So, you’ve carried out your testing and run a series of successful Plan Do Study Act (PDSA) cycles. Now it’s time to implement your changes into business as usual and sustain the gains. This is a really important stage of your QI project, as it’s when you get to share the great results you have achieved and deploy and embed the changes into your organisation. In this article we’re going to look at what you need to do next in order to implement improvement projects effectively and how to roll out your project implementation plan.
After testing comes implementation
You tested your project and it performed well in your PDSAs - now you might be asking yourself what happens next? Well this is the time to look at creating an implementation plan so you can sustain the gains and incorporate them into your ‘business as usual’ processes.
In the BMJ Open Quality paper: ‘Quality Improvement Project Guide’, the writers explore how you can deploy your QI changes more widely once you have rolled out and tested your solution locally. We are going to look at how you can share and implement your changes further than your department, and into other areas of the organisation – and even further afield - where others might benefit from this good practice.
Before you start the process to implement QI projects, you need to consider carefully who exactly you are going to target with communications about your project. For example, which departments might benefit the most? Once you’ve established this, you will need to work out which team members within this department are important to target. For example, would your target audience be nurses, doctors, other clinicians?
The next step is to work out how to communicate the changes that you’ve tested to your target audience and how to encourage them to engage with these changes. You also need to consider how you will learn from their feedback and what tools you need to do this. Do you already use tools that help collect feedback? Or do you need to look into solutions that can help with this to spread your ideas more widely?
Often a solution such as Life QI is helpful for spreading change ideas and monitoring feedback, as well as keeping all your QI information together in one place.
It's sometimes useful to view spreading your changes as similar to carrying out PDSA cycles on a much wider scale. You might want to read more about PDSA cycles in our blog ‘How to write a PDSA.’
The Institute for Healthcare Improvement (IHI) has identified ‘7 Spreadly Sins’ which set out what not to do when you are trying to spread your healthcare improvement project.
Conversely, they recommend putting time into the following areas when you are looking at spreading your new project:
- Target population
- Promotion and communication
- Schedule for spread
- Review and guidance
- Control and sustain
The 6 steps for adopting successful solutions into routine practice
Six steps have been identified for adopting successful solutions into routine practice and to help you plan your implementation. These are summarised in this very helpful video by Dr Amar Shah, Chief Quality Officer at ELFT.
In the video, Dr Shah talks about the process of QI implementation when changes have been tested in multiple conditions and data has been collected. To implement a change more widely, he recommends to think about who should do what to make this standard practice. You need to document and measure this whole process.
You may need to consider training and support for staff, and - as there may be resource implications such as new equipment - what would the cost be? It is also helpful to consider how you are going to convince people about your new idea. And using data from testing will help. Dr Shah mentions the six common elements for implementation, which we will now look into.
Here are six steps to enable you to implement QI projects effectively:
It's a good idea to use a standard implementation template to show how successful change ideas will be carried forward into standard practice. (You can download our template later on in this blog).
You need to decide where/how you will document the new or updated processes, so staff have a resource they can learn from. For changes to existing processes they may well involve updating existing standard operating procedure documentation.
Agree what your team will continue to measure during the implementation process, so you can monitor new performance levels and check whether the new standard is being adhered to.
4. Staff education and training
Ensure the new ways of working are being integrated into staff training programmes. This is a crucial step in ensuring existing practices evolve to the new way of working you have designed.
There may will be ongoing resource implications that are associated with the new ways of working. You will need to have discussed this with your stakeholders and agreed plans for how this will be managed going forward.
6. Socialisation and the human dimension of change
To sustain your gains, you need collective leadership and continuous engagement to motivate and guide staff. After all you can re-write all the processes you want, if people aren't effectively engaged in changing their behaviour an actions - the change won't stick.
Once you are ready, you will need to consider quality control with your team and what you will continue to measure in this Quality Control (QC) phase. This enables you to monitor and manage via a ‘QC feedback loop’ which is: ‘review, reflect and respond’. You can use a system called ‘visual management’ which will help you visualise your QC system.
NHS Education for Scotland has a really helpful ‘Readiness for Spread’ checklist that you might want to look at. You can easily achieve all of the above using your Life QI solution to measure and report.
Implementation plan template
We’ve put together an Implementation Plan template for you to download, which will enable you to work through every step you need to implement the results of your projects, deploy your changes and sustain the gains.
We’ll leave you with a powerful quote from the BMJ Quality Improvement Programme article ‘Improving communication between phlebotomists and doctors: a quality improvement project’: ‘A key lesson learnt during the process was the importance of PDSA cycles, which helped to ensure that at each stage the model was optimised before full distribution across the hospital.’