Keep calm, start small and measure

Does the thought of PDSA cycles send you into a spin? Does the mention of measurement make your heart sink? Well, sit back, keep calm and read this blog!

Plan, Do, Study, Act

As National Improvement Advisor for Focus on Dementia Programme at QuEST at Scottish Government, my focus is on improving the experience, safety and coordination of care for people with dementia, their families, carers and staff. So where do Plan Do Study Act (PDSA) cycles and measurement come into this?

Picture 1

PDSA cycles are small tests of change which enable teams to plan, test out ideas, study the results and act on these ideas. By starting small, the risks are less and it is safer and less disruptive for people using the service as well as for staff.

When developing something new people can often interpret things differently and so testing a new idea out on a small scale, even initially with just one person on one day, can help to iron out any issues before sharing with a few more. This approach helps get something which is fit for purpose and by engaging with people at very early stages there is usually more ownership and less resistance to change.

So what about measurement?

Measurement is key in showing the impact of these small changes and whether these changes have resulted in improvement. It lets us know how well the process is performing, whether we have reached our aim, how much variation is in our system, whether the changes are making an improvement and have been sustained over time. Data for improvement is continuous and real time, telling us what is happening now in the system and over time. It doesn’t need to be complicated. Start with pen and paper and draw a chart for that week.

Focus on Dementia

Within the Focus On Dementia Programme we are working with teams across Scotland to test out new ideas on a small scale. The model for improvement has provided a helpful framework in clearly setting out the aim of the improvement work, choosing measures and testing ideas using PDSA cycles.


Starting small has many benefits and doesn’t mean that we stay small. The learning and results from this work will be shared across Scotland, Europe and internationally and will inform Scotland’s next Dementia strategy in 2016.

The Next Big Idea

So when you next have an improvement idea, think about what you want to achieve (your aim), how you will know the change will be an improvement (measures) and test small (PDSA). Start with one person on one day. Go back to basics with pen and paper and keep it simple! In other words, keep calm, start small and measure!

I would welcome any comments on this blog and your reflections on the questions I have presented to you below:

  • What is your “next big idea” to improve the experience, safety and coordination of care for people with dementia, their families, carers and staff?
  • How will you know that a change is an improvement?
  • What changes can you make that will result in improvement?


For more information visit Focus on Dementia : and follow us on twitter via @FocusOnDementia

michelleMichelle Miller – National Improvement Advisor, Focus on Dementia

@MichelleMillrx @FocusOnDementia

Michelle is the National Improvement Advisor for Focus on Dementia programme at QuEST at Scottish Government.  Michelle works in partnership with key agencies including Joint Improvement Team and Alzheimer Scotland and health and social care practitioners, to provide an improvement infrastructure to support developments in post diagnostic support and testing the 8 pillar model of community support for people with dementia, their carers and families.


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