The PDSA cycle looks like this:

Plan – Identify your project. What do you want to improve, and how will you do it?

• Choose a project that can be repeated over multiple cycles.
• Decide your aim.
• Assemble a team.

Do – Put your plan into action:

• Make your changes.
• Collect data.
• Document what happened.

Study – Analyse and evaluate your data:

• Display your data and look for trends.
• Determine whether you achieved your aim.
• Evaluate whether the project was a success.

Act – Decide what to do next:

• Adopt your improvements.
• Adapt by making any adjustments needed, so you can run the whole cycle again.
• Abandon the changes you made if they didn't work.

This process is sometimes referred to as "adapt, adopt, abandon".

A clinical audit involves comparing your current clinical outcomes against defined, evidence-based standards, and making improvements to meet those standards.

The clinical team receive data and feedback to measure improvements through repeated cycles.

The steps are:

1. Identify your topic or problem.
2. Decide the standard or criteria against which you will compare your findings.
3. Collect your data for comparison.

   You can generate and collect data as part of a new project, or use existing data, provided you know that it is reliable and that the method of collection was suitable.

4. Analyse your data and compare it with the standard or criteria.
5. Decide what changes are needed, based on how close you are to the standard you set.

As the name suggests, Lean Six Sigma is a combination of the Lean, and Six Sigma tools, aimed at improving processes.

• Lean is an approach that improves processes by eliminating operational waste. Waste in this sense can be something physical or time. It is any undesired output that makes a process less efficient, and slows or stops you getting the desired end result. Even a problem that seems quite removed from direct patient care can have an effect further down the track.

  Lean relies on people to identify what is causing waste.

• Six Sigma is a tool that aims to improve end results by consistently reducing or removing defects in a process.

  Six Sigma relies on data to identify where problems occur in work processes.

• Lean Six Sigma uses a five step process.

The Model of Improvement asks three questions before going into the PDSA cycle:

1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What change can we make that will result in improvement?
4. Plan – Do – Study – Act

Performance benchmarking involves comparing a process or service against those of a similar organisation that is doing the same thing to a good standard.

For example you might compare:

• service quality, using patient survey/satisfaction results
• patient outcomes in a particular scenario
• time to carry out a process
• efficient use of staff and facilities.

Once you've identified areas of strength/weakness, you can make a plan for change where needed.

Statistical Process Control (SPC) is the use of statistical techniques to identify where processes can be improved. Any process with a measurable output can be used.

Statistical results can be plotted onto SPC charts to show data over time. The chart gives a visual indicator of results that are within, or outside, acceptable tolerances. When changes are made, the same processes are run and the results compared.