DEVELOPING AND TESTING CHANGES IN DELIVERY OF CARE

Improving the daily practice of medicine requires making changes in pr ocesses of care. In many circumstances, the most powerful way to make such changes is to conduct small, local tests-Plan-Do-Study-Act (PDSA) cycles-in which one learns from taking action. Learning in these cycl es has much in common with learning from prudent clinical work, in whi ch therapies are initiated under close observation and adjustments are made as data and experience accumulate. For many system improvements, PDSA cycles are more appropriate and informative than either formal s tudies with experimental designs (such as randomized trials) or the me re implementation of changes without reflection or evaluative measurem ent. Physicians can encourage systemic improvement by endorsing and pa rticipating in prudent, local tests of change in their own offices and in the health care organizations in which they work. To do this, they must understand the scientific value and integrity of such small-scal e tests.