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

2. 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

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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