Post by Deborah Udy Okusaga Akanne (@deborah_udy_okusaga)
The PDSA Cycle In NHS Interview Language — The Version That Scores Outstanding.
You have heard of the PDSA cycle.
Plan, Do, Study, Act.
You can name it. You may have used it. You may have referenced it in a previous interview answer.
And the panel scored you a 2.
Not because you were wrong about PDSA. Because you described it at the level of awareness — and the panel is scoring at the level of application.
Here is the difference — and this is the verified, specific NHS improvement framework language that changes your score:
PLAN — what the panel needs to hear:
The failing answer describes what you planned to change. We planned to improve the handover process.
The passing answer describes the problem analysis that preceded the plan — because in NHS improvement methodology, a plan without a problem analysis is not a plan. It is a guess.
Before planning any change, I conducted a process mapping exercise to identify the specific point in the handover pathway where information was being lost. I used a driver diagram to identify the primary and secondary drivers of the problem — and I identified that the root cause was not the handover format itself but the timing of the medical review that fed into it. That analysis shaped a change that was specific enough to test.
The words process mapping and driver diagram are NHS improvement methodology language. Saying them signals to the panel that you understand the analytical foundation of improvement work — not just the cyclical framework.
DO — what the panel needs to hear:
The failing answer describes implementing the change. We introduced a new handover template.
The passing answer describes a small-scale test — because the PDSA cycle is specifically designed around testing changes at a small scale before implementation. Testing at scale without first running a small PDSA cycle is not improvement methodology. It is implementation. And it is a governance risk.
I tested the change on a single ward, on a single shift, with a single team — specifically to understand whether the change worked as predicted before proposing wider adoption. This small-scale test allowed me to identify a modification that significantly improved the change before it was scaled.
STUDY — what the panel needs to hear:
The failing answer describes the result. The handover improved.
The passing answer describes measurement against a baseline — because improvement without measurement is not improvement methodology. It is anecdote.
I measured against the baseline I had established before the change — specifically [named metric: percentage of complete handovers, time to task completion, error rate]. The measurement confirmed a [specific percentage] improvement against baseline — which gave me the evidence to recommend scaling.
ACT — what the panel needs to hear:
The failing answer describes what was implemented. We rolled it out across the ward.
The passing answer describes the iteration — because PDSA is a cycle, not a linear process. The Act phase either scales the tested change, modifies it and runs another cycle, or abandons it based on evidence.
Based on the Study findings, I modified the change — specifically [named modification] — and ran a second PDSA cycle before recommending adoption at departmental level. The second cycle confirmed sustained improvement. The change was subsequently adopted as standard practice and included in the department's SOP.
That four-part answer — with process mapping, driver diagram, small-scale testing, baseline measurement, iteration, and SOP adoption — scores Outstanding on the service improvement competency at every band from Band 6 upward.
It is not a longer answer than the failing version. It is a more structured one. And the structure is exactly what the scoring matrix rewards.
📩 In my NHS interview coaching sessions, I build your specific PDSA improvement story from your actual career experience — identifying the right clinical improvement example, structuring it in NHS improvement methodology language, and practising it until it is as natural as your clinical scenario answer.
DM me "NHS" to find out what this looks like for your specialty.
Post 3 lands at 11:00 AM — and it is for the doctor specifically. The research and publications question. The one that internationally trained doctors with genuine published research consistently answer in a way that scores below their actual academic contribution — and I am going to show you exactly why and how to fix it.
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