Quality improvement in nursing homes works best when it is structured, measurable, and grounded in daily operations. One of the most effective tools for this work is the Plan Do Study Act cycle, often referred to as PDSA. This simple framework helps facilities test changes, evaluate results, and refine processes without disrupting care or overwhelming staff.
The PDSA cycle is a continuous improvement method designed to test small changes in real time. It breaks improvement work into four clear steps:
CMS expects nursing homes to use systematic, data-driven methods to identify, monitor, and improve care processes under the QAPI regulations (F865). The PDSA cycle is one of the primary tools facilities use to demonstrate ongoing performance improvement and leadership oversight.
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In nursing homes, PDSA cycles are commonly used to address clinical, operational, and regulatory challenges. Examples include reducing falls, improving infection control practices, strengthening documentation accuracy, or addressing repeat survey citations. Facilities often apply PDSA as part of their Quality Assurance and Performance Improvement (QAPI) work, testing changes on a small scale with real data before broader implementation.
This method supports interdisciplinary collaboration. Small-scale testing may include resident groups, CNA assignments, shifts, or hallways, allowing teams to learn quickly without disrupting facility-wide operations. Nursing, therapy, dietary, and administrative staff can participate in identifying issues and reviewing outcomes, which builds shared accountability and a sense of ownership in improvement work.
The strength of the PDSA cycle lies in its practicality. It does not require large-scale changes or complex technology to be effective. Benefits include:
Helps identify root causes instead of treating symptoms
Surveyors often look for evidence that a facility understands its challenges and is actively working to improve systems. Documentation of each PDSA cycle- including the goal, data reviewed, decisions made, and follow-up actions- helps demonstrate an active and effective QAPI program during survey. Even brief summaries can show meaningful improvement work over time. Well-documented PDSA cycles show thoughtful analysis, follow-through, and leadership oversight.
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PDSA is a central tool within a strong QAPI program, which is required for nursing homes and emphasizes data collection, performance measurement, and sustained improvement. Qsource supports facilities in developing or strengthening QAPI programs by providing tools, frameworks, and coaching that integrate PDSA and other performance improvement methods into daily operations. These resources help nursing homes formalize written plans, identify gaps in systems, and track improvements over time so they can consistently monitor results and sustain change. With a well-designed QAPI program, PDSA cycles become a foundation for measurable quality gains rather than isolated efforts.
As a long-standing partner to nursing homes, Qsource offers practical support that aligns directly with quality improvement goals. Our consultants work collaboratively with facility teams to bring structure and clarity to improvement efforts.
Our approach is collaborative, not one-size-fits-all. We work with facility leadership and frontline staff to build systems that fit the culture and capacity of the organization. This partnership fosters greater engagement and accountability, which are critical for long-term success.
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When used consistently and with support, the PDSA cycle becomes part of how a nursing home operates. Facilities that embed this process into meetings, performance dashboards, and staff routines are better prepared to respond to changing regulations, resident needs, and workforce challenges.
Over time, PDSA helps move facilities away from reactive responses. Teams gain confidence in testing solutions, reviewing outcomes, and making informed adjustments. This leads to stronger compliance, improved resident outcomes, and a culture of continuous improvement.
Improvement does not happen overnight, and PDSA is not about perfection. It is about structured learning. With the right support and tools, nursing homes can use this simple cycle to make steady, measurable progress toward safer, higher-quality care.