Supporting quality improvement strategies

Keys to improve PDSA cycle fidelity


As many hospitalists know, a frequently deployed approach to quality improvement (QI) is the Plan-Do-Study-Act (PDSA) cycle method. But it comes with challenges, according to a recent paper in BMJ Quality & Safety.

“There is little evidence on the fidelity of PDSA cycles used by frontline teams, nor how to support and improve the method’s use,” according to the authors. They used document analysis and interviews to review 421 PDSA cycles, tracking fidelity over three annual rounds of projects.

The researchers found that modest, statistically significant improvements in PDSA fidelity occurred, but overall fidelity was low.

“Challenges to achieving greater fidelity reflected problems with understanding the PDSA methodology, intention to use and application in practice,” the authors reported. “These problems were exacerbated by assumptions made in the original QI training and support strategies: that PDSA was easy to understand, that teams would be motivated and willing to use PDSA, and that PDSA is easy to apply.”

The study describes several strategies to help improve PDSA cycle fidelity: different project selection process, redesign of training, increased hands-on support, and investment in training quality improvement support staff. “The findings suggest achieving high PDSA fidelity requires a gradual and negotiated process to explore different perspectives and encourage new ways of working,” the authors concluded.


1. McNicholas C et al. Evolving quality improvement support strategies to improve Plan-Do-Study–Act cycle fidelity: A retrospective mixed-methods study. BMJ Qual Saf. 2019 Mar 18. doi: 10.1136/bmjqs-2017-007605.

Next Article:

   Comments ()