Leadership PDSA and the Psychology of Change

Leadership PDSA and the Psychology of Change


Dave Verble offers a compelling suggestion for leaders who want their organizations to embrace and practice continuous improvement:

“I believe if leaders experiment with these five new behaviors the impact on engagement will be remarkable:

  • Asking questions they don’t think they already know the answer to

  • Listening to the person not just the problem

  • Acknowledging they heard and what they heard (nothing does more to show respect)

  • Asking questions focused on things they wonder about, not about what they are thinking

  • Ask what help is needed or wanted”

Dave offers the advice in a short article on leader behavior, here, part of a three-part series, all parts worth reading.

Explicit use of the Plan-Do-Study-Act cycle to test these behaviors will drive insight and build skill as part of purposeful practice. 

To qualify as a PDSA cycle, Gerald Langley et al. (2009), The Improvement Guide, 2nd edition, Jossey-Bass:  San Francisco, chapter 5, outline the basics.

A leader will plan the test of one or more of the behaviors, including prediction(s) of what will happen; attempt the plan and observe what happens; set time aside to compare the data with predictions and study results; act to repeat the test under new conditions, modify the expression or details of the behaviors, or decide to set the behaviors aside in some settings.  

While skilled leaders will use most or all the behaviors in both formal and informal settings, you can test the behaviors one at a time.


In a current project that aims to improve a hospital’s unit level management, we’re carrying out a test with one unit, based on the approach described here.   Our approach includes a weekly stand-up huddle to review performance.  The ‘single minute huddle’—a huddle less than 10 minutes--will review performance measurements and unit level actions to improve quality, cost, and staff effectiveness.  The unit already does a daily huddle overlapping the night and day shift that reviews status of patients on the unit and asks about any equipment or supply problems.  The daily huddle aims to create situational awareness about the patients already on the unit or soon to arrive.  By analogy, the weekly management huddle aims to create situational awareness about the unit’s work processes.

The senior executive sponsors of the project will be invited to the weekly huddle.   Will they be more than tourists?  Verble’s suggestion offers a way:  the leaders can practice elements of his engagement bundle.

Given that the weekly huddles are not the place for extended discussion and problem-solving, there will be only a minute for the leaders to practice.   Any of the behaviors is worth testing.   If it isn’t clear which one(s) to choose, start with the listening behaviors—"Listening to the person not just the problem” and “Acknowledging they heard and what they heard (nothing does more to show respect)”.  Asking what help is needed or wanted invites an exchange that can help the unit move forward.

Connection to the Psychology of Change

Last year, Kate Hilton and Alex Anderson summarized the psychology of change relevant to improvement activities, Hilton K, Anderson A. IHI Psychology of Change Framework to Advance and Sustain Improvement. Boston, Massachusetts: Institute for Healthcare Improvement; 2018, available here.

They outline five components to activate people’s agency:  Unleash intrinsic motivation; co-design people-driven change; co-produce in authentic relationship; distribute power; adapt in action.

In their discussion of co-production, Hilton and Anderson advocate for authentic relationships that include the behaviors flagged by Verble:  asking open-ended questions for which the questioner does not already know the answer; demonstrating that the person asking questions has indeed heard the answers offered; and have a genuine exchange between people working to achieve a common purpose.

The value management project at the hospital provides a test bed for management at the unit level.  It also provides a test bed for leadership behaviors to sustain engagement and improvement.



The Problem-Solving Process

The Problem-Solving Process

Job Instruction

Job Instruction