Fathers and Continuous Learning in Child Welfare Project

Instrument 12: Plan Do Study Act (PDSA) Worksheet

A Breakthrough Series Collaborative for

Engaging Fathers and Paternal Relatives in Child Welfare

The purpose of this document is to track your team progress with tests of change conducted as part of engaging fathers and paternal relatives in child welfare. It is intended to be a companion to the Collaborative Change Framework, with improvement in each measure moving you closer to the global aim of this Breakthrough Series Collaborative (BSC). Your team will plan and conduct tests of change to meet the aims of the Collaborative Change Framework and will usually conduct multiple PDSA cycles in order to achieve the aim. You can use this template to guide the information you input into SharePoint.

Public documentation burden for this collection of information is estimated to average 15 minutes per PDSA cycle. Providing this information is voluntary, and all responses that are collected will be kept private to the extent permitted by law.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this information collection is 0970-0531 and the expiration date is 07/31/2022.

Plan Do Study Act (PDSA) Worksheet

Improvement team name:
Date:	Team lead:	Cycle:

The Plan Do Study Act (PDSA) worksheet is a tool for documenting small tests of change. Using the worksheet, you will test practice changes that are based on the PDSA cycle process. In this process, teams develop a plan (Plan), carry out the test (Do), observe and learn from the test (Study), and determine what modifications are necessary in order for the outcome to be more successful (Act). This cycle is also known as a small test of change. You will enter this information into SharePoint.

Plan Do Study Act Worksheet

PDSA information: What are you trying to accomplish?

Team Name:

Start Date

End Date

CCF Domain most closely aligned with this PDSA:

Measure(s) you expect to impact with this PDSA:

Name of PDSA:

What is the Objective (Aim)?:

Description: What are we trying to accomplish?

Plan

Description: Describe what you plan to test.

a. What changes will be made?

b. What are the steps for the plan (who, what, where, when)?

c. What data will you collect? Who will collect it?

d. What do you predict will happen?

Do

Description: What actions were taken?

Study

Description: What were the results of your actions? Did the test work as expected? Why or why not?

Act

Description: What actions are you going to take as a result of this cycle? Will you adjust the strategy and keep it small, adjust the strategy and expand it, expand the strategy with no changes, or abandon the strategy?

Current Cycle

Description: How many times you’ve tested this strategy (e.g., first cycle, second cycle).

Status

Description: What is the current status of your test (In progress (still testing), Fully implemented, Sustainable, Abandoned)?

Updates

Description: Briefly describe what improvements your team has made to this test since the first cycle and your plans for the next cycle as you move it towards sustainable implementation.