FOCUS PDCA: Creating a Culture of Continuous Quality Improvement

A Quality Improvement Devloped By Healthcare, for Healthcare

Medical instruments sit in a tray.
Medical instruments sit in a tray. Andrew Brookes/Getty Images

There are plenty of acronyms and labels for the many methodologies to improve quality in healthcare and they can be daunting to the untrained. Most, if not all, of the quality improvement methods do in fact require varying degrees of intensive training. However, one of the earliest and longest-lasting methods used in healthcare--FOCUS PDCA--can be explained in everyday speech, with common and accessible language.

Process Matters in Healthcare

The pressure is on to deliver higher quality care at lower costs. Everyone in the healthcare services continuum needs to pitch in to reach this goal. Devices, drugs, supplies, and equipment all need to be produced for the lowest possible cost. In the administrative and clinical areas of a hospital or clinic, there are many opportunities to reduce waste, including:

A Simple Plan

W. Edwards Deming created the acronym FOCUS PDCA so organizations could have a simple plan to eliminate waste in their production and service processes. This was a big shift from the old way of thinking. Before Deming started to persuade people to examine the process, companies typically only had a retroactive quality control effort.

That is, a process or service would happen, and hopefully someone checked the result of that effort. Anything that did not meet the benchmark standard would be re-worked. Deming's focus on process showed people that a greater impact on waste occurs when you begin upstream, by understanding the entire process, not just looking for the end result.


This acronym really packs a punch, here's what it stands for:

F for find a process to improve
O for organize a team that knows the process
C for clarify current knowledge of the process
U for understand the variability and capability of the process
S for select a plan for continuous improvement

PDCA, the acronym for Plan, Do, Check, Act, gives the team a continuous quality improvement cycle to test their improvement strategies one by one, in a controlled manner, to measure results and drive further improvements.

Sample Improvement

Using an example to work through a process improvement using FOCUS PDCA might look like this:

  • Find a process to improve: Discharge process for hospitalized heart failure patients over 65.
  • Organize a team that knows the process: Could include Chief of Cardiology, cardiology nurse, administration
  • Clarify current knowledge of the process: The team meets to create a flow chart or process map
  • Understand the process: The team measures the process as-is to determine a range of data, which in this example could be: (1.) what percentage of patients with heart failure, over 65, are readmitted within 30 days?; (2.) how long does it take the staff to discharge this type of patient?
  • Select what to improve: The team chooses to reduce the 30-day readmission rate.
  • Plan: The first plan they select is to set up heart failure patients over 65 with a connected health program upon discharge
  • Do: The team implements this one change during a fixed time period
  • Check: The team measures and checks the results of their connected health discharge intervention
  • Act: The team acts on the results. If the intervention worked, then the team keeps this new program in their discharge process. They may even take some action to try to further improve their 30-day readmission rate reduction. If the test did not improve 30-day readmission rates, they would try another idea, and run it through the PDCA Cycle.

    There are other, more complicated statistical tools and methodologies such as Six Sigma, which require intensive training. However, Deming's FOCUS-PDCA (some people refer to the "PDCA" Cycle as the "PDSA" Cycle...Plan, Do, Study, Act) is a great place to start, especially when you need to create an early victory to get people on board with making changes for improvement.​

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