Hello everyone!
At this fall’s regional meetings, we’ve been talking about the Plan-Do-Study-Act (PDSA) approach to quality improvement in oncology. This approach is one that most of you have used—even if you haven’t called it that—in your practices to bring to life the remarkable improvements in the quality of care we’ve seen across the state. I thought it would be interesting to review the history of the PDSA cycle.
The PDSA (Plan-Do-Study-Act) cycle, originally known as PDCA (Plan-Do-Check-Act), has its roots in the scientific method applied to the production of goods. Introduced as a linear, 3-step process by engineer and statistician Walter Shewhart in the 1920s, it was later transformed by W. Edwards Deming, the “father of quality improvement,” into a cyclical four-step process (PDCA/PDSA), emphasizing continuous learning, improvement, and the importance of iteration. (Deming preferred PDSA over PDCA because he believed that study more accurately reflected the learning and improvement process.)
While it is not clear exactly when the PDSA cycle was first used in medical care, it was being widely used and studied in healthcare settings by the 2000s. In oncology, one published example of the PDSA cycle in action includes reductions in chemotherapy wait times from 2 hours 27 minutes to 30 minutes on average through multiple PDSA cycles involving workflow changes and patient education. Another study reported reducing discrepancies in medication lists by over 50% and increasing accuracy of physician-documented medication lists from 47.3% to 92.6% through rapid PDSA cycles. I’m struck by how often the word “rapid” is used to describe the repeated experiments that practices make, first introducing one change, then assessing its success before making additional changes.
The MOQC Coordinating Center members are here for you and your practice as you conduct your own experiments. While life may already feel “rapid” enough, there’s an energizing nimble‑ness to making small changes and assessing the impact of those changes by, for example, logging into your dashboards to see how you’re doing without having to wait until the next MOQC meeting.
The MOQC Coordinating Center is also working on our own improvement. Thank you for filling out surveys when we request that you do. We have spent considerable time reading your responses and listening to your suggestions. Even more important, we are making changes and will then assess how we work to support you and your practices. Please be on the lookout for a short email from me addressing the comments and questions you’ve made in response to the requests for feedback. And you don’t have to wait…we’re always here to listen to what MOQC can do better.
With great appreciation for you and the work you do,
Dr. Jennifer Griggs
Program Director