Application of PDCA Cycle in Quality Management: A Case Study

This case study examines the application of the PDCA (Plan-Do-Check-Act) cycle in the context of Onehealth hospital to improve quality management, particularly in nursing care. The study highlights the current quality gaps at Onehealth, including poor hygiene, inadequate patient care, and declining patient numbers. It reviews the PDCA cycle's stages, emphasizing planning, implementation, inspection, and action, and how it can be used to address these issues. The study proposes the PDCA cycle as a solution to enhance hygiene, standardize nursing procedures, and improve patient satisfaction. It also provides a literature review supporting the PDCA cycle as an effective tool for rapid change and continuous improvement in healthcare settings. This case study emphasizes the cyclical and iterative nature of the PDCA model, promoting gradual optimization and continuous improvement within the hospital's quality management system. The assignment is contributed by a student to be published on the website Desklib, a platform which provides all the necessary AI based study tools for students.

Running head: CASE ON APPLICATION OF PDCA CYCLE IN QUALITY MANAGEMENT
Case on Application PDCA Cycle in Quality Management
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Introduction and Problem Statement
The 21st century is an era of competition in medical service quality. The quality of
hospitals has become the first factor for most patients to choose a hospital. Among them, the
quality of nursing is a hospital nursing technology due to the extensiveness of nursing work. The
core of level management and the top priority of implementing quality leading strategy and new
service strategy. The PDCA cycle management method is a quality management activity that can
be effectively applied in various fields, as evidenced by multiple cases. Previously, some
scholars have shown that applying the PDCA cycle theory to the quality of care in hospitals can
further improve patient satisfaction. Reduce various medical disputes, improve the image of the
hospital, and promote the coordinated development of other aspects of the hospital. Many small
and medium-sized hospitals are far from perfecting the quality of care of large hospitals. At
present, the diagnosis and treatment of many hospitals shows that it is difficult and expensive to
see a large hospital, but many grass-roots small and medium-sized hospitals have a small number
of people. Even today, with the local governments attaching great importance and vigorously
promoting the hierarchical diagnosis and treatment system, this situation has not been well
resolved in many places (Hashim & Cuthbert 2014). The reason is that in addition to the
differences in medical resources between large and small hospitals, the quality of service
between the two is also an important reason for patient selection. The quality of hospital nursing
management is a concrete manifestation of whether the hospital can provide effective medical
services to patients. The use of PDCA cycle management method to improve the quality of
nursing care in small and medium hospitals can increase the competitiveness of small and
medium hospitals and promote the advancement of medical reform.
Problem statement

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Despite the fact that there are models that can help hospital improve the quality of their
services, Onehealth hospital has done little to implement any of the quality management tool. It
is because of this that the current paper intends to propose the need for adoption of PDCA cycle
management method as a quality improvement measure for Onehealth hospital
Literature Review
The PDCA cycle was first proposed by Dr. Deming, a well-known quality management
scientist in the United States, so it was also widely known as Deming Circle (Johnson &
Raterink 2009). The current international quality management concepts and methods are set in
conjunction with the PDCA cycle concept. From the perspective of the PDCA cycle itself, it
mainly refers to dividing the quality management work into four periods, which include the
planning period (P), execution period (D), inspection period (C), and processing period (A). In
the implementation of quality management, the obtained implementation results need to be
converted into corresponding management standards, and the relevant experience accumulated in
this cycle and the problems that need to be resolved will continue to be transferred to the
management activities of the next cycle to continuously The characteristics of circulation and
gradual optimization ensure the overall management quality (Seeber 2012). Each stage has its
specific content: guidelines, goals, plans, and management projects should be formulated in the
planning stage; the implementation stage is to implement specific countermeasures in a planned
way; the work in the inspection stage is to check the effect after implementation; the focus of the
processing stage It is to summarize successful experiences and implementation criteria; identify
gaps and unresolved issues, and then enter the next cycle. Specifically in the quality management
of hospital care, the PDCA cycle management method requires large rings to set up small rings,

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which promote each other, that is, the hospital is the large ring, the nursing department is the
small ring, each nursing unit is the small ring, each ring is stepped, one step Rotate one step.
P-stage- Planning
The first step in PDCA is planning stage. The stage aims to establish the necessary goals
and processes to provide results based on customer requirements and organizational policies.
When setting goals, an organization can use association diagrams and cause-effect diagrams to
systematically reveal the connections between various possibilities. At the same time, Gantt
charts are used to formulate planning schedules, so that the research progress can be determined
and effective control can be performed (Li et al 2015). The third step of planning stage is to
propose various solutions and determine the best solution. Distinguishing the major and minor
causes is the key to the most effective solution. Innovation does not simply refer to innovative
products created by invention, but also includes product innovation, product improvement, and
product imitation. The process is to set up a hypothesis, and then to verify the hypothesis.
D stage- Do
D stage of PDCA is to “Do”. That is, according to a predetermined plan and standard,
based on known internal and external information, a specific action method and plan are
designed and layout is carried out; according to the design plan and layout, specific operations
are performed to strive to achieve the desired goal (Wang 2015). The key tasks here is to design
specific action methods, schemes, layout, and take effective actions; product quality, energy
consumption, etc. are designed. By using and processing internal and external information of the
organization, design and decision making are contemporary. The most important core
competencies of the organization. The level of design and decision making determines

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organizational execution (Ting, Shojania & Montori et al. 2009). After the formulation of the
countermeasures, we entered the experiment and verification stage, which is the stage of doing.
In addition to implementing the plan and plan at this stage , the process must be measured to
ensure that the work can be implemented as planned. At the same time, data collection is
established to collect project records such as the original records and data of the process.
C-Stage- Check
The inspection of Phase C is mainly to check the specific implementation situation
against the various goals formulated in the first phase, and then to summarize the problems in the
implementation of the various systems in a timely manner (Gao 2016). In the feedback stage of
the inspection, it is important to strengthen the two-way communication between the head of the
department and relevant staff, and reach a consensus based on the inspection results, to find out
the root cause of the problem in order to take feasible measures.
Action stage
The main work of the disposal phase is to process the results of the check phase, to refine
and promote successful management experience in a timely manner, to summarize the existing
problems in a timely manner, and to propose relevant rectification measures and plans to achieve
continuous improvement (Xie 2015). If the problem is not resolved at this stage, it can be
resolved in the next PDCA cycle.
Case Description
At present, the nursing quality management in Onehealth hospital already has a mature
management system. It is difficult to reflect the requirements of modern quality management.
Traditional quality management believes that “people always make mistakes”, so nursing errors

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are allowed when formulating some quality standards, but this often makes nursing staff lower
their requirements, and thus also reduces the hospital's nursing quality management standard. In
addition, the current nursing quality management standards have relatively deadly rules for the
work steps of nursing staff. They are too procedural and cannot reflect the "patient-centric"
service concept, which greatly reduces the level of nursing service in the hospital. The number of
patients visiting the hospital is decreasing significantly as more prospective clients opt for other
hospital nearby hospital because of poor services and poor quality of treatment offered at
Onehealth hospital. Generally, Onehealth hospital experiences errors, poor diagnosis and poor
treatment of patients due to inability to make accurate diagnosis. The cases of transmission of
diseases within the hospital is high. This is because the procedures followed by nurses are not
standard.
Detailed explanation of synthesized literature
The PDSA cycle is an effective tool for rapid test change through planning, trial,
observation, and implementation. This is a scientific method for action-oriented learning. Many
US quality improvement practitioners are convinced that using the PDSA cycle can quickly
locate the current improvement project at which stage, and can quickly predict the future
development trend of quality improvement projects (Tea, Ellison and Feghali 2008). It should be
noted that PDSA is cynical. The end of a PDCA cycle means the beginning of the next fantasy.
Because work is inherently periodic and continuous. Work improves after one cycle, but it is
impossible to solve all problems. The remaining problems need to continue to find solutions to
the problem. The working configuration is not unique, nor does it have an optimal solution, only
the most suitable solution (Badri, Attia and Ustadi, 2009). Over time, we need to constantly find

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more suitable solutions. The size of the unit will continue to expand with the improvement of the
overall work capacity, which also requires the new PDCA cycle to continue to cooperate with it.
Another important feature of PDCA is that it is carried out stepwise. The PDCA cycle not
only repeats itself, but also has the characteristics of the previous cycle to guide the next cycle,
which is constantly evolving and gradually optimizing. In the specific implementation process,
the "inspection (C)" and "processing (A)" links can accumulate experience in the PDCA cycle
and analyze the deficiencies in the work. In the next cycle, there will be focus arrangements
(Chang, Chiu and Chen 2010). Work, focus on solving problems that have not been solved
before, and avoid mistakes of previous work. Therefore, every PDCA cycle has room for
improvement. In the continuous cycle, the goal set by the work is infinitely close.
One advantage of PDCA is that it can be applied in every department in hospital. It can
be applied in quality department, human resource department and operation department. The
work will focus on application of PDCA on quality department. The quality management system
is cyclical, at the beginning of each cycle, an assessment is made of the possibilities of satisfying
consumer expectations, technologies are developed, work is carried out, and efficiency is
assessed. Based on the evaluation of the results, changes in resources and technologies are again
planned (Bani-Hani and Al-Omari, 2012). Within the framework of the quality management
system, taking into account consumer opinions, identifying deviations from the standard,
analyzing the causes of these deviations, encouraging distinguished ones for the better (creating
positive motivation instead of the negative one used in the quality control system, appears where
the identification of deviations from the specified quality parameters is punished administratively
or economically) (Hall, Moore & Barnsteiner 2008). The most important element of the system
of continuous improvement (ensuring) of quality is the widespread, at every workplace,

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conducting activities in order to increase the efficiency and effectiveness of activities. PDCA
cycle (Deming cycle: Plan - Do - Check - act) “works” in healthcare as effectively as in other
sectors, because improving the quality of medical care leads to a decrease in costs and losses
(Bastable, 2011).
Case summary
Currently, Onehealth hospital has a lot of quality gaps that can only be addressed through
PDCA cycle. The hygiene and sanitation is poor. The quality of care is poor and the number of
customers are currently opting for nearby hospitals. . In addition, some medical staff had
problems such as insufficient hand washing time, wrong six-step hand-washing steps, long nails,
and wrong hand-drying methods. Some nursing staff do not pay enough attention to the nursing
process, the procedures are random, and the inspection feedback is not timely.
Proposed solutions
PDCA cycle can help Onehealth address the quality and care gaps identified above. As
stated, poor hygiene at hospital leads to hospital-borne infection and transmission. With PDCA
cycle, Onehealth hospital can have practical experiences on how to handle hygiene issues. PDCA
can reduce hand pollution and reduce the spread of pathogenic bacteria. Correct hand washing
can remove hand skin dirt, debris and some pathogenic bacteria. The PDCA cycle can guide in
analyzing and rectifying the problems that occurred in management (Tomolo, Lawrence & Aron
2009). Through the six-step hand-washing video teaching, watching could deepen the impression
of medical staff, and improve the qualification rate of hand washing.
Evaluation plan

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Actual improvements can only be proven through measurement evaluation. Medical
institutions need to consider how much difference an improvement can make in practice. And
medical institutions need to agree on what data to collect when evaluating improvements. If the
change in the assessment results moves towards the expected results, then it can be considered an
improvement. At the end of each month, the completion of each month's work is sorted,
calculated, and compiled into a work plan to complete the report, mainly to check the timely
processing rate of received and sent documents, the seal management error rate, the publication
of the academic journals, and the publicity rate (Moen & Norman 2010). Whether the target is
met, etc. Complete the report against the previous month's work and analyze the degree of
completion of the work improvement goals. Onehealth can use indicators such as the incidence
of hospital related transmission, the umber of hygiene related problems, the number of patients
who visits the hospital and overall recovery rate.
Conclusion
Nursing quality management is the process of planning, organizing, coordinating, and
controlling the various elements that make up the quality of care to ensure that nursing services
meet and exceed the needs of patients. It includes the establishment of a quality management
system; the formulation of nursing quality standards; the quality control of the nursing process
and the elements that constitute the quality of nursing; the mobilization of all nursing staff to
participate in quality management. The entire hospital's service quality management requires
nursing management. Therefore, the nursing quality management is comprehensive and
comprehensive. At the same time, the quality of care is not an auxiliary quality issue, it has its
own independence. Nursing work is a big link in the whole hospital work. In this big link, there
are many small jobs. This requires the management of nursing quality to strengthen continuous

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and whole-process management. By adopting PDCA cycle, Onehealth would stand a chance of
improving the quality of its services, increasing its competitive advantage and attracting more
clients. Applying the PDCA cycle helps the organization become agile and quickly integrate
organizational learning. This involves identifying the sources of variability and their negative
and relative impacts, and eliminating or reducing these variabilities as much as possible by
modifying the design, processes or business rules of the supply chain. Contingency plans are
developed to manage the remaining risks. Using multiple PDSA cycles can help the quality
improvement team better achieve the improvement goals. Although the continuous PDSA cycle
focuses on the improvement of a certain link, in the actual operation process, it can also reflect
other contents that need to be improved in the intervention of the medical link.

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