Plan-Do-Study-Act Worksheet

A PDSA worksheet can help plan, organize and track the testing process. This Plan-Do-Study-Act Worksheet is also available in Word format (doc, 1 page)

Team Name: ___________________________

Overall team/project aim: _____________________

Start date: ______________________________

End date: ________________________________

What is the objective of the test?

What do you predict will happen?


Briefly describe the test:

How will you know that the change is an improvement

List of tasks, including data collection, necessary to complete the test (what) Person responsible When Where

Do: Test the change interventions

  1. Was the cycle carried out as planned? Yes No
  2. Data and observations recorded and attached? Yes No
  3. What did you observe that was not part of the plan?

Study: Assimilate and summarize lessons learned

Did the results match your predictions? Yes No

Compare the result of your test to your previous performance:

What did you learn?

Act: Decide to adopt, adapt or abandon

Adapt: Refine the change based on what you have learned and continue testing. List plans/changes for the next test.

Adopt: Select changes to implement on a larger scale. When ready, use additional PDSAs to implement change across the whole system. Develop an implementation plan and plan for sustainibility.

Abandon: Discard this change idea and try a different one. List the different change interventions.

Adapted from: Institute for Healthcare Improvement, How to Improve - Improvement Methods at :