The Plan-Do-Study-Act cycle can have a meaningful impact on the outcomes of a clinical simulation program. Since the goals of the healthcare delivery system are to provide safe, quality patient care to improve clinical outcomes and efficiency, healthcare simulation has emerged as a powerful tool to train professionals, test new protocols, and refine processes in a controlled environment. To keep abreast of the constantly changing healthcare environment, a simulation program needs a process to monitor and adapt based on measurable outcomes. One of the most effective frameworks for continuous improvement in healthcare simulation is the Plan-Do-Study-Act (PDSA) cycle. This iterative model provides a structured approach to testing changes, refining strategies, and achieving sustainable improvements in healthcare practices. This HealthySimulation.com article by Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, will discuss the PDSA Cycle and how to implement the method in clinical simulation.
The PDSA Cycle in Healthcare Simulation
The PDSA cycle is a four-step method used to drive continuous quality improvement. The cycle consists of Plan, Do, Study, and Act, and each stage builds upon the insights gained from the previous step.
- Plan: Identify an area for improvement, set objectives, and design a plan for implementation.
- Do: Execute the plan on a small scale (pilot) in a simulated environment.
- Study: Analyze the results, collect data, and evaluate the impact of the change.
- Act: Implement successful changes on a broader scale or refine the plan and repeat the cycle if necessary.
This structured approach allows healthcare educators and professionals to systematically test changes before implementation in an actual learning or patient care settings to minimize risks and maximize patient safety.
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The PDSA Cycle Application in Healthcare Simulation
Healthcare simulation provides a safe, controlled environment to experiment with new processes, technologies, and protocols without jeopardizing patient safety. Integration of the PDSA cycle, organizations can ensure that changes are effective and sustainable. Here are several ways in which the cycle can be incorporated into healthcare simulation:
Improving Clinical Skills Training: Healthcare simulation is extensively used to train clinicians in essential skills, from basic procedures to complex decision-making in emergency situations. The PDSA cycle can be applied as follows:
- Plan: Identify a clinical skill that requires improvement, such as airway management or CPR efficiency.
- Do: Conduct a simulation-based training session using manikins or virtual reality.
- Study: Assess trainee performance through metrics like time taken, accuracy, and error rates.
- Act: Refine the training program based on measurable outcomes and implement changes for future training sessions. This iterative approach ensures that clinical training remains dynamic, effective, and responsive to evolving healthcare needs.
Enhance Team Communication and Crisis Management: Teamwork and communication are critical in high-pressure healthcare environments such as operating rooms and emergency departments. Simulation-based training can improve these aspects using the PDSA framework:
- Plan: Develop a scenario that tests team communication, such as a multidisciplinary response to a cardiac arrest.
- Do: Conduct a simulation exercise with healthcare teams.
- Study: Analyze communication breakdowns, leadership effectiveness, and team coordination.
- Act: Adjust protocols, introduce structured communication tools (e.g., SBAR), and repeat the simulation. With continuous teamwork alignment strategies, healthcare teams become more cohesive and better equipped to handle real-world crises.
Test New Protocols and Equipment: Healthcare institutions can use simulation to evaluate the effectiveness of new protocols or advanced medical technologies before they are implemented.
- Plan: Identify a new process or technology (e.g., a new electronic health record system).
- Do: Test the implementation in a simulated clinical environment.
- Study: Gather feedback from participants, identify usability issues, and measure workflow efficiency.
- Act: Adjust the process based on feedback before full-scale implementation. This approach prevents disruptions in patient care and ensures seamless adoption of new technologies.
The integration of the PDSA cycle into healthcare simulation fosters a culture of continuous improvement to enhance patient safety, clinical efficiency, and healthcare education. By systematically testing and refining changes, healthcare institutions can proactively address challenges, optimize training programs, and improve healthcare delivery. As the industry continues to evolve, leveraging simulation alongside the PDSA cycle will remain a cornerstone of innovation and quality improvement in healthcare.
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AHRQ Resources for PDSA Cycle
For more information and a deeper comprehension of the PDSA cycle, the Agency for Healthcare Research and Quality (AHRQ) has multiple resources available on their website. A voice-over PDSA presentation that explains the PDSA cycle. In addition to this presentation, a PDSA fillable form and tool is available.
Benefits of the PDSA Fillable Form and Tool
The PDSA Worksheet provides a guide to help healthcare simulation professionals to create an action plan to achieve the desired outcomes. In the PLAN section of the worksheet, the guide asks questions to determine what you want to do to reach a goal and the steps required to reach that proposed goal. For a successful experiential learning process, the PLAN must include SMART objectives: specific, measurable, achievable, realistic, and time-measured. This is in alignment with the INACSL Healthcare Simulation Standards of Best Practice. Another important aspect is to determine the metric for the evaluation of outcomes and objectives.
This worksheet can be created in a shared document to allow team members to provide input to increase the buy-in of the stakeholders. The stakeholders can monitor the progress of the plan and work simultaneously, even in different locations. The healthcare simulation team now knows what is to be accomplished, measurable outcomes, and what and how data will be collected.
Once the plan is developed, the next step is the iterative process is the “DO” section. In this phase of the cycle, the simulation professionals have to determine what was observed Time to collect the data. The team should have more than one member to observe and measure. This presents another important aspect of interrater reliability. The team members should have a shared mental model by this time. Each member has their own perception of what is observed, so take the time to establish the evaluation rules.
Next is the STUDY section of the worksheet and cycle. In this stage, the evaluation occurs to determine what was learned. This is accomplished through the measurement and evaluation of the SMART Objectives. The team has to determine what was learned during this process. Were the goals, outcomes, and objectives met? If not, what were the possible causes? If successful, what could be improved to make the process better?
Now is the time to act. The team needs to determine what to do based on the questions answered in the STUDY phase. The last thing to consider is whether the process should continue. If so, it would start over, and the team would go back to the PLAN phase with the changes implemented.
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