Holding the gains: Tips for Sustaining Improvements Over Time                                       Holding the gains: Tips for Sustaining Improvements Over Time                                           Susanne Salem-Schatz, Sc. D. sss@hcqi.com June 17, 2014

7/27/2019 Objectives Understand ways to hold the gains from your initial improvement work Make a plan to help guide holding the gains made by your team(s) MCPP Healthcare Consulting

UTI in the Elderly Collaborative 10/13 Kickoff Workshop 12/13 Clinical Webinar 1/14 Evaluating Altered mental status webinar 2/14 Regional workshops 4/12 Antibiotic Stewardship 4/14 Coaching and sharing call 6/12 Closing Workshop MEASURE / MONITOR TEST / IMPLEMENT / SUSTAIN

Continuum of Improvement Hold Gains / Sustain Test Implement During testing During implementation After implementation Objective: Refocus to frame of continuum of improvement; moving to Holding the Gains: after implementation. Explanation: After solidly implementing a change we can begin to focus on holding the gains strategies, the phase labeled “after implementation”. (White bolded) Bridge to next slide: First let’s start by looking at some inhibitors to holding the gains after implementation.

Testing vs. Implementing 7/27/2019 Testing vs. Implementing Testing – Trying and adapting existing knowledge on small scale. Learning what works in your system Implementation – Making this change a part of the day-to-day operation of the system MCPP Healthcare Consulting

Testing your way to implementation Changes That Result in Improvement Learning from Data A P S D D S P A Very small scale test Follow-up tests Wide-scale tests of change Implementation of change A P S D Objective: Emphasize progression to and through implementation. Explanation: After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the change is ready for implementation on a broader scale-for example, for an entire pilot population or on an entire unit. For example, testing a change might be 3 nurses on different days using a new case management referral form; implementing a change might be all nurses on staff at the pilot clinic begin using the new case management referral form. Bridge to next slide: So tip #1 is to plan the implementation of the new process using PDSA cycles. A P S D Hunches Theories Ideas

What inhibits holding gains? 7/27/2019 What inhibits holding gains? Turnover- new employees aren’t educated in new processes Competing priorities - putting out fires kept us from paying attention One and done – we met our goals and started to work on something else Understaffed – too busy to pay attention MCPP Healthcare Consulting

What inhibits holding gains? 7/27/2019 What inhibits holding gains? Turnover Competing priorities One and done Understaffed Turnover Competing priorities - putting out fires kept us from paying attention One and done – we met our goals and started to work on something else Understaffed – too busy to pay attention MCPP Healthcare Consulting

What facilitates holding gains? 7/27/2019 What facilitates holding gains? Success of collaborative team Intention to hold gains Organizational priority Clear leadership support What gets measured gets done. MCPP Healthcare Consulting

Core principles for sustainability Hardwire changes – create systems Implement policies Ongoing leadership Maintain staff engagement Create an oral history Maintain visibility Embedding into practice HARDWIRE CHANGES- structures to foolproof change (dipsticks? Approval processes?) Implementing policies Building capacity and leadership Maintaining relationships Developing lessons learned and passing them along –CREATE AN ORAL HISTORY Maintain visibility

Systems and process solutions 7/27/2019 Systems and process solutions Policies Documentation Hiring procedures Job descriptions Staff education / training Information flow Equipment purchases MCPP Healthcare Consulting

Culture of improvement 7/27/2019 Culture of improvement It’s not just a project It’s a way of thinking about the work Resident centered care Engaged and empowered front line staff Make the connections between various quality initiatives ASK: Who sets the priorities in your organization? MCPP Healthcare Consulting

Planning to hold your gains Goals Activities Who needs to be included; who else? Resources needed What else is needed Make a one-page summary in plain English