Summary of PDSA cycles
| PDSA | Aim | Strategy for change | Key learning | Impact on change process |
| Measurement 1 | Review questionnaire content by domain | Two linked cycles using interviews with front-line staff on unit | Staff predicted that patient understanding would be best for follow-up and worst for medication. Barriers: Medical jargon (people in the system) and different descriptions of the same condition given to patients (tasks in the system). Facilitators: Doctors always floating around so patients could ask questions. | The patient questionnaire should have multiple questions surrounding medication changes to understand what part is misunderstood. Information given to patients should avoid medical jargon. |
| Measurement 2 | Assess response rate and patient rating of understanding on all questions | Three linked cycles testing with patients | Despite consenting 10 patients the response rate was only 4. Patients rated their understanding very highly.47 Questionnaire should be given verbally to not exclude those with poor vision or low literacy. | Need to consent as many patients as possible to compensate for low response rate. Need to measure comparative understanding of patients to determine true understanding of domains. Telephone questionnaire determined as method of data collection. |
| Measurement 3 | Develop scoring system to assess patient knowledge | Four linked cycles of testing with patients | Admin team needed to come on board with project to print out EDDs. Three scales were required as there were both Likert and binary questionnaire answers. In addition, medication changes were complicated to grade so needed a separate criterion. It was hard to create a robust scoring system due to the heterogeneity of patient conditions. | Comparative scoring to allow true patient understanding to be determined so true impact of change could be assessed. |
| Change ideas 1 | Identify facilitators and barriers to change through review of driver diagram | Two cycles of interviews with staff | Facilitators: Staff willingness to help patients; repetition of information to patients; use of discharge summary to provide information. Barriers: Time constraints of staff; patients not interested in managing their condition; mood of patient being stressed or tired; staff confidence in conveying information; staff overestimation of patient understanding. | Use jargon free EDD1 for patient information, create educational materials for doctors with interactive presentations, poster for the ward and summary document for each doctor. |
| Change ideas 2 | Use patient preferences to revise structure of the information to general practitioner in the EDD | Two cycles of interviews with patients | As anticipated patient preference was spacing out information; signposting and avoiding jargon. Tested three formats for information: (1) block text; (2) spaced out information with signposting (headings); and (3) spaced out bullet points. | Patients preferred structure 2: ‘it was clear the information that was being given’. In contrast to less preferred structure 1 as she was ‘lazy and it was less appealing’. Information given to patients will use the format of 2. |
| Documentation 1 | Improve patient information and consent forms | One cycle of interviews with patients | Revise from long pieces of text to check box statements of agreement. Include contact information. Supplement with verbal information, especially for patients with vision or literacy problems. | Revised information sheet was friendlier to patients as it had key information and made it simpler to identify what they were agreeing to. Will add patient Community Health Index number and participant number on the back of consent forms to make it easier for admin to find the EDDs. |
| Documentation 2 | Develop spreadsheet for patient questionnaire responses from telephone interviews | Four cycles of telephone interviews with patients | Find appropriate ways to code the information given. Make it easier to navigate the spreadsheet during telephone interviews by using bold headings. | Use symbols to code recurring response, for example, ‘/’ for question irrelevant to the patient ‘*’ for a detail omitted from the EDD |
EDD, electronic discharge document; PDSA, Plan-Do-Study-Act.