QAPI Program Utilization_Manual

PDSA Worksheet Staff Name: ______________________________ Cycle start date: __________ E nd date: __________ Plan-Do-Study-Act (PDSA) testing Aim Statement: PLAN: Area to work on: Describe the improvement intervention you are testing: What question does this test seek to answer? (If I do ‘x,’ will ‘y’ happen?) What do you predict or expect the outcome will be? What measure will you use to learn if this test is successful or has promise? Plan for intervention and testing process: (who, what, when, where) Data collection plan: (who, what, when, where) DO: Report observations from when you carried out the test. Describe findings, obstacles (unexpected and expected), and special circumstances. STUDY: Compare your results to your predictions. What did you learn? Any surprises? ACT: What will you do next? Adopt, adapt or abandon the change? Act Plan Do Stud y Langley GJ, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. In. 2nd ed. San Francisco: Jossey-Bass; 2009:36-7. This material was prepared by Quality Insights of Pennsylvania, the Medicare Quality Improvement Organization for Pennsylvania, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication number 10SOW-PA-IPC-KD-051112. App. 5/12. 118