Using the PDSA Cycle to Improve Well Child Metrics

Steve Reville, MD, MMM, FAAP
Physician Executive, Mary Bridge Children’s Hospital

At the November 4th Pediatric Population Health Forum, Samantha Hughes and I presented a breakout session on how we used the PDSA cycle of process improvement to improve our HEDIS (Healthcare Effectiveness Data and Information Set) metrics regarding well child checks in patients up to 15 months of age.  Samantha is the supervisor at the Mary Bridge Pediatrics primary care clinic in Auburn.  At the session, it came to light that the PDSA terminology was new to many, so I wanted to present the quickest of explanations regarding our approach to process improvement.

The PDSA cycle (Plan, Do, Study, Act) has been used to great effect for nearly 100 years in manufacturing, but it is a much more recent addition to the healthcare playbook.  The Institute for Healthcare Improvement (IHI) has been promoting the concept for about 15 years.  It sounds a bit formulaic at first, but it’s actually pretty familiar to practicing physicians if you think about how we diagnose and treat less straightforward pathology.  We start with some background information and develop a differential diagnosis and a Plan for how to proceed.  This may involve gathering more data (tests, symptom logs, inpatient observation), a trial of therapy, or watchful waiting.  The Do stage involves carrying out the plan.  The next follow-up visit is where we Study the results of our plan and then we Act on our new knowledge to make a new Plan, thus initiating the next PDSA cycle.

By implementing the PDSA formula and studying many small tests of change, the Mary Bridge Pediatrics clinic in Auburn in less than six months increased the percentage of patients who had at least six well child visits before they turned 15 months old from 58% to 78%.  A similar initiative in the same practice brought their no-show rate from 12% to less than 5%.  Process Improvement is a science, and the tools work.  Good luck with your own PI projects.  For more information check out this video from the IHI.