Plan-Do-Study-Act (PDSA) performance improvement cycles are an important quality improvement tool that can help health workers identify local solutions to immunization challenges and use data to determine if solutions have resulted in improvements. This brief highlights key findings from key informant interviews, focus group discussions, and a review of facility documents on how using PDSA cycles as part of the Reaching Every District using Quality Improvement (RED-QI) in Ethiopia encouraged stronger links between facilities and communities.