Worksheet for Plan-Do-Study-Act (PDSA) Cycle Planning

Resource: PDSA Worksheet (PDF, 162 KB, 2 pages)

This worksheet is for primary care staff to help plan a quality improvement (QI) Plan-Do-Study-Act (PDSA) cycle, outlining the QI goals and how the practice will try to reach them, as well as providing space for actual outcomes and analysis of next steps. The practical, easy-to-follow steps for implementation and evaluation of a PDSA cycle support Key Driver 2: Implement a data-driven quality improvement process to integrate evidence into practice procedures.

Institution of origin: Qualis Health

Permissions: Used with permission of Healthy Hearts Northwest.

Acknowledgements: Adapted by Qualis Health from materials developed by the Institute for Healthcare Improvement prepared under contract with the Centers for Medicare and Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services.

Publication date: December 2012