Ehlers, Lars Holger

Knudsen, Søren Valgreen

Laursen, Henrik Vitus Bering

Mainz, Jan

English

    Aalborg UniversitetDoes Quality Improvement improve the Quality of Care? A Systematic Review of theEffect and Methodological Rigor of the Plan-Do-Study-Act (PDSA) MethodKnudsen, Søren Valgreen; Laursen, Henrik Vitus Bering; Ehlers, Lars Holger; Mainz, JanPublication date:2018Document VersionPublisher's PDF, also known as Version of recordLink to publication from Aalborg UniversityCitation for published version (APA):Knudsen, S. V., Laursen, H. V. B., Ehlers, L. H., & Mainz, J. (2018). Does Quality Improvement improve theQuality of Care? A Systematic Review of the Effect and Methodological Rigor of the Plan-Do-Study-Act (PDSA)Method. Poster presented at ISQua International Conmference 2018, Kuala Lumpur, Malaysia.https://epostersonline.com/isqua2018/node/2358General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            ? Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            ? You may not further distribute the material or use it for any profit-making activity or commercial gain            ? You may freely distribute the URL identifying the publication in the public portal ?Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Downloaded from vbn.aau.dk on: November 25, 2020Does Quality Improvement improve the Quality of Care?A Systematic Review of the Effect and Methodological Rigor of the Plan-Do-Study-Act (PDSA) MethodS. V. Knudsen1, H. V. B. Laursen2, L. H. Ehlers2, J. Mainz11) DACS - Danish Center for Clinical Health Services Research, Psychiatry - Aalborg University Hospital, Denmark 2) Danish Center for Healthcare Improvements, Aalborg University, DenmarkBackgroundThe Plan-Do-Study-Act (PDSA) method is essential in many Quality Improvement (QI) strategies. The scientific literatu-re, however, has previously indicated that the evidence for effect of the method is at best limited. A problem is low fi-delity to central elements of the method which hampers the interpretation of reported improvements and the effects in terms of better clinical practices and patient outcomes. To assess whether these limitations are still actual, we re-viewed recently published studies describing PDSA-based QI-interventions by self-reported improvement and use of key features in the study designs.MethodsA systematic literature search was performed in the PubMed, CINAHL and Embase databases. Studies published in 2015 and 2016 using PDSA in a clinical setting were included. A framework was created to assess the use of the following key features: • iterative cyclic method• use of a theoretical rationale• continuous data collection• small-scale testing.ResultsOf the 120 individual studies included less than a third set a specific, quantitative aim and reached it. In addition, more than half of the projects did not set an aim but claimed to have achieved improvements. A total of 72 studies docu-mented PDSA-cycles sufficiently for inclusion in full analysis for key PDSA-features.Regarding use of key features, 10 studies (14%) used small scale testing, 26 studies (36%) had an explicit theoretical ra-tionale, 48 studies (67%) used measurements over time and 75 studies (79%) used iterative cycles (figure 1A).All key features of the method were applied in 3/72 studies (4%), while 20 (28%), 26 (36%), and 18 (25%) used three, two, and one feature, respectively. Five studies (7%) lacked all features (figure 1B).Conclusion This systematic review documents methodological challen-ges in recently reported PDSA-based QI interventions. Indi-vidual improvement projects should strive to contribute to a scientific foundation for QI by conducting and documenting with a high rigor.There seems to be a need for methodological improvement in quality improvement initiatives.Figure 1: A) Bar-chart depicting how often the four key features were used across the studies. Figure 1: B) Bar-chart depicting the amount of studies, which had used zero to four key features.

Does Quality Improvement improve the Quality of Care? A Systematic Review of the Effect and Methodological Rigor of the Plan-Do-Study-Act (PDSA) Method

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Does Quality Improvement improve the Quality of Care? A Systematic Review of the Effect and Methodological Rigor of the Plan-Do-Study-Act (PDSA) Method

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