Tool K: PDSA cycle checklist Cycle # Start date: Meeting # date End date: – Objective of cycle ____Collect data to develop a change ____Test a change* ____Implement a change** objective of the cycle: Plan Questions: ? Prediction: ? Prediction: ? Prediction: ? Prediction: Note: Test/Implementation plan: What change will be tested or implemented? *For test cycles reference p96 of Improvement How will the change to be tested or implementation be conducted (consider small scale early)? for testing checklist Who will run the test or implementation? **For Implementation cycle reference p136 of Improvement Guide for implementation checklist When will the test or implementation take place? Collect data plan (usually required for all PDSA cycles): What information is important to collect? Why is it important? Who will collect the data? Who will analyse the data prior to study? Where will data be collected? When will the collection of data take place? How will the data (measures or observations) be collected?
Tool K: PDSA cycle checklist Cycle # Meeting # – date Start date: End date: Objective of cycle ____Collect data to develop a change ____Test a change* ____Implement a change** objective of the cycle: Plan Questions: ? Prediction: ? Prediction: ? Prediction: ? Prediction: Note: *For test cycles reference p96 of Improvement for testing checklist **For Implementation cycle reference p136 of Improvement Guide for implementation checklist Test/Implementation plan: What change will be tested or implemented? How will the change to be tested or implementation be conducted (consider small scale early)? Who will run the test or implementation? When will the test or implementation take place? Collect data plan (usually required for all PDSA cycles): What information is important to collect? Why is it important? Who will collect the data? Who will analyse the data prior to study? Where will data be collected? When will the collection of data take place? How will the data (measures or observations) be collected?
ARRC-quality-improvement-toolkit-Tool-K-Mar-2016.docx