RAPID PDSA CYCLES

Application guide (2008–2010)

Contents
1 Introduction…………………………………………………………………………………………..2
2 Rapid PDSA cycle criteria…………………………………..………………………………………2
3 Background information for completing page 1 & 2 of the Rapid PDSA application form…..2
3.1 Domains of general practice…………………………………………………………….2
3.2 Specific topic requirements……………………………………………………………...3
3.3 Procedural and emergency medicine grants for rural and remote GPs ……………3
3.4 International classification of primary care (ICPC) system…………………………..3
4 Background ‘Preparation, planning and implementation’ information……………………..…..4
4.1 Select a leader/facilitator and decide who will be in the PDSA group……………...4
4.2 Topic and change principle…………...…………………………………………………5
4.3 Plan – what, who, when, where, predictions and data to be collected.…………….5
4.4 Do – implement the plan and record .………………………………………………….6
4.5 Study – review and reflect on results…………………………………………………..6
4.6 Act – what action will you take now?.......................................................................6
5 Additional information for completing application…….………………………………………….6
5.1 The effectiveness of the group………………………………………………………….6
5.2 Suggest ways that you’re your group could be improved..…………………………..6

6 QA&CPD processes after the Rapid PDSA cycle……………………………………………….7

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1 Introduction
The ‘plan,do, study,act’ (PDSA) cycle is the implementation of a planned program that has as its
primary focus systematic changes in general practice. It measures the effectiveness of the
program by monitoring the effects of change over a relatively short period of time. This module:
• encourages a general practice to implement a plan that starts with manageable small
changes, which can be readily incorporated in planned larger scale improvements
through successive cycles of change
• emphasises starting on a small scale, reflecting and building on learning
• can be used to test suggestions for improvement quickly and easily based on existing
ideas and research, or through practical ideas that have been proven to work elsewhere.
This application guide provides background information that will assist general practitioners (GPs)
to organise a high quality activity that is likely to attain QA&CPD Program standards and criteria.
Refer to the QA&CPD Program handbook (2008–2010 triennium) for general information
regarding, and specific examples of, Rapid PDSA cycles.

2 Rapid ‘plan, do, study, act’ cycle criteria

• Assign a facilitator
• A minimum of two (one GP and one other [eg. Practice manager/practice nurse/receptionist])
and a maximum of 10 participants
• A minimum of three rapid PDSA cycles must be completed within a 3 month period to gain
Category 1 points
• May be conducted face-to-face, via teleconference or as an online group. A mixture of
technology may be used.

The following eight steps in the Rapid PDSA cycle need to be completed.
1. Select a leader/facilitator and decide who will be in the PDSA group
2. Discuss the following questions:
o What are we trying to accomplish?
o How will we know that a change is an improvement?
o What changes can we make that can lead to an improvement?
3. Select a topic
4. Start the first rapid PDSA cycle using the appropriate QA&CPD forms:
o Plan (what, who when, where, predictions and data to be collected)
o Do (implement the plan and record)
o Study (review and reflect on results)
o Act (what action will you take now)
5. Develop the second cycle
6. Develop the third cycle
7. At the completion of the PDSA cycle describe what mechanisms have been put in place
to promote reliable use of the improvement
8. Complete the QA&CPD application and send to your state faculty QA&CPD unit.

3 Background information for completing page 1 & 2 of the Rapid PDSA

application form

3.1 Domains of general practice

General practice is defined by the RACGP as the provision of primary, comprehensive and
continuing whole patient care to individuals, families and their community. After an extensive
review of the literature and consultation through the profession, the RACGP has identified five
broad domains of competence as a framework representing the scope of general practice.
The five domains are:
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• communication skills and the patient–doctor relationship

• applied professional knowledge and skills
• population health and the context of general practice
• professional and ethical role
• organisational and legal dimensions.
General practitioners need to identify relevant domains of general practice on the Rapid PDSA
application form to enable GPs and the QA&CPD Program to readily identify the content of the
education activity. This data will also be reflected on an individual basis on GP online credit point
statements to assist GPs to identify gaps in their learning.

3.2 Specific topic requirements

The QA&CPD Program flags activities for GPs who have additional requirements in specific areas
separate to activity point allocation. Indicate on the form against the relevant topic area if the
clinical audit includes material that is significantly related (greater than 50% of the content) to any
of the specific interest topics.

3.3 Procedural and emergency medicine grants for rural and remote GPs
The Commonwealth Government is offers rural and remote procedural GPs and locums (practising
obstetrics, anaesthetics and / or surgery in areas classified RRMA 3-7) a grant of $2000 per day
for up to 10 days a year to assist them in accessing skills maintenance and up-skilling in their
procedural disciplines. In addition, GPs and locums delivering hospital based emergency medicine
in RRMA 3-7 can access grants of $2000 per day for up to 2 days per financial year for emergency
medicine CPD.
Eligible training activities must be a minimum of 6 hours (can be two 3-hour sessions), be pertinent
to obstetrics, anaesthetics, surgery or emergency medicine and can be courses or clinical
attachments.
An activity can be approved for either a procedural or emergency medicine grant or both if it has a
minimum 6 hours each of relevant procedural content and relevant emergency medicine content.
For further information please contact Pauline Curtis, the National Rural Faculty, phone
1800 636 764 or 08 8267 8351 or email Pauline.curtis@racgp.org.au.

3.4 International Classification of Primary Care (ICPC) system

The International Classification of Primary Care (ICPC) system is an internationally recognised
coding system designed for primary care that was developed by the World Organisation of Family
Doctors (WONCA).
It classifies information relating to why the patient has come for the consultation, the problems
managed during the encounter, procedures, referrals, and imaging and pathology tests.
The ICPC system has been endorsed as the Australian standard for classification in general
practice and patient self-reported data and is distributed exclusively in Australia by the Family
Medicine Research Centre (FMRC) at the University of Sydney.
GPs can access ICPC codes at www.globalfamilydoctor.com/wicc/pagers/english.pdf or access a
demonstration package at www.fmrc.org.au/classifi.htm about the ICPC system.
Why do GPs use ICPCs?
General practitioners use the ICPC system to retrieve data for auditing, quality assurance or
continuity of care. The data retrieved is more reliable than manually counting patient records to find
out how many patients in their practice are being treated for a particular condition.
Why is the QA&CPD Program using ICPCs?
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The RACGP Examination process has used the ICPC system for sometime in the matrix of
examination questions to ensure that GPs are competent in core general practice areas. By
continuing to use the ICPC system within the QA&CPD Program, GPs will be able to complete
education activities that meet their individual learning needs using the ICPC matrix to identify areas
for further study.
By coding education activities against ICPCs, the QA&CPD program will be able to identify the
medical areas GPs are currently receiving education in and match this with data that identifies the
national health priority areas. The QA&CPD Program will then be able to analyse gaps in GP
education and work towards ensuring activities are provided in national health priority areas.
In addition, the QA&CPD calendar of events will be able to specifically identify ICPC areas to allow
GPs to tailor their education to suit their individual needs. It is envisaged that GPs will be able to do
a search for particular ICPC areas on the RACGP website and be able to identify a range of
educational activities and resources that can assist their continuing professional development.

Example of ICPC code for a Rapid PDSA cycle

Using the example in the handbook on page 40 this Rapid PDSA cycle activity could be allocated
the following codes:
P-45 = Psychological (P), -45 process code for observe/educate/advice/diet

4 Background preparation, planning and implementation for Rapid PDSA

Cycles
4.1 Select a leader/facilitator and decide who will be in the PDSA group
Before starting your PDSA cycle you will need to nominate a facilitator. The facilitator can be
rotated however it is usually best if the facilitator has some training which is available through the
college and other organisations. The group also needs to decide on its members and as PDSA
cycles are a quality review activity it is often very useful to include other members of your team
such as practice managers/nurses, receptionist/s, allied health professionals. It may even be
appropriate to include a consumer representative. These team members can often ensure that the
change is implemented in the practice in a reliable way.
The facilitator
The facilitator’s key role is to:
• be aware of the group's functioning
• be alert to 'blockages' or impediments to optimal engagement and participation
• constructively steer the group towards a productive way of working.
Key characteristics of successful small groups include:
• shared understanding and commitment to agreed goals and objectives
• shared understanding of the principles of confidentiality and privacy within the group
• agreed on basic rules for interaction and decision making processes
• appreciation of the value of diverse views and opinions
• individuals having the right to constructively express themselves without fear of criticism
or rejection.

When participating in a group, most group members are focused on the content issues being
discussed or addressed by the group. A key feature of the facilitator’s role is to 'step back' and
monitor the group’s process and the quality of interactions between participants. If the facilitator
becomes aware of a 'blockage' in any of these three components, s/he can bring it to the attention
of the group to be resolved.
Common 'process' issues to remain alert for might include:

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Is there a dominant individual who is limiting opportunities for others to contribute?

Consider:
• 'directing traffic' a little by specifically addressing group members who have not been able
to contribute; use names to invite contributions.
• forming 'break out' groups to discuss issues and increase opportunity for contribution.

Are interpersonal issues interfering with group discussion?

Consider:
• re-establishing or reiterating the 'ground rules' for participation (no interruption, avoid
negativity and negative body language, personal comments etc).
• refocussing the discussion on content issues if personal issues are interfering.

Is the group 'digressing' or drifting off topic?

o Consider restating agreed objectives for the meeting, and consciously focus discussions by
relating them back to your goals and objectives.

Is discussion leading to a conclusion - or is it circular?

Consider
o alerting the group to a circular discussion, and prompting the group to make a decision or
move forward to another topic.
o writing major issues down, reassure that the group will return to reconsider them, and seek
agreement to move on.

4.2 Topic and change principle

What idea do you want to test?
Knowing what needs changing and then setting goals for improvement is the first step in planning.
One way of getting started is to conduct a needs assessment which can be conducted by auditing
case notes, using practice team’s knowledge, conducting patient surveys and/or reviewing what
suggestions they offer for improvement. Your team may want to discuss other means of conducting
a needs assessment that is specific to them and your practice.
Discuss the following questions:
• What are we trying to accomplish?
• How will we know that a change is an improvement?
• What changes can we make that can lead to an improvement?

The next step is to gather the practice team together to consider the information obtained in the
needs assessment and to prioritise processes you want to change. The key to success is to
choose a few areas where change is relatively simple to achieve, and where there are likely to be
clear and measurable benefits for GPs, practice staff and patients. A coordinating group of
interested practice staff should be convened to manage the process.
4.3 Plan – what, who, when, where, predictions and data to be collected
Consider the following:
• What do you want to achieve, what actions need to happen and in what order?
• Who will be responsible for each step and when will it be completed?
• What resources are required?
• Who else needs to be kept informed or consulted?
• How will you measure changes to practice?
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• What would we expect to see as a result of this change?

• What data do we need to collect to check the outcome of the change?
• How will we know whether the change has worked or not?

4.4 Do – implement the plan and record

Put the plan into practice and test the change by collecting the data. It is important that the ‘do’
stage is kept as short as possible, although there may be some changes that can only be
measured over longer periods. Record any unexpected events, problems and other observations.
4.5 Study – review and reflect on results
• What were the results?

• Did they differ from the group’s expectations? (If so, how/why)?

• What has the group learned from completing this cycle?

4.6 Act – what action will you take now?

Make any necessary adaptations or improvements, acknowledge and celebrate successes. Collect
data again after considering what worked and what did not. Carry out an amended version of what
happened during the ‘do’ stage and measure any differences.
An example of a Rapid PDSA cycle is provided in the QA&CPD Program Handbook (page 40) and
further examples are offered in the RACGP Putting prevention into practice: guidelines for the
implementation of prevention in the general practice setting (2nd ed).
It is a minimum requirement of this category 1 activity to develop and complete a minimum of three
cycles. Groups are also required to consider what mechanisms have been put into place to
promote reliable use of the improvement.

5 Additional information for completing application

5.1 The effectiveness of the group
When the Rapid PDSA group has decided to complete their module, it is recommended that the
group reflects on positive and negative aspects of the rapid PDSA cycles. This reflection is aimed
towards assisting GPs to raise issues in a non threatening environment that will allow the group to
improve. At this reflection time you may consider some of the following:
• Where all team goals achieved?
• Where the goals realistic?
• Did the energy invested lead to the desired degree of change. Is the return worth the
effort?
• Have the factors that helped or hindered the change been documented?
• Are there any further strategies or measures needed to bring about the desired changes
and/or improve cost effectiveness?

5.2 Suggest ways that your group could be improved

After reflection on the group’s effectiveness it is recommended that suggestions are made on ways
the group can be improved. Ideas for improvement might be:
o Asking all participants to review an article before meeting if possible
o Organise some group training on any weak areas of critical appraisal or research skills if
required.

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6 QA&CPD processes after the Rapid PDSA cycle

At the end of each Rapid PDSA cycle module (minimum of three cycles within a 3 month period),
each GP participant should be listed on the application form along with their QA&CPD number.
Each GP participant should complete a ‘Rapid PDSA – Individual GP Review form’ personally
reflecting on the following:
o What areas of knowledge were you hoping to improve during your Rapid PDSA
cycle?
o What learning strategies did you complete during your participation in the Rapid
PDSA cycle? eg: discussions with peers, reading, testing systems in the practice
o How will you apply what you have learned into your daily practice?
o If any new systems were discussed with your group, please explain how these
affect your daily practice?

To obtain 40 Category 1 points for each GP involved in the Rapid PDSA module the following
should be completed.
• Rapid PDSA Application form (at completion of module)
• PDSA cycle forms (minimum 3)
• Individual GP Review form (1 per GP participant for each Rapid PDSA
Module)

All completed forms should be submitted to your state QA&CPD unit for adjudication.

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