Evaluating the design and implementation of an adapted Plan-Do-Study-Act (PDSA) approach to improve health system bottlenecks in Nigeria
Bibliographic record
Abstract
Abstract Background The Plan-Do-Study-Act (PDSA) cycle is fundamental to many quality improvement (QI) models. For the approach to be effective in the real-world, variants must align with standard elements of the PDSA at the design stage. The adapted design must also be implemented with fidelity. Gaps at the adaptation or implementation stages result in design and implementation failures respectively. Using Taylor’s framework, this study evaluates the alignment between theory, design and implementation of the DIVA (Diagnose-Intervene-Verify-Adjust) model, a PDSA variant adapted for Nigeria’s health system performance improvement. Methods An iterative consensus building approach was used to develop a scorecard evaluating new conceptual indices of design and implementation of QI interventions (design and implementation index, defects and gaps). The scorecard assigned quantitative scores that measured the extent to which the reported or documented design or implementation activity aligned with Taylor’s theoretical framework. Results Design (adaptation) scores were across all standard features indicating that design was well adapted to the typical PDSA. Conversely, implementation fidelity scores were only optimal with two standard features: prediction-based test of change and the use of data over time. The other features, use of multiple iterative cycles and documentation, had implementation gaps of 17% and 50% respectively. This may imply that observed effectiveness deficits of DIVA may be attributable to implementation rather than design gaps. Conclusions The effectiveness of QI interventions depend of good contextual adaptation and implementation fidelity such that core features (theory and internal logic) must not be compromised. This study demonstrates how both adaptation and implementation are important for success of QI interventions. It also presents an approach for evaluating other QI models using Taylor’s PDSA assessment framework as a guide, which might serve to strengthen the theory behind future QI models, and provide guidance on their appropriate use.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.089 | 0.083 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.004 | 0.003 |
| Open science | 0.002 | 0.004 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".