Module 4 Appendix

PDSA Worksheet for Testing Change

Aim: (overall goal you wish to achieve)

Every goal will require multiple smaller tests of change

Describe your first (or next) test of change:Person responsibleWhen to be doneWhere to be done


List the tasks needed to set up this test of changePerson responsibleWhen to be doneWhere to be done


Predict what will happen when the test is carried outMeasures to determine if prediction succeeds

Do      Describe what actually happened when you ran the test

Study  Describe the measured results and how they compared to the predictions

Act      Describe what modifications to the plan will be made for the next cycle from what you learned

Cambridge, MA: Institute for Healthcare Improvement. Adapted with permission.

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Page last reviewed May 2013
Internet Citation: Module 4 Appendix: PDSA Worksheet for Testing Change. May 2013. Agency for Healthcare Research and Quality, Rockville, MD.