[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Nursing](https://durgical.com/en/nursing/) › [Care management](https://durgical.com/en/nursing/areas/management/) › The PDCA (PHVA) cycle in nursing services # The PDCA (PHVA) cycle in nursing services - Safe practice PDCA (Plan, Do, Check, Act) is a repeating cycle for testing a small change, measuring its effect and keeping, adjusting or dropping it. Updated Nov 12, 2026 ## Key points - Plan: the goal, the change, the indicator and when data will be collected. Do: try the change. Check (Study): analyse the data. Act: adopt, adapt or drop it. - Start small (one shift, one ward, a few patients) and scale up as confidence grows. - Run linked cycles: what you learn in one cycle shapes the next. - Measure before and after, and often (for example monthly), so a real change can be told apart from chance. - In Colombia, autocontrol (plan, do, check, adjust) is the first level of the audit for quality improvement. ## What it is The PDCA cycle, called PHVA in Spanish (planear, hacer, verificar, actuar), is the basic method of continuous quality improvement. A version called PDSA replaces Check with Study to stress learning from the data. Open RN frames improvement around three questions: what are we trying to accomplish, how will we know a change is an improvement, and what change can we make. The team plans a change and how it will be measured, tries it, studies the data and decides what to do next; then the cycle repeats. Colombia's quality rules describe the same logic as autocontrol: each member of an institution plans, carries out, checks and adjusts the procedures in which they take part. A systematic review found that most published projects ran a single cycle and few measured data often enough, so the method works best as a series of small, well-measured cycles. ## What it requires - A clear, measurable aim (what, how much, by when) agreed with the team. - A baseline: the current value of the indicator before any change. - A prediction of what the change will achieve, written down before testing. - Regular data collection and a time set aside to review it with the team. - A record of each cycle so the next one starts from what was learned. ## Components - Plan (Planear): define the problem, the aim, the change to test, the indicator and the timeline. - Do (Hacer): carry out the change on a small scale and collect the data. - Check or Study (Verificar): compare the results with the baseline and the prediction. - Act (Actuar): adopt the change, adjust it and test again, or drop it. ## How it is applied (and why) - Choose a problem that matters to patients, using data such as falls or incident reports: improvement starts from a measured gap, not an impression. - Write an aim with a number and a date (for example, fewer falls on the ward within six months): a clear aim tells you when you have succeeded. - Measure the baseline with a defined indicator: without a starting value you cannot show improvement. - Plan one change with the team and predict its effect: staff who help design a change are more likely to carry it out. - Test it small, on one shift or a few patients: small tests limit risk and teach quickly. - Collect the data as planned and on time: frequent data show the trend instead of a single snapshot. - Study the results with the team and compare them with the baseline and the prediction: this is where the learning happens. - Act: adopt the change, adjust it or drop it, then start the next cycle: improvement is continuous, not a one-off project. - Document each cycle and share the results with the unit: feedback keeps staff engaged and avoids repeating failed ideas. ## A worked PDCA cycle (made-up example): fewer falls on a medical ward | Phase | What the team does | Example | | --- | --- | --- | | Plan | Sets the aim, the change and the indicator | Baseline of 6 patients who fell in one quarter; test hourly rounding on the night shift for patients at risk | | Do | Tries the change on a small scale | One team applies the rounding for one month and records each round | | Check | Compares the data with the baseline | 2 patients fell during the test month; staff say the rounds are hard to keep at shift change | | Act | Adopts, adjusts or drops the change | Keeps the rounding, moves one round away from shift change and extends the test to the day shift | ## In nursing practice - Typical nursing PDCA projects target falls, pressure injuries, catheter infections, medication events, hand hygiene and patient experience. - Each person at the bedside applies the same loop to their own work: plan the care, give it, check the result and adjust. - PDCA evaluates and improves existing processes; it is not the same as research, which looks for new knowledge. ## Common mistakes - Running a single cycle and calling the project finished. - Testing the change on the whole hospital at once instead of starting small. - Not measuring a baseline, so the result cannot be compared. - Collecting data too rarely to see a trend. - Not writing down a prediction or the lessons of each cycle. ## Test yourself Think of the answer, then tap the question to see it. ## What do the four letters of PDCA (PHVA) stand for? Plan, Do, Check (or Study in PDSA) and Act: planear, hacer, verificar y actuar. ## Why should a PDCA change be tested on a small scale first? Small tests limit risk, give quick feedback and let the team adjust the change before spreading it to the whole unit. ## What weakness did a systematic review find in most published PDCA projects? Most ran a single, isolated cycle instead of linked cycles, and few collected data often enough to show change over time. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/nursing/the-pdca-cycle-in-nursing-services/) ## Connections ## Related 4 - [Quality of nursing care: indicators and how they are measured](https://durgical.com/en/nursing/quality-of-nursing-care-indicators-and-how-they-are-measured/) - [Managing nursing care: planning, organising, directing and controlling a unit](https://durgical.com/en/nursing/managing-nursing-care-planning-organising-directing-and-controlling-a-unit/) - [Colombia's mandatory health-care quality system: habilitación, auditoría and acreditación](https://durgical.com/en/nursing/colombia-s-mandatory-health-care-quality-system-habilitacion-auditoria-and-acred/) - [Preventing falls: risk assessment and measures](https://durgical.com/en/nursing/preventing-falls-risk-assessment-and-measures/) [← All of nursing](https://durgical.com/en/nursing/) Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order. Sources: [Nursing Management and Professional Concepts, 9.3 Measuring and Improving Quality](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Management_and_Professional_Concepts_1e_(OpenRN)/09%3A_Quality_and_Evidence-Based_Practice/9.03%3A_Measuring_and_Improving_Quality) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts edition, 2022); [Systematic review of the application of the plan-do-study-act method to improve quality in healthcare (BMJ Quality & Safety)](https://pmc.ncbi.nlm.nih.gov/articles/PMC3963536/) (Taylor MJ et al., open access in PubMed Central, 2014); [Decreto 780 de 2016, Decreto Único Reglamentario del Sector Salud (art. 2.5.1.4.2, niveles de la auditoría: autocontrol)](https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%200780%20de%202016.pdf) (Ministerio de Salud y Protección Social (MinSalud), Colombia, 2016). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/nursing/the-pdca-cycle-in-nursing-services/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/the-pdca-cycle-in-nursing-services/