Think of action planning as an iterative process of active experimentation that involves progress monitoring. If some items on the Action Plan are not fruitful, the Implementation Team may need to rethink the plan and adapt, change, or add activities. Using Plan-Do-Study-Act (PDSA) cycles will help the team do that! PDSA cycles are often used as part of quality improvement efforts in health and human service organizations and are a great way to inform change processes based on local needs and contexts. Using this method will enable the team to test out changes in a structured way and on a small scale, gathering evidence to support the uptake of the changes on a larger scale.
As shown in Figure 1, key questions to ask before implementing or testing an idea for change:
- What is the Implementation Team trying to accomplish?
- How will the Implementation Team know that a change is working out well? What measures of success will it use?
- What other changes may be necessary to bring about desired improvements?5
The four stages of the PDSA are:
- Plan the change to be implemented or test;
- Do implement or test out the change;
- Study by collecting data before and after the change to see whether specified outcomes based on the SMART objectives have been achieved and reflecting on the impact of the change and what was learned; and
- Act by planning for the next change cycle or full implementation.5
Figure 1. Plan-Do-Study-Act Cycles
| The figure was adapted from the National Health Service model of improvement.5 |
The team can use the data it collects to decide on whether a more considerable investment in the change is warranted or what adjustments might be needed. Based on these decisions, the team can advocate to adopt the change more widely, modify the change, or revisit how it originally conceptualized the problem and accompanying solution.
The PDSA cycles may be completed in as little as a few weeks or as long as a year, depending on the scope of the problem and proposed change. Documentation of the PDSA cycles should occur through meeting minutes of the Implementation Team, the Implementation Activity Log that clarifies when activities occur (date/time), their purpose, the persons involved in them, and other data collected to measure achievement of SMART objectives. Data can also come from repeating the organizational assessment. In addition, there are several project management templates available for free that can help the team carry out PDSA cycles, including ones recommended by the National Health Service in England (click here),5 and the Agency for Healthcare Research and Quality (click here).6 We advise the team to complete such templates to monitor each change it implements. Because the team may need to test multiple changes, each change may need to go through several PDSA cycles. The team should keep an electronic or hard copy file of project management templates for all changes it tries to implement.
The Implementation Team should monitor progress on Action Plans regularly. Teams should check plans for items that have been completed at specified intervals, items yet to be completed, and the results yielded. Some questions for monitoring progress are:
- Did the actions required to implement a specific innovation take place as planned?
- For completed items, what made it possible to carry out these actions?
- For incomplete items, what prevented the actions from being completed?
- What additional human or material resources are needed to complete the actions?
- What were the intended or unintended consequences associated with the actions?
- What mid-course corrections or adaptations are needed to support the implementation of the innovation?
- What other actions need to be carried out?
These questions prompt reflection on the part of the Implementation Team, making it possible to take stock of the next steps and identify and celebrate its achievements. As the items outlined in the Action Plans are completed, and strategy implementation is achieved, we encourage the team to shift its focus toward maintaining momentum and sustaining the changes made.