QI teams often use Dr. W. Edwards Deming’s Plan-Do-Study-Act (PDSA) model to implement QI projects. Deming incorporated knowledge of engineering, operations, and management with the goal of improving accuracy, reducing costs, and increasing efficiency and safety, all leading to satisfied customers. Deming described his philosophy as “a system of profound knowledge” composed of four parts:

(a) appreciation for a system,

(b) understanding process variation,

(c) applying theory of knowledge, and

(d) using psychology (Evans, 2008). The PDSA model and the actions within each step can be seen in Figure 11.1. Although some refer to the cycle as Plan-Do-Check-Act (PDCA), as originally developed by Walter Shewhart, Deming had strong beliefs that the terminology, PDCA, and PDSA, were very different and he only used the “PDSA cycle” to describe process improvement (Moen & Norman, 2009). Deming argued that “study” implied more of a rigorous scientific approach to QI measurement and outcomes analysis where “check” did not have the same connotation.

The advantage of using the PDSA cycle is that it is easy to understand, can be used cyclically on a smaller scale to perform small tests of change, or can be used when implementing large, system-wide improvements. The following questions can be used during the PDSA process (Langley et al., 2009):

1.

What is the goal of the project?

2.

How can it be determined that the goal of the project was reached?

3.

What needs to be done in order to reach the goal?