Q&A: Using the PDCA model for quality process improvement

January 16, 2019
Medicare Web

Q: I have heard of the Plan, Do, Check, Act process for quality management. Can you explain how this process works?

A: New projects must follow a set process. The case manager should be involved in the project design, analysis, and adjustments. Consider following a quality process improvement model when initiating a project. PCDA is a userfriendly process and well suited for interdisciplinary teams.

  • Plan. Identify a need and an opportunity. The project leader assembles a team to review the necessary change and conduct a literature review to determine best practice based on evidence. A detailed project plan is written with attention to data collection and measuring outcomes. The project manager creates a cost benefit analysis to explain the business case for the change. The team may propose changes that involve workflows but without increased costs. The project leader will organize education for the team and discuss the reason for the change and why it is necessary. Team members have an opportunity to question and offer additional suggestions to contribute to the success of the project. The project manager and the team may have to present the project to key stakeholders prior to implementing the project.
  • Do. Test the project; initiate a pilot. The pilot project is implemented. The project manager pays close attention to detail through the entire project to ensure all deviations from the original plan are documented. The team reports unplanned circumstances to the project manager, and these too are detailed.
  • Check. Review the pilot; analyze what you have learned. The project manager implements the evaluation or check phase in the continuous process. He or she measures outcomes against the planned metrics and determines whether the new process or intervention was successful on the pilot scale.
  • Act. Take action based on the project results. If it was not successful, the team reassembles and reviews the data associated with the intervention and with the outcome measures. The process continues with another planning stage. The team develops another plan or a variation of the original plan and the process. If the pilot is successful—in that it produced the outcome metrics expected—the team may report to the stakeholders and prepare to launch the project. The project manager initiates the project systemwide or includes additional units in the project, and the process will continue with the plan for the project expansion.

For more information, see Case Management Guide to Population Health. Need expert advice? Email your questions for consideration in the Revenue Cycle Daily Advisor. Note: We do not guarantee that all questions will be answered.