Whether your improvement has been successful or not, there comes a time to close it out and doing so effectively is the difference between harnessing the learning for future projects and wasting that opportunity for learning. In this article, we’re going to show all you need to do to close out an improvement project so others can learn from your work.
How to analyse the results and benefits obtained
As the QI team at East London NHS Foundation Trust says: ‘We want to make sure that we capture the learning from all our QI projects, whether they are successful or not’. These wise words help to keep a positive focus on any QI project that hasn’t quite worked out.
There are many things you need to do to analyse the results before you close out an improvement project. You need to analyse your results and establish what – if any - benefits have been obtained. This process will be easier for you if you already use a QI software solution, such as Life QI.
The QI team at ELFT use Life QI as their main workspace for QI, in order to submit, view and review QI projects from across the Trust and from further afield. Users can plan and track Plan Do Study Act (PDSA) cycles and edit driver diagrams. And most importantly they can measure and view data in automatically generated run and control charts. It's something that can really help you, not only to run, but also to close out a quality improvement project.
If you want to measure and analyse your results, the BMJ have a useful ‘Quality Improvement Project Guide’ workbook to guide you through your QI project. They recommend that you test the impact of your intervention in real time throughout the project or PDSA cycle and incorporate measurement into your project, which helps you assess and improve. They also recommend the following: ‘Don’t forget that you will be collecting these measures continuously - or frequently - throughout your project. You may wish to start thinking about how you will obtain continuous measurement throughout your project. At the very least we'd expect data collection at baseline, during every PDSA cycle and after your final PDSA cycle.’
As well as PDSAs, you should also be reviewing your run charts and/or control charts. If you want to read more about either of these, please take a look at our blog.
Discussing the best practices and lessons learnt during the QI project
The Health Foundation’s document: ‘What’s getting in the way? Barriers to improvement in the NHS‘ says that: ‘Many policymakers and NHS managers and practitioners are passionate about improving health services – and a wide variety of initiatives have been tested. There are some examples of tangible change in the way that care is delivered and the outcomes for service users. However, there may be just as many examples of improvement initiatives that fail to get off the ground. Once you establish initiatives, their effectiveness may be inconsistent. Improvement is essential for the NHS – but it is not easy’. Part of the process of reaching project closure is learning lessons from your QI project and discussing best practice with your team. So it’s helpful to remember that many people may have been through this situation before.
As part of your project, you'll have scheduled in regular catch ups with your team to discuss the project. This will be the same for when you are looking at project closeout.
The BMJ’s ‘Quality Improvement Project Guide’ states that an important part of carrying out an improvement project is enabling others to learn from your experiences. Sharing what you learn from a project when it is not successful helps others to avoid the same issues you may have experienced and avoids duplication of effort. This is where a focus on ‘Lessons and Limitations’ can be really helpful. These can be included in a final project report and are an opportunity to outline the lessons learned from the projects, the strengths, any problems, as well as limitations.
Further on in the Health Foundation’s report ‘What’s getting in the way? Barriers to improvement in the NHS‘, the authors talks about barriers to improvement. They recommend categorising barriers to improvement according to where they occur along the improvement process. ‘In other words, barriers are evident at the design, delivery and dissemination stages’. This is something that you can discuss with your team when you are discussing best practice and lessons learned.
Finally, going back to the Health Foundation’s article ‘Quality Improvement made simple’, the authors discuss the importance of evidence in QI projects. ‘In recent years it has been widely recognised that unnecessary harm happens in the process of providing healthcare. Quality improvement approaches are increasingly being used to address these system failings. The reliability of the application of evidence has been used as a key approach in several national initiatives to encourage healthcare organisations to measure and aim to reduce harm.’
How to close out a quality improvement project
When you've agreed that you're ready to close out your project, there are a number of steps to carry out. This is when you may find the functionality within a solution such as Life QI will help support you to close out your project quickly and easily.
As part of the project closeout process, you will need to create a report, archive your data and ensure an implementation plan is in place and responsibilities have been accepted for sustaining the gains. You can use our template to help you with this.
For archiving, if you are using Life QI, the QI team at East London Foundation Trust (ELFT) has created a helpful guide to closing out a QI project. It goes through all the necessary steps you need to take to close down a project. You can also look at the Life QI help centre for further details.
The BMJ’s ‘Quality Improvement Project Guide’ talks you through how to submit a quality improvement report template. This article gives you information on how to provide a summary of what your results and run chart or control chart showed. This means you can describe the variation in your data and outline the interventions you made and whether they were responsible for any improvements.
The authors also recommend that you reflect on your background research for the project and look at what your project added to the topic. They also recommend to look back at your aim statement and reflect on: ‘Did your project achieve its aims? Did you adjust your aims as you went along? Was it a useful project? Were your measures appropriate and did you use balancing measures?’
They also recommend highlighting what would help others to make the case for carrying out a similar project. Or - if your project was not successful – how you would do something differently next time around.
There are plenty of resources to help you close out an improvement project and learn lessons from the experience. Let us conclude with the words from the Health Foundation report. ‘However, there may be just as many examples of improvement initiatives that fail to get off the ground. Once initiatives are established, their effectiveness may be inconsistent. Improvement is essential – but it is not easy.’