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									 Research and Theory for Nursing Practice: An International Journal, Vol. 23, No. 2, 2009


        Implementing Practice Changes:
            Walk Before You Run

            e can learn a lot from the practice improvement literature (Langley, Nolan,
            Nolan, Norman, & Provost, 1996) about how to walk before we run when
            implementing evidence-based innovations in our health care organiza-
tions. Specifically, the cycle known as PDSA—Plan, Do, Study, Act—informs us about
how to conduct “small tests of change” before implementing a larger pilot test or
spreading a change throughout an organization. This RTNP issue’s Evidence-Based
Practice column focuses on describing the components of PDSA cycles, suggesting
how they fit into an EBP approach to improving the quality of care, and providing an
actual example of how the PDSA cycle was used to implement a nursing practice
change in a hospital.
    A PDSA cycle (see Figure 1) consists of the four components or phases stated
above (Langley et al., 1996). During the first Plan phase, a project team develops
specific objectives for the cycle, makes predictions about how the project will turn
out, and develops a protocol for implementing the small test of change. In the
second or Do phase, the test of the innovation is conducted, process issues are
elicited from participants, problems or issues with implementation are shared with
the project team, and, finally, team members begin to analyze initial feedback or
data. Data accumulated during phase two is evaluated completely during the Study
phase of the PDSA cycle. This data is then compared to the predicted or hoped for
implementation pro
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