Completing the circle: from PD to PDSA

Int J Health Care Qual Assur Inc Leadersh Health Serv. 2004;17(6):349-58. doi: 10.1108/09526860410557606.


Problem-solving teams, involving front-line staff, are widely used to achieve continuous process improvement. Approaches such as "plan-do-study-act" (PDSA) cycles, are now a core element of many health-care improvement initiatives. This paper evaluates the use of PDSA improvement cycles within the UK National Health Service, using emergency care improvement activity as a source of research evidence. It was found that, despite an abundance of information on how to implement this type of change, many senior professionals still misinterpret how this should work. This has implications for how such methodologies are implemented. There is a long way to go in allowing greater employee involvement, moving much further away from the "management committee" style of change. Care has to be taken to ensure that empowered employees are working to consistent and appropriate objectives. It is important that senior personnel develop process understanding alongside the workforce, rather than simply providing distant support.

MeSH terms

  • Emergency Service, Hospital / standards*
  • Emergency Service, Hospital / statistics & numerical data
  • Health Services Research
  • Humans
  • Leadership
  • Management Quality Circles
  • Models, Organizational
  • Organizational Innovation
  • Patient Care Team
  • Pilot Projects
  • Planning Techniques*
  • Problem Solving*
  • Process Assessment, Health Care
  • Social Responsibility
  • State Medicine / organization & administration
  • State Medicine / standards*
  • Total Quality Management / methods*
  • Total Quality Management / organization & administration
  • United Kingdom