The completion of each PDSA cycle rolls directly into the start of the next one. A team learns from the test (What worked and what did not? What should be kept, changed, or abandoned?) and uses this information to plan the next test. By linking PDSA cycles in this way, teams refine the change until it is ready for broader implementation.
People are far more willing to test a change when they know the changes can and will be modified as needed, and quickly. Linking small tests helps overcome an organization's natural resistance to change. The phrase "It is only a test" is very reassuring to many.
Teams also find that they can test more than one change at a time, although each test ultimately leads to the same goal. The accompanying graphic shows the PDSA cycle as a dynamic process in which "hunches" can lead to results - as illustrated by the cycles showing how changes in family discussion, ventilator weaning, and sedation usage can point to improved family satisfaction with the intensive care unit (ICU).
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved.
For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ].