PDSA Cycle Worksheet Template

One PDSA test of change: Model for Improvement aim and measures, driver diagram, plan with prediction, do, study, act, ramp of cycles, run chart with rules

SaludEstándarIHI Model for Improvement (Langley et al. 2009); run chart rules (Perla et al. 2011)pdsa cycle diagramActualizada 29 oct 2026

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Cómo usar: Use it for each small test of change in a quality improvement project. Fill the aim, the measures and the prediction first, before the test runs. The main pitfall is claiming improvement from before and after averages instead of applying the run chart rules.

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PDSA Cycle Worksheet: [Change idea being tested]

Worksheet for one Plan-Do-Study-Act (PDSA) test of change, set inside the three questions of the Model for Improvement, with a ramp log for linked cycles and a run chart of the outcome measure. The Model for Improvement was developed by Associates in Process Improvement and is described in Langley GJ et al., The Improvement Guide (2nd edition, Jossey-Bass, 2009); IHI teaches it as its core improvement method. Run chart rules follow Perla, Provost and Murray, BMJ Quality and Safety 2011. Replace every [bracketed] value and every row marked Example. This is a quality improvement format, not medical advice; follow local policy, clinical judgement and your organisation's governance process. Use aggregate, de-identified data only.

Document control

Field	Value
Document ID	[PDSA-PROJ-NN-C1]
Project	[Project name and ID]
Cycle number	[1 / 2 / 3]
Team	[Names, roles]
Sponsor	[Name, role]
Version	[1.0]
Status	[Planned / Running / Studied / Closed]
Owner	[@qi-lead]
Approvers/reviewers	[@clinical-lead], [@qi-team]
Last updated	YYYY-MM-DD
Classification	[Internal, aggregate data only]

Revision history

Version	Date	Author	Change
0.1	YYYY-MM-DD	[Name]	Plan and prediction written
1.0	YYYY-MM-DD	[Name]	Study and Act completed

1. Model for Improvement

Question	Answer
What are we trying to accomplish? (aim)	[Measure, from baseline to target, for which population, by when]
How will we know that a change is an improvement? (measures)	[Outcome, process and balancing measures, section 2]
What change can we make that will result in improvement? (change ideas)	[Change ideas from the driver diagram, section 3]

Example: Aim: on Ward 5 of the fictional Halvermoor District Hospital, raise the share of adult admissions with medicines reconciled within 24 hours from a baseline of 46.1% (149 of 323, eight weeks) to 75% by YYYY-MM-DD.

2. Measures

ID	Type	Definition (numerator / denominator)	Source	Frequency	Owner
M-01 (Example)	Outcome	Admissions with a completed reconciliation within 24 hours of the decision to admit / all adult admissions to Ward 5	Electronic record report	Weekly	[Pharmacy lead]
M-02 (Example)	Process	Admissions with a best possible medication history taken from two or more sources / all adult admissions	Weekly audit of 10 records	Weekly	[Ward pharmacist]
M-03 (Example)	Balancing	Pharmacy technician minutes spent on the ward per day	Time log	Weekly	[Pharmacy manager]

3. Driver diagram and change ideas

Read the diagram from left to right: the aim, the primary drivers that must change to reach it, the secondary drivers under each, and the change ideas the team will test. Example below.

4. This cycle

Plan

Item	Detail
Objective of this cycle	[What you want to learn]
Change being tested	[Change idea ID and description]
Prediction	[What you expect to happen, with a number]
Who	[People involved]
Where	[Unit, bay, clinic]
When	[Dates, shifts]
Data to collect	[Measure IDs, plus notes on problems]

Example: Cycle C1 tests CI-01 on one bay for one week. Prediction: technician-led histories will raise M-01 above 55% that week, and each history will take under 20 minutes.

Do

Record what happened, including problems and observations that were not part of the plan.

Example: The technician took 14 histories. Two patients were too unwell to be interviewed, so the GP record and the patient's own list were used. Median time per history was 18 minutes.

Study

Compare the results with the prediction. What did you learn?

Measure	Prediction	Result	Matches?
M-01 (Example)	Above 55%	58.5% (24 of 41)	Yes
Time per history (Example)	Under 20 minutes	Median 18 minutes	Yes

Act

Choose one: adopt, adapt or abandon, and define the next cycle.

Decision	Reason	Next cycle
Example: Adapt	Worked on weekdays, weekend admissions missed	C2: extend to all weekday admissions, C3: test CI-03 at weekends

5. Ramp of cycles

Cycle	Weeks	Change	Scale	Decision
C1 (Example)	9	CI-01 technician history	One bay, weekdays	Adapt
C2 (Example)	10 to 11	CI-01 plus CI-02	Whole ward, weekdays	Adopt
C3 (Example)	12 to 16	CI-03 weekend rota	Whole ward, seven days	Adopt, hand over to business as usual

6. Run chart

Week	W1	W2	W3	W4	W5	W6	W7	W8	W9	W10	W11	W12	W13	W14	W15	W16
Reconciled (Example)	18	20	17	21	19	16	20	18	24	26	27	29	28	30	31	30
Admissions (Example)	40	42	39	41	40	38	43	40	41	40	39	42	40	41	42	40
Percent (Example)	45.0	47.6	43.6	51.2	47.5	42.1	46.5	45.0	58.5	65.0	69.2	69.0	70.0	73.2	73.8	75.0

Run chart rules (Perla, Provost and Murray 2011), applied to the example:

Rule	Signal of non-random change	Example result
Shift	Six or more consecutive points all above or all below the median (points on the median are skipped)	Met: weeks 9 to 16, eight points above the baseline median of 45.75%
Trend	Five or more consecutive points all going up or all going down	Met at the limit: weeks 12 to 16 are five consecutive points, each higher than the one before, from 69.0% to 75.0%
Runs	Too few or too many runs for the number of points, read from the published table	Not used: the median was frozen at baseline
Astronomical point	A point obviously different from all others, agreed by people who know the process	None

Example summary: weeks 1 to 8 reconciled 149 of 323 admissions (46.1%); weeks 9 to 16 reconciled 225 of 325 (69.2%); the last four weeks reconciled 119 of 163 (73.0%). The shift shows a non-random improvement, but the 75% aim is not yet met in a sustained way.

7. Learning and next steps

What we learned: [Key learning in two or three lines]
Surprises: [What happened that you did not predict]
Next cycle or handover: [Next test, or how the change becomes standard work and who owns the measure]
Write-up: [Link to the quality improvement report, if the project will be reported]

References

Reference	Status	Use
IHI, How to Improve: Model for Improvement, https://www.ihi.org/library/model-for-improvement	Checked 2026-10-30	Three questions, PDSA, credit to Associates in Process Improvement
Langley GJ, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance. 2nd ed. San Francisco: Jossey-Bass; 2009	Cited from IHI page	Source of the Model for Improvement. Official text: Jossey-Bass (Wiley), purchase or licensed access: https://www.wiley.com/
IHI, Plan-Do-Study-Act (PDSA) Worksheet, https://www.ihi.org/library/tools/plan-do-study-act-pdsa-worksheet	Checked 2026-10-30	One worksheet per test (free download after a form)
Perla RJ, Provost LP, Murray SK. The run chart: a simple analytical tool for learning from variation in healthcare processes. BMJ Qual Saf 2011;20(1):46-51, https://doi.org/10.1136/bmjqs.2009.037895	Citation checked on PubMed 2026-10-30	Run chart rules

Standard and licence note

Structure aligned with the Model for Improvement and PDSA cycle as described publicly by IHI (page checked 2026-10-30) and in The Improvement Guide (2nd edition, 2009), with run chart rules from Perla, Provost and Murray (2011). This template is original text written for this collection; it does not reproduce the IHI worksheet or the book. All names, wards and figures in examples are fictional. This is a quality improvement format, not medical advice; check the current official pages and follow local governance. Template licence: MIT.

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