PDSA Cycle: Plan, Do, Study, Act

Plan

• Determine how you will incorporate new procedures into your office flow. The workflow should identify by whom, how, when, and where oral health risk assessments, anticipatory guidance, oral examination of teeth and gums, preventive care provided such as fluoride varnish application, and other related activities will take place. In some practices, the workflow may delineate a handoff from one member of the practice to another.
  • Establish documentation processes for activities such as the following:
  • Establishment of the dental home
  • Referral to the dental home
  • Caries risk assessment, which may include an oral health previsit questionnaire
  • Anticipatory guidance and educational materials provided and discussed
  • Follow-up plan, as applicable
  • Recall/reminder alerts to verify those referred to a dental professional have established care or follow-up
• Determine staff roles and responsibilities. You may want to identify a dental champion to lead the practice in establishing oral healthcare procedures and conducting PDSA cycles.
• Train providers and staff on techniques such as examinations and fluoride varnish application and provide ways for them to demonstrate confidence in such techniques (eg, role-play exercises).
• Identify educational materials to share with patients and families.
• Identify and develop relationships with dental providers in the community so you can match referrals to patients’ needs.
• Establish billing and payment procedures for oral healthcare services.

Do

• Pilot the processes you have laid out, allowing staff a chance to evaluate their feasibility for the practice and patients.

Study

• Gather feedback from staff on the new processes. What worked? What did not work?
• Use the information gathered to help refine and improve your processes.
• Stay current with oral health initiatives, guidelines, and best practices. Talk with other pediatric practices and members of your AAP chapter or district about their experiences and what is working for them.

Act

• Implement changes that resulted in success.
• Standardize improvements and begin to use them regularly.
• Consider formalizing processes in office policy/procedure documentation.
• After some time, return to stage 1, Plan, and re-examine processes to determine what can be further improved. The value of the PDSA cycle is the continuous search for improvement.