results.

• Complete the analysis of the data.
• Compare the data to your predictions.
• Summarise and reflect on what was learned.

Step 4: Act
Refine the change, based on what was learned from the test.

• Determine what modifications should be made.
• Prepare a plan for the next test.

The following resources provide a useful overview of clinical practice improvement methods. For additional links and resources click the Useful links section.

Improvement methods - http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/

Publisher: Institute for Healthcare Improvement
Summary: Web-based step-be-step guide to service improvement methods

Plan, do, study, act worksheet - http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/Tools/Plan-Do-Study-Act+%28PDSA%29+Worksheet.htm

Publisher: Institute for Healthcare Improvement
Summary: Worksheet to help health professionals and health services work through a PDSA cycle

Easy Guide to Clinical Practice Improvement - http://www.health.nsw.gov.au/quality/pdf/cpi_easyguide.pdf

Publisher: NSW Health
Summary: Web-based PDF document designed to provide practical advice to clinicians and managers on how to use health care data to improve the quality and safety of health care in a systematic way

The Clinician's Toolkit for Improving Patient care - http://www.health.nsw.gov.au/pubs/2001/pdf/clinicians_toolkit.pdf

Publisher: NSW Health
Summary: to provide clinicians with a guide about the various strategies that are available to them for identifying problems with systems of care and with an individual clinician's practice, and to give clinicians an overview of the 'pragmatic' scientific methodology that can be used to act upon the information that those methods provide, in order that care is continually improved

Institute for Healthcare Improvement - http://www.ihi.org/ihi/topics

The Institute for Healthcare Improvement (IHI) is an independent not-for-profit organisation helping to lead the improvement of health care throughout the world. Based in the USA, IHI works to accelerate improvement by building the will for change, cultivating promising concepts for improving patient care, and helping health care systems put those ideas into action.

The 'Topics' section provides the core information on the website. Each Topic features the best available knowledge for improvement in that area, including tools, literature, and changes to help health services implement and measure service improvement. Each Topic also has a commentary by an 'Expert host'.
Topics include:

• Leading system improvement
• Flow
• Health professional education
• Last phase of life
• Patient-centred care
• Patient safety
• Reducing mortality
• Reliability

Each topic features background information, tools, case studies, literature and useful links. A user rating system allows you to judge the usefulness of individual tools and resources.

National Health Service Improvement Portal - http://www.improvement.nhs.uk/

NHS Improvement is a newly formed national improvement programme working with clinical networks and NHS organisations to transform, deliver and sustain improvements across the entire pathway of care in cancer, cardiac, diagnostics and stroke services.

Formed in April 2008 after a national review, NHS Improvement has brought together over eight years practical service improvement experience from the Cancer Services Collaborative 'Improvement Partnership', Diagnostics Service Improvement Programme, NHS Heart Improvement Programme, the longest running Improvement programmes within the NHS.

The website has a specific Cancer Improvement section that houses reports about specific projects as well as tools and resources to assist with change management approaches.
Sub-sections include:

• Sustainability
• Inpatient experience
• Knowledge management
• Improvement resources

NHMRC National Institute for Clinical Studies (NICS) - http://www.nhmrc.gov.au/nics/asp/index.asp?page=materials/materials

As part of the NHMRC, NICS works to improve health care by getting the best available evidence from health and medical research into everyday practice.

The Materials and resources section of the NICS website houses a range of resources and information that can be searched by subject. Subject groupings include:

• Barriers to using evidence
• Cancer
• Electronic decision support
• Guideline implementation
• Mental health
• Pain management
• Using guidelines

Resources include a specific guide for cancer 'Taking action locally: Eight steps to putting cancer guidelines into practice'. http://www.nhmrc.gov.au/nics/asp/index.asp?page=materials/materials_subject_article&cid=5212&id=403

The Using Evidence website http://www.usingevidence.com.au/resources.php houses information from a conference hosted by NICS in 2006 and includes resources and tools aimed at improving guideline implementation.

Australian Commission on Safety and Quality in Healthcare - http://www.safetyandquality.gov.au/

The Commission has been funded by the Australian, State and Territory Governments to develop a national strategic framework and associated work program that will guide its efforts in improving safety and quality across the health care system in Australia.

The website houses information about ACSQHC programs as well as relevant publications. The website also has a Knowledge portal providing a searchable list of information resources relating to a range of quality and safety initiatives.

Royal Australasian College of Physicians - Better Practice Portfolio - http://www.racp.edu.au/page/health-policy-and-advocacy/better-practice

The Better Practice Portfolio utilises the central concepts of Clinical Practice improvement (CPI) and Evidence Based Practice (EBP) to enable clinicians to embed best practice routinely in clinical care. The Better Practice Coordinating Committee (BPCC) provides advice to the Better Practice Program on safety and quality issues appropriate to the training and CPD activities of the College.

Clinical Excellence Commission NSW - http://www.cec.health.nsw.gov.au/

The Clinical Excellence Commission (CEC) was launched on August 24 2004, as part of the NSW Patient Safety and Clinical Quality Program. The CEC is a board-governed statutory health corporation with the CEO reporting directly to the NSW Minister for Health.

The mission of the CEC is 'To build confidence in healthcare in NSW, by making it demonstrably better and safer for patients and a more rewarding workplace.'

The website houses information about NSW-based programs, toolkits and case studies across a range of health areas.

Queensland Health - Clinical Practice Improvement Centre - http://www.health.qld.gov.au/cpic/

The Clinical Practice Improvement Centre (CPIC) was formed in February 2005 through a merger of three Queensland Health clinical quality improvement programs

• Clinician Development Program
• Clinical Pathways Program
• Collaborative for Healthcare Improvement

with the key objective to mainstream the successful health care improvement activities from project status to recurrent operational status.

The key objective of CPIC is to improve patient outcomes in high impact areas by supporting and working with clinicians and health service managers to better understand issues related to their clinical services and how these may be addressed.

The website houses information about state-wide clinical improvement activities.

Victorian Quality Council - http://www.health.vic.gov.au/qualitycouncil/

The Victorian Quality Council is responsible for fostering better quality health services in Victoria by working with stakeholders to develop useful tools and strategies to improve health service safety and quality.

The website houses information about Victorian-based programs, as well as safety and quality tools, guidelines, information sheets and reports developed by the VQC for use in health care.

Department of Health Western Australia - Office of Safety and Quality in Healthcare - http://www.safetyandquality.health.wa.gov.au/home/index.cfm

The Office of Safety and Quality in Healthcare aims to work with and share ideas, creativity and information in order to make healthcare safer and better for communities in Western Australia.

The website houses information about safety and quality initiatives in Western Australia as well as publications, reports and policy documents.