This mixed-methods study used direct observation and interviews to determine whether plan–do–study–act (PDSA) cycles were implemented as planned in a series of quality improvement efforts. The authors found that initial training efforts did not support PDSA implementation and that careful project selection, redesigned training, and hands-on support were all required to support frontline teams in using the PDSA method.

This systematic review of the plan-do-study-act method of quality improvement showed that most studies do not report on the key methodological features of iterative cycles, tests of change, and data use in real time.

A classic article that told one patient's tale of the "hospitalization from hell"—an elective admission for an orthopedic procedure that was marked by disorganized, inefficient, and inattentive care—exemplified the need for patient-centeredness as an essential component of high-quality care. Since then, patient satisfaction has become an important quality metric for both hospitals and clinics. This systematic review provides strong evidence supporting the use of patient experiences in this fashion. The authors found a moderately strong correlation between better patient experience and improved patient safety and quality of care metrics across a range of patient populations and health care settings. These findings allay concerns that patient perspectives might focus more on service quality than patient safety and support efforts to improve the patient experience as part of an overall safety improvement strategy.

This survey of physicians about the UK equivalent of the "July effect"—a tradition of nearly 50,000 new doctors starting on the first Wednesday in August—found a high degree of concern for patient care, safety, and training. The authors conclude that there is a need for structural changes.