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Meta-Analysis
. 2019 Oct 4;19(1):683.
doi: 10.1186/s12913-019-4482-6.

Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects

Søren Valgreen Knudsen  1   2 , Henrik Vitus Bering Laursen  3 , Søren Paaske Johnsen  4 , Paul Daniel Bartels  5 , Lars Holger Ehlers  3 , Jan Mainz  4   6   7   8
Affiliations
Meta-Analysis

Can quality improvement improve the quality of care? A systematic review of reported effects and methodological rigor in plan-do-study-act projects

Søren Valgreen Knudsen et al. BMC Health Serv Res. .

Abstract

Background: The Plan-Do-Study-Act (PDSA) method is widely used in quality improvement (QI) strategies. However, previous studies have indicated that methodological problems are frequent in PDSA-based QI projects. Furthermore, it has been difficult to establish an association between the use of PDSA and improvements in clinical practices and patient outcomes. The aim of this systematic review was to examine whether recently published PDSA-based QI projects show self-reported effects and are conducted according to key features of the method.

Methods: A systematic literature search was performed in the PubMed, Embase and CINAHL databases. QI projects using PDSA published in peer-reviewed journals in 2015 and 2016 were included. Projects were assessed to determine the reported effects and the use of the following key methodological features; iterative cyclic method, continuous data collection, small-scale testing and use of a theoretical rationale.

Results: Of the 120 QI projects included, almost all reported improvement (98%). However, only 32 (27%) described a specific, quantitative aim and reached it. A total of 72 projects (60%) documented PDSA cycles sufficiently for inclusion in a full analysis of key features. Of these only three (4%) adhered to all four key methodological features.

Conclusion: Even though a majority of the QI projects reported improvements, the widespread challenges with low adherence to key methodological features in the individual projects pose a challenge for the legitimacy of PDSA-based QI. This review indicates that there is a continued need for improvement in quality improvement methodology.

Keywords: Health services research; PDSA; Plan-do-study-act; Quality; Quality improvement.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Plan-Do-Study-Act (PDSA) based quality improvement. Each cycle informs the subsequent cycle. Ideally, the complexity and size of the intervention is upscaled iteratively as time pass, knowledge is gained and quality of care is improved
Fig. 2
Fig. 2
PRISMA diagram
Fig. 3
Fig. 3
a) Bar-chart depicting how often the four key features were used across the projects. b) Bar-chart depicting the number of projects, which had used zero to four key features
See this image and copyright information in PMC

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