Sustain and spread

Once the change (with measurable improvement) has been implemented, 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.

To achieve this, the project team needs to develop a plan to ensure the improvements made are not lost. Rather than waiting until the end, it is worthwhile for the project team to think about sustainability during the early stages of the project. As part of this process, it is recommended to involve your quality improvement advisor.

Use the NHS Sustainability Model to sustain your improvement.

Considerations to integrating changes into everyday work practice include:

  • Standardisation (work processes, roles and responsibilities, documentation)
  • Incorporating education and training into existing training for all clinicians involved in medication management
  • 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. You can also include staff and patient stories and other feedback as part of the ongoing monitoring to track sustainability.

The continued collection of data can be done less frequently and with less data than was done during the testing process. For example, reducing data collection from monthly to 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 improvements?

Spreading is about actively disseminating the improvement across the health 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 improvement process to make any modifications to suit the nuances of your next targeted ward/unit (e.g. culture, processes).

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 its ongoing success.

The ever-shifting health care environment and evolving technologies mean that established processes can be impacted. For example, the evolution from paper-based medication charts to eMeds.

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).