Act

Review and make changes

What do you need to do next – the adopt, adapt, or abandon decision.

What you do next depends on how successful your project has been so far.

You could:

• Adopt – Make permanent changes to systems or processes.

  To adopt successful changes, you could:

  • embed changes to your standard procedures
  • present the results to the whole team so they see the impact of your changes
  • train people to do things differently.
• Adapt – Adjust the changes you've made.

  You could:

  • adjust your processes
  • collect more or different data, if your data wasn't useful or accurate
  • make changes within the team or the environment
  • run another cycle of the project.
• Abandon – Change what you're doing if it hasn't worked.

  If there was no improvement, use what you have learned to either:

  • revise the existing plan substantially before running it again
  • start afresh with a new plan.

The adopt, adapt, abandon decision is crucial to give the project long-term value to the practice.

When making decisions about what to do next, consider:

• If you're thinking of adopting changes permanently, can you sustain them for the long term? If not, you may need to adjust instead.

  Think about whether you can keep your planned improvements going over time:

  • Do you have enough people to sustain the improvements without causing staffing issues somewhere else?
  • Do you have the equipment or other physical resources you need?
  • Are your ongoing staffing and equipment needs affordable?
  • How can you embed the improvements into practice systems and culture?
• If the project has been successful, can it be scaled up to achieve more improvement?

  In future, is it possible to repeat this project:

  • with a larger group?
  • with a different set of people?
  • for a longer time?
  • using a different setting or scenario?

Keep moving forward

At this point, you've completed one PDSA cycle.

However, a PDSA cycle is meant to be continually repeated. The idea is to carry out a small experiment, learn from it, adjust it, trial the adjusted version, learn from that version, and so on. Repeat the whole process again through numerous cycles.

Even if your project met or exceeded its overall goal, look for small ways to improve what you're doing.

This is how your project will lead to continued quality improvement.

Whichever options you choose, remember to:

• communicate your results to everyone involved, including patients and the practice community
• celebrate successes
• keep on revising things.