In advance of the exercise, you will need to prepare the coins and print the required forms.

• Four Coins. per each four to eight people – Coins from any currency that are capable of spinning are acceptable. The key is to have the same combination of coins for all teams.
• Timer. Any timing device that tracks in minutes and seconds works. Participant smartphones are often the best option.
• PDSA Tracking Form. Use a PDSA tracking form to encourage participants to complete the full four-part cycles and experience documenting their tests. It’s important to include prediction as part of the plan.
• Run Chart Form to Measure Time. Track time in seconds and plot data by hand.

Handouts may be distributed at the start, but withhold the coins until you are ready to begin.

The exercise works best when participants receive clear instructions before beginning.

• Roles. Instruct teams to decide on a tester and timekeeper.
• Starting Setup. Each PDSA cycle begins with a surface clear for spinning and a coin.
• Measurement Definitions.
  • Time: Clock starts when tester begins the coin spin. Clock stops when the coin comes to a full stop on the surface.
• Documentation. Each participant is instructed to track their team’s data on their own handouts. This includes the four phases of each PDSA and plotting the time data on the run charts.
• Pacing. For each cycle, participants will make a “plan” to test a change idea and capture the time and accuracy scores predicted for the test. Tables may “do” their test and complete the “study” and “act” phases including documentation.
• Optional. Have each team write their time scores on a slip of paper at the end of each test and submit to the facilitator. Enter the team data into a spreadsheet to track small multiples of all of the teams’ data for discussion at the end.

Instruct the teams to develop a plan and make a prediction. When they are ready, let them begin their test.

• Walk Around. Observe the teams doing their tests and look for teaching points to share with the larger group that reinforce key concepts of PDSA testing.
• Clarify Instructions. Correct teams that are not following instructions. Answer questions from participants wishing to clarify the constraints.
• Identify Best Practice. Between each cycle, identify the team with the fastest time and share the time with the group.
• Share Learning. Between each cycle, share one teaching point noted while observing team tests.

Build in time to debrief the exercise and share information.

• Test vs. Talk. Teams frequently spend too much time planning and not enough time testing and learning. Testing leads to learning that facilitates future tests and improvement. Testing reveals considerations that cannot be predicted.
• Parallel Testing. Discourage parallel testing of change ideas in the exercise. This can lead to multiple participants testing different ideas but not learning together.
• Competition. While competition between teams is not introduced in the aim, teams frequently become competitive and challenge winning teams and times that are significantly better than others. Note the competition that emerges and inquire if it is helpful for improvement work.
• Collaboration. It’s very common for teams to never think to visit another team to learn ideas and share knowledge. Ask why no one visited another team and highlight the missed opportunity.
• Documentation. Ask how much time it took to complete the PDSA tracking form and run chart for each test. Note that documenting improvement does not need to be a burden. Some participants will fail to document their PDSAs and run chart data or abandon it; inquire why and discuss the missed learning.
• Testing Considerations. Teams will often ask about several testing considerations including switching testers and changing test ideas versus iterative testing on a single idea. Each consideration offers a chance to discuss various considerations you might encounter when doing PDSA testing.
• Collaborative or Networked Learning. If participants are participating in an IHI Breakthrough Series Collaborative or networked learning process, it can be helpful to show the group’s aggregate mean scores along with small multiples for each table. Note the variation represented in the group and connect how this is similar to the variation noted in teams or sites participating in collaborative or networked improvement initiatives.