FOCUS-PDSA: Applying Process Improvement Models

One of the most useful models for quality improvement initiatives in healthcare is PDSA (plan-do-study-act). The necessary four steps give nurses an ability to collect and analyze information and turn it into practical knowledge and a strategy that can be implemented in the unit and the organization (Agency for Healthcare Research and Quality [AHRQ], 2015). Nonetheless, this model can be improved further with the addition of FOCUS – an approach that considers underlying causes and issues that require change (Spath, 2013). The approach of FOCUS-PDSA is explained further concerning the practice problem of pressure ulcers.

Model Description and Implementation

FOCUS-PDSA is an enhanced approach to improving the quality of nurses’ performance. It includes nine steps, five of which focus on the analysis of the process and organizational details. The last four steps are directed at designing and implementing the program.

  • F – Find. The first action is to locate the problem and determine who will be impacted as the result of the change (Spath, 2013). In this case, the problem lies in the high rate of pressure ulcers that develop in patients residing in the facility. The project should lower the risks of pressure ulcers in patients that depend on nursing care and hospital supplies. As a result, the patients will be the main benefactors of the improvement process – they will not develop bedsores which will also lower the risk of infections and pain. Moreover, nurses and the hospital will also benefit. The hospital will decrease financial spendings from lowered readmissions, complications, and time of patient stay (Richardson, Peart, Wright, & McCullagh, 2017). The nurses will not have to deal with complications from pressure ulcers.
  • O – Organize. During this step, the project leader should organize a team of capable persons who will design the intervention. The group can include multiple nurses, including those with specifications in geriatrics and disability to address different populations. The nurse manager and a financial advisor should also participate to direct others and propose an available budget.
  • C – Clarify. Here, the team should explain which steps should be taken by the staff to improve the situation. For example, the current process does not incorporate visual cues for nurses to move patients in their beds. Thus, this factor should be implemented in the process.
  • U – Understand. It is vital to understand the underlying causes of the issue. One can monitor nurses’ current performance to evaluate noncompliance or use of outdated guidelines.
  • S – Select. The new steps to achieving progress should be selected. Gill (2015) suggests color coding patients with different levels of pressure ulcer risk, shortening periods between turning to 2 hours, and creating a new scale for patient assessment.
  • P – Plan. The planning phase involves analyzing the information gathered during the FOCUS part of the process. In this case, identified areas for improvement will likely be nurses’ lack of knowledge about the latest practices, low levels of compliance with pressure ulcers prevention activities. Furthermore, the failure to provide nurses with a regular schedule of assessment and patient moving and the use of poor-quality beds may also be outlined. The use of statistical analyses of acquired pressure ulcers may serve as a measurement of success.
  • D – Do. A small-scale implementation of the plan will include a schedule for nurses to turn patients every two hours. Assessment guidelines will be updated, and nurses will be trained in implementing them. Patients’ rooms or documents will show the risk of pressure ulcers, ranging from low to high probability.
  • S – Study. The data of acquired pressure ulcers, the length of patient stay, and the stage of developed ulcers will be measured and evaluated. Moreover, nurses’ rate of compliance and their understanding of the instructions will also be considered.
  • A – Act. The change activities will be updated according to the findings, and the improved version of the plan will be implemented in the unit.


Agency for Healthcare Research and Quality. (2015). Plan-do-study-act (PDSA) directions and examples. Web.

Gill, E. C. (2015). Reducing hospital acquired pressure ulcers in intensive care. BMJ Open Quality, 4(u205599.w3015), 1-5.

Richardson, A., Peart, J., Wright, S. E., & McCullagh, I. J. (2017). Reducing the incidence of pressure ulcers in critical care units: A 4-year quality improvement. International Journal for Quality in Health Care, 29(3), 433-439.

Spath, P. (2013). Introduction to healthcare quality management (2nd ed.). Chicago, IL: Health Administration Press.