<p> Rapid Cycle PDSA Worksheet for Testing Changes</p><p>Aim Statement: (Overall goal you would like to reach)</p><p>Person When to be Where to be Every goal will require multiple smaller tests of change Responsible done done Describe your first (or next) text of change Plan</p><p>List the tasks needed to set-up this test of change 1. 2. 3. 4. 5.</p><p>Predict what will happen when the test is carried out Measures to determine if prediction succeeds 1. 1. 2. 2. 3. 3. 4. 4.</p><p>Do Carry out the change/test, collect data, and begin analysis. Describe what actually happened when you ran the test.</p><p>Study Describe measured results, how they compare to the predictions. Did original outcomes improve? Complete analysis of data, summarize learning. </p><p>Act Are you ready to make a change? Plan for next cycle. Describe modifications to plan for next cycle from what you learned.</p><p> www.primaris.org PDSA Cycle</p><p>Organization:</p><p>Cycle #___/Date: ______Objective: PLAN</p><p>ACT DO</p><p>STUDY</p><p>Plan Questions: Predictions: Plan for change or test—who, what, when, where: Plan for collection of data—who, what, when, where:</p><p>Do Carry out the change or test, collect data, and begin analysis:</p><p>Study Complete analysis of data and summarize what was learned:</p><p>Act Are you ready to make a change? Plan for the next cycle.</p><p> www.primaris.org</p><p>MO-06-31-HPMP February 2006 This material was prepared by Primaris, the Medicare Quality Improvement Organization for Missouri, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. </p>