1. PDSA Planning & Progress Form
Start Date End Date (estimated)
PLAN
Specific Objective: What idea or process do we want to test during this cycle? What do we want to
learn?
What exactly will we do? What are the steps involved in carrying out our test?
Who will be involved in each step? What are each person’s roles and responsibilities?
Where will it take place?
When will it take place? If appropriate, when will each person need to complete their step?
What do we predict will happen?
What do you need to measure to see if our idea is leading to improvement? (e.g., counts, short
surveys, percentages, verbal feedback). Consider staff and patient reactions.
Describe what happened. Was the test carried out as planned? Did anything unexpected cause us
DO to deviate from the plan? What did we observe that was not part of the plan?
What were the results of our measurements? How did or didn’t the results agree with our
STUDY predictions? What were our key learnings? Include data gathered through our measures.
ACT Next steps? Do we abandon? Modify and test again? Move to testing of implementation?
March 26, 2007