Now that you have an improvement project goal and a team gathered to test changes, it is time to focus on the second question in applying the PDSA model:
1. What is our goal (i.e. what are we trying to accomplish)?
2. What change can we make that will result in improvement?
3. How will we know the change is an improvement?
As your team now moves into the Plan stage of the PDSA model, your team will engage in two types of activities to answer the second question above: problem exploration and test of change selection.
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Problem Exploration
You may already have in mind a potential issue or opportunity that you want to address using the PDSA model or you may be experiencing the symptoms of a problem but not yet know the cause. During the Plan stage of the PDSA model, you will engage in problem exploration. Problem exploration helps your team to brainstorm contributing factors and root causes to issues and hypothesize solutions while building team buy-in to make changes. Problem exploration seeks to answer questions like:
- What is the reason this problem is occurring?
- What systems or processes are impacting this issue?
- What change would be most effective?
- How can we save the most time or resources?
The resources below provide information and activities to guide your team through problem exploration. Your team does not have to complete all activities but would ideally complete at least one of the activities that best fits your project. After your team completes one or more problem exploration activities, prioritize the problems your team identified that they want to address with your PDSA project. Write a problem statement to summarize your team’s consensus on the problem(s) and write it in your PDSA Project Charter. If your team has identified more than one problem, it is helpful to prioritize problems and include a justification of why you chose that prioritization in your charter as well.
The 5 Whys exercise can be used to explore any type of organizational problem and involves bringing together a group of knowledgeable staff or stakeholders to brainstorm and discuss why issues are occurring.
A walk-through is an exercise where staff walk through a process (i.e., a series of steps of interaction between staff/clients) to experience the service as a ‘client’ experiences it. Taking this perspective is a helpful way to understand how the client feels, and to identify improvements that will serve the client better.
Voice of the customer interviews are a structured interviewing technique designed to capture stakeholder frustrations and needs associated with a process.
Test of Change Selection
Next, your team must decide what change will lead to an improvement. Your team will now need to engage in brainstorming solutions to the problem(s) you identified. You will then take one solution and it will become your first test of change, the starting point for your first PDSA cycle. Enter the identified solution in part 2 of your PDSA Project Charter under expected outcomes/deliverables. If you choose to test two or more solutions, you will fill out separate PDSA forms for each test and enter them as separate deliverable in your project charter.
Test of Change Brainstorm Activity pdf
At times, teams will brainstorm many potential solutions they believe would be effective to test using PDSA. If your team is having a difficult time choosing which solution to test OR if your last solution tested using PDSA was abandoned, use the guide below to help your team have deeper discussions on the best potential solution(s) to test using PDSA.
PDSA Form
Your team has now explored the problem and decided on one or more tests of change. At this point, your team should begin to fill out the PDSA tracking form. The PDSA form is the most important tool in this toolbox. Your team will use this tool on every PDSA cycle to formulate a testable hypothesis, organize your test and measurement plans, and assess whether the tested change led to an improvement.
Remember most PDSA tests (and especially initial tests) should be small in scope and quick to accomplish. Most PDSA tests are something that can be accomplished in just one week (e.g. What can I do by next Tuesday?). In the sick houseplant example from the introduction video in this PDSA toolkit, the first PDSA test may be to only change the amount of water applied to the plant for one week. In social work practice, you may want to consider trying your first test of change with one worker and one family/case.
In the Plan stage of PDSA, start by filling in the cycle number, date, goal, next change to be tested, hypothesis, and ‘Plan Step 1’ box on the PDSA Form. Please see the PDSA: Measure section of this toolkit for more guidance on measuring change to inform the ‘Plan Step 2’ box on the PDSA Form. Members of your team can be working on multiple small PDSA tests at the same time. Remember to fill out a PDSA Form for each test separately.
The PDSA Form plays several roles. It organizes your teams’ plans. It can help keep your team accountable to deadlines. You fill the PDSA Form out for every consecutive PDSA cycle so it tracks how your team’s knowledge and progress is built over time (remember to update your charter with team learnings). Last, it can also serve as a communication tool to agency staff and leadership about the plans, project outcomes, and team progress.
The PDSA Toolkit is brought to you through partnership between the Wisconsin Department of Children and Families and the Wisconsin Child Welfare Professional Development System