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Step 3: Implement the Plan

Once you have trained your staff and identified processes to implement developmental screening, you will want to perform small tests to figure out the best way(s) to integrate these new processes into practice workflow. This toolkit uses the Plan-Do-Study-Act (PDSA) approach to quality improvement (QI) to help you figure out which strategies fit best into your practice. This method provides a systematic framework to help you refine your strategies and tasks, document the process, communicate with staff, and work through issues that may arise.


Plan Do Study Act (PDSA)

The PDSA Worksheet will help you plan and test implementation strategies. Use the worksheets you completed in Step 1, and the training information in Step 2 to create an implementation plan for each screen or screening-related activity. Then use the PSDA Worksheet to test it, evaluate how it went, and decide what to do next. You will need to complete a new PDSA worksheet each time you run through a test. The second page of the PDSA Worksheet has an example to help guide you through the process. This 3-minute video will also provide more information on what to do for each step of the PDSA.





PDSA Worksheet Guidance

  1. Plan: Develop a test and make a prediction
    Use the information you have already gathered to create a plan for how you are going to integrate new services into your clinic’s workflow. Who will be performing the task? What specific things will they need to do? Where will the task be performed? When will it happen? Answer these questions and make a prediction about what you think the outcome will be.
  2. Do: Conduct the test and collect data
    Carry out the plan you created. Start small. You can test out your tasks on a few patients, with a few providers, or over a short period of time. Document what happened and include any data you were able to gather (formal or informal).
  3. Study: Analyze the data and summarize results
    How did it go? Look at the data you collected and summarize the results. Note what went well, as well as any barriers or challenges you encountered. Compare the actual results to the prediction you made in the Plan phase of the PDSA cycle. How do they compare?
  4. Act: Refine changes for the next cycle
    Based on the results, decide what to do next. The 3 options are:
    • Adapt: Consider what changes could be made to improve the way your process was implemented. Get a new PDSA worksheet and go through these steps again, this time with those modifications. Continue making small changes and working through the PDSA cycle until you find a strategy that works well.
    • Adopt: If you are satisfied with how the test went and want to implement it across the clinic, create a timeline for bringing it up to full scale.
    • Abandon: If your plan did not work at all, or you have gone through this cycle a few times and nothing seems to be working, you may want to abandon the idea. If you decide to abandon this plan, consider other strategies that could get you closer to your desired results.

There are many free, evidence-based QI trainings available to support QI teams. Visit the Resources page to view some of our recommended resources on this topic.

Electronic Health Records





Integrating developmental screens into your practice’s electronic health record (EHR) will make it easier to ensure consistent service delivery and track data. EHRs can help minimize redundancy, direct anticipatory guidance, document topics covered at each visit, and cue topics for subsequent visits.

Although we cannot customize your practice’s specific EHR system for you, we do have some recommendations for things to consider. EHRs can typically be modified to provide prompts based on the age of the patient/which well-child visit the patient is there for. You can build in prompts that bring up milestone checklists to review with families, as well as the screening tools themselves. Prompts can alert your clinic staff that a screening needs to be completed (based on the recommended screening periodicity). If your EHR system supports an online patient portal, use the portal to send out checklists or screens to caregivers before a visit; and follow-up resources afterward.


  Need Help? Our developmental screening expert is available to assist you with planning and implementing PDSA cycles. Check out our Implementation Training and Support page to get our contact information and learn more about how we can help.