Sustain and spread
Once the change (with measurable improvement) has been reliably implemented, the final step of the project is about sustaining and spreading the improvement.
How do you sustain the improvements made?
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. It is recommended as part of this process to involve your quality improvement advisor.
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, unit 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, patient, carer and family understanding of REACH calls is collected three-monthly, then move to six-monthly. Importantly, this data needs to be visible to your project sponsor, health service executive or senior management.
It is also recommended that all REACH calls are reviewed by the local CERS or Clinical Governance/Safety and Quality committee for evaluation on effectiveness and opportunities for improvement. This is a long-term strategy for continued improvement and oversight of the process.
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 improvement process 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).