“PDSAs are a tool from the Transformational Change Partnership that we have integrated into our work and decision-making at our agency. We often ask our clients to help develop PDSAs so we can incorporate their change ideas into our system.”
– Placer County Behavioral Health Professional and TCP Participant
The value of continuous quality improvement
Transformational change in public systems doesn’t happen overnight. It requires thoughtful experimentation, learning, and adaptation. One powerful tool for this process is Plan-Do-Study-Act (PDSA)—a structured, iterative approach that allows organizations to test small-scale changes before committing significant resources to full-scale implementation.
The Transformational Change Partnership (TCP) has seen firsthand how PDSA cycles empower counties to make data-informed decisions, reduce risks, and create sustainable improvements in behavioral health, education, and other public systems. By focusing on continuous learning, PDSA prevents costly missteps, preserves goodwill, and leads to more effective solutions.
What is PDSA?
PDSA is a structured, low-cost, rapid cycle approach that guides organizations through testing and refining changes to learn what works best before full implementation:
- Plan: Define the objective, make predictions, and outline the steps for testing a change, including data collection methods.
- Do: Carry out the test on a rapid small scale, document observations, and begin analyzing data.
- Study: Analyze results, compare findings to predictions, and summarize lessons learned.
- Act: Refine the change based on insights gained, determine modifications, and plan the next test.
Why PDSA Matters for System Transformation
When counties and public agencies adopt PDSA, they gain three critical benefits:
- Saves Resources: Instead of investing time and money into an untested implementation that may not work well, PDSA allows teams to test small changes first and learn what works best. This ensures that only effective strategies are scaled up, maximizing impact while minimizing waste.
- Preserves Goodwill: Too often, well-intentioned initiatives fall short, leaving stakeholders frustrated and disengaged. PDSA helps build confidence by ensuring that changes are refined and validated before full-scale implementation.
- Drives Better Outcomes: Learning through PDSA leads to stronger solutions than simply launching an initiative and making adjustments later. By iterating and improving at every step, organizations create programs that are not only functional but truly responsive to community needs.
Real-World Examples of PDSA in Action
Across multiple counties participating in the Transformational Change Partnership, PDSA has helped agencies navigate complex challenges and improve services. Here are a few examples of how public-serving organizations have leveraged this approach:
- Enhancing Mental Health Transitions for Justice-Involved Individuals: Placer County is applying PDSA to improve communication between in-custody providers and community-based mental health services. By testing how mental health clients booked in jail can be successfully connected to an appointment within 14 days of release, the county is identifying and addressing gaps in coordination and information sharing before expanding the approach.
- Expanding Youth Engagement in Service Design: Monterey County is using PDSA to test how to better involve students in shaping behavioral health services. By piloting empathy interviews, they aim to refine the questions and interview format to ensure youth voices are meaningfully included in decisions about service offerings and providers.
- Improving School-Based Behavioral Health Guidance: Santa Cruz County is using PDSA to test how best to disseminate and support the use of state materials on privacy regulations (HIPAA/FERPA) for school-based counselors. By piloting these materials with a small group of counselors and families, they aim to refine the content and its distribution strategy before a broader rollout.
Centering Equity in PDSA
In order to maximize the quality and effectiveness of a change, it is helpful to investigate who is at the table when designing and implementing PDSAs. Each phase of the PDSA cycle can integrate an equity lens by asking:
- Where did the change ideas being tested come from? Were impacted communities involved in generating potential solutions?
- Who was involved in planning and testing? Are diverse voices, including those most affected by the issue, engaged?
- Who is analyzing the results? Are stakeholders contributing to the interpretation of findings?
- How are disparities being addressed by the change? Are changes leading to improved equity in outcomes, or do they reinforce existing inequities?
Making PDSA a Standard Practice
Embedding PDSA into everyday operations shifts an organization’s culture from reactive to proactive. It creates a mindset of continuous improvement, where learning is valued, and innovation is encouraged. For counties engaged in transformational change, this approach ensures that new strategies are not just well-intentioned but proven to work before being widely adopted.
The Transformational Change Partnership supports counties in integrating PDSA into their system improvement efforts, helping public agencies move beyond guesswork to data-driven, community-informed solutions. As more organizations embrace this tool, they position themselves to create meaningful, lasting change—one cycle at a time.
Final Thoughts
Transformation is not about making one big change; it’s about making small, strategic changes that add up to something bigger. PDSA provides a roadmap for testing, refining, and implementing solutions that truly serve communities. By embracing this approach, public agencies can avoid costly missteps, sustain trust, and build systems that are both effective and equitable.
Interested in learning more about how PDSA can support your system improvement efforts? The Transformational Change Partnership is here to help.