Sustain and spread

Once the change has been implemented and there is measurable improvement, the final step of the project is about sustaining and spreading the improvement.

How do you sustain the improvements made?

The sustainability phase is about maintaining the improvements achieved by the project and ensuring the changes are embedded into practice, that is, early recognition of dying patients, standardising the use of a symptom and comfort assessment chart and best practice prescribing of medication.

To achieve this, you need to develop a sustainability plan to ensure the improvements made are not lost. Rather than waiting until the end, it is worthwhile you think about sustainability during the early stages of the improvement project.

Using the NHS Sustainability Model will assist you in considering the sustainability of the improvement.

Considerations to integrate improvement into everyday work practice include:

  • Standardisation (work processes, roles and responsibilities, documentation)
  • Incorporating education and training into existing training for all staff
  • Ongoing data collection and evaluation to monitor and refine process.

Data collection of project measures should be part of ongoing monitoring and embedded into standard practice, by your ward or health service. This forms part of the sustainability plan. You can also include staff and patient stories and other feedback as part of the ongoing monitoring.

The continued collection of data can be done less frequently and with less data that was done during the testing process. For example, collecting data three-monthly, then move to six-monthly. Importantly, this data needs to be visible to your project sponsor, health service executive or senior management.

If at any point the improvement is not maintained, the project team can intervene and may resume more frequent measurement to better understand why compliance has reduced. This is where you may need to repeat your PDSA cycles.

How do you spread the improvement?

Spreading is about actively disseminating the improvement across the heath service or district/network by implementing the changes in other wards/units. What works in one setting, may not work in another so it is worth revisiting the PDSA cycles to make any modifications to suit the nuances of your next targeted ward/unit (for example, culture, processes). The IHI's Seven Spreadly Sins provides practical tips on how to successfully spread an improvement.

The future and beyond

Once an improvement project is completed and the improvement has been sustained and spread, it is the responsibility of the health service to continually monitor the ongoing success.

The ever-shifting health care environment and the evolving technologies mean that established processes can be impacted.

It is recommended that measures are built into the health service's performance indicators and audits are completed regularly (as determined by the health service).