PDSA Template

School:
District:
Participants:
Date range of PDSA Cycle:
Cycle Number:
Area of Focus Based on Data
Describe your school’s data (Index, AMO, other school context data)
Which subgroup will be the focus of your CoP intervention?
o  Students with disabilities
o  English Learners
o  Socio-economically disadvantaged
o  Racial/Ethnic group: ______
What outcome areas were you trying to address?
o  Academics – ELA
o  Academics – Math
o  Academics - High School Readiness (for middle schoolers)
o  Academics – Graduation
o  Social Emotional/Culture-Climate: Absenteeism
o  Social Emotional/Culture-Climate: Student/Staff/Parent Perceptions of Climate
o  Social Emotional/Culture-Climate: EL Redesignation
o  Social Emotional/Culture-Climate: Disproportionality in SPED
o  Social Emotional/Culture-Climate: Social-Emotional Skills
o  Social Emotional/Culture-Climate: Suspensions/Expulsions/Discipline
o  Other: ______
PROBLEM OF PRACTICE
What is your problem of practice (e.g., what’s your problem statement)?
What your long-range goal for addressing this problem?
What is our short-term goal for this test?
PLAN
What is the Change (or strategy or approach) we are testing?
What do you need to do before you run the “test”?

What are the questions we want this “test” to answer?

If we do X (actions being tested)... / ...Y will happen (prediction)
1. If / 1. then
2. If / 2. then
3. / 3.
4. / 4.

How will we carry out the test?

What data and how will we collect data to evaluate our predictions?

DO
What happened? Describe observations, data findings, problems, and special circumstances.
Write down observations you had during your implementation. Ask, “Did everything go as planned?” “Did I have to modify the plan?”
Implementing the action steps:
Collecting evidence as planned:

STUDY

How do our results compare to our predictions?

Predictions (from above) / What actually happened?
1. If X then Y / 1.
2. If X then Y / 2.
3. / 3.
4. / 4.

What did we learn from the test? Were there any surprises we encountered?

ACT
What modifications or refinements should we make for the next cycle? What will we do next?
●  Options may include expanding the intervention to more classes, modify the original intervention and re-test, try a new intervention
●  Who can benefit from this learning?
●  How will you share your learnings across your CoP?

CoP Binder 2015-16 Document #7