Process improvement for behavioral health

Encourage Clients to Use PDSA Cycles to Test Their Own Changes


Clients are often stuck in ambivalence between wanting to change and at the same time, not wanting to change.


Encourage clients to use PDSA Cycles to pilot test their own personal changes.

Featured Stories

Gosnold, Inc. in Falmouth, Massachusetts increased continuation rates through four weeks of treatment from 72 percent to 88 percent by introducing a Gosnold Course of Solutions for patients to develop their own small scale, rapid-cycle changes using PDSA cycles, which they called Plan-Do-Measure-Act (PDMA) cycles. Patients made personal changes and tracked their progress. For more information, see the Gosnold Change Bulletin

Lessons Learned

  • This practice can be used by less experienced counselors.
  • Clients benefit from creating and succeeding at self-motivated change projects.

Tracking Measures

Cycle Measure

No-show rate for treatment sessions

Data Collection Form

No-show Tracking Spreadsheet



1. Select a group in which to test this change.

2. Collect baseline data to track the no-show rate at the selected group.


3. Encourage clients to use PDSA cycles to pilot test their own personal changes for the next two weeks.

4. Track and calculate the no-show rate for the selected group for the same two week period.


5. Check the fidelity of the change. Was the change implemented as planned?

6. Evaluate the change:

    • Did the no-show rate decrease?
    • How did clients react to using PDSA cycles for their own changes?
    • Does this change lesson the workload of your counselors?


7. Adjust the process used for having clients create their own PDSA cycles based on the experience of this group of clients and re-test this practice for two more weeks.

Repeat this series of steps until you have refined the process of having clients create their own PDSA cycles and expand this practice to other groups that would benefit.