SynthesisBMJ quality & safety2014
Systematic review of the application of the plan-do-study-act method to improve quality in healthcare.
Synthesis in BMJ quality & safety, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 753 papers, 5 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Enhancing And Supporting Early Development to Better Children's Lives (EASEL) Trial
Adaptation of the World Health Organization Surgical Safety Checklist to High-Income Healthcare Settings - Phase III: Site Testing Study
Who cites it
753 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Effectiveness and Safety of Continuous Quality Improvement and Failure Mode and Effect Analysis for Preventing Adverse Events in Hospitalized Patients: A Systematic Review of Complex Interventions.Journal of patient safety · 2026Pooled it
- Quality improvement interventions in surgical oncology: systematic review of international studies.BJS open · 2026Pooled it
- A systematic search for evaluated interventions to increase nursing students' participation in international scientific conferences: an empty review and implementation implications.BMC medical education · 2026Pooled it
- Learning health system for implementation, scale-up, and sustainment: a systematic review to consolidate guidance for improvement.Implementation science : IS · 2026Pooled it
- The use of healthcare simulation to identify and address latent safety threats: a scoping review.Frontiers in health services · 2025Pooled it
- Sustained mental health outcomes from the youth readiness intervention: A four-year effectiveness follow-up of a hybrid type II trial in Sierra Leone.Journal of child psychology and psychiatry, and allied disciplines · 2026Trial
- Medication administration errors in a Norwegian ambulance service: a quasi-experimental study on the impact of a team training program.Scandinavian journal of trauma, resuscitation and emergency medicine · 2026Trial
- The Impact of Using Standardized Autism Screening on Referral to Specialist Evaluation for Young Children on the Autism Spectrum: A Cluster-Randomized Controlled Trial.Journal of the American Academy of Child and Adolescent Psychiatry · 2025Trial
- Mechanisms of change of a multifaceted implementation strategy on fidelity to a guideline for the prevention of mental health problems at the workplace: a mechanism analysis within a cluster-randomized controlled trial.Implementation science : IS · 2025Trial
- Article
- Article
- Occupational health and safety management when digitalizing public services: Local government manager experiences in Sweden.Work (Reading, Mass.) · 2026Article
- Early enteral feeding following flap surgery for head and neck defects: a quality improvement project using the Plan-Do-Study-Act cycle.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- Financial concerns: a critical gap in survivors' experience of the implementation of the national standards for cancer survivorship care.Journal of cancer survivorship : research and practice · 2026Article
- From Patient Voice to Organizational Adaptability: A Critical Narrative Review and Conceptual Model for Personalized Care.Healthcare (Basel, Switzerland) · 2026Review
- A case study of patient and public involvement in sepsis genomics research.Research involvement and engagement · 2026Article
- Quality improvement project for minimising red blood cell unit wastage at a secondary referral hospital in Malawi.BMJ open quality · 2026Article
- Optimising data visualisation formats for reporting medication-related care quality indicators: residential aged care staff preferences, interpretations and actions.BMJ open quality · 2026Article
- Real-World Impact of Remote Patient Management on Care Consumption and Care Time in Heart Failure: Retrospective Cohort Study.JMIR formative research · 2026Article
- Enhancing nasal irrigation adherence through a multimodal health communication strategy: a phased improvement study.Scientific reports · 2026Article
693 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPlan-do-study-act (PDSA) cycles provide a structure for iterative testing of changes to improve quality of systems. The method is widely accepted in healthcare improvement; however there is little overarching evaluation of how the method is applied. This paper proposes a theoretical framework for assessing the quality of application of PDSA cycles and explores the consistency with which the method has been applied in peer-reviewed literature against this framework.
methodsNHS Evidence and Cochrane databases were searched by three independent reviewers. Empirical studies were included that reported application of the PDSA method in healthcare. Application of PDSA cycles was assessed against key features of the method, including documentation characteristics, use of iterative cycles, prediction-based testing of change, initial small-scale testing and use of data over time.
results73 of 409 individual articles identified met the inclusion criteria. Of the 73 articles, 47 documented PDSA cycles in sufficient detail for full analysis against the whole framework. Many of these studies reported application of the PDSA method that failed to accord with primary features of the method. Less than 20% (14/73) fully documented the application of a sequence of iterative cycles. Furthermore, a lack of adherence to the notion of small-scale change is apparent and only 15% (7/47) reported the use of quantitative data at monthly or more frequent data intervals to inform progression of cycles. DISCUSSION: To progress the development of the science of improvement, a greater understanding of the use of improvement methods, including PDSA, is essential to draw reliable conclusions about their effectiveness. This would be supported by the development of systematic and rigorous standards for the application and reporting of PDSAs.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.