Once an organization has redesigned the process for prenatal patients accessing care in the first trimester, it can be tempting to move on to other issues and stop monitoring the process. Ongoing monitoring ensures that an organization holds the gains over time.
Although an organization may be able to reduce the frequency of monitoring the process, some ongoing assessment of the measure is necessary to ensure an organization continues to meet its intended goal. Processes that work well now may need to change as the environment shifts. For example, if a new immigrant population moves to the community, processes and strategies may need adjustment to engage that population in prenatal HIV screening. Often organizations designate a staff member(s) to be responsible for monitoring these issues, updating protocols/order sets, and revising the frequency of measurement based on the outcomes reported.
Because all systems are dynamic, they change unless efforts are made to ensure that the improvements continue. Organizations often do a few simple things to ensure that successful changes are embedded in the daily work. Examples include:
Spread can be defined differently based on an organization's defined target population for the improvement effort. An organization often begins an improvement intervention on a smaller scale, possibly focusing on one site or one provider's patient panel, and then increases the population of focus (POF) or the number of providers. Spread can mean spreading improvements to another area of an organization. An organization can still focus on prenatal patients accessing care in the first trimester but also include other or all providers that provide prenatal care. Ideally, others can learn from the initial improvement experience and implement the interventions of the improvement team in their own environments. Spread of this kind is often at an accelerated pace as there is experience about changes that work within the organization.
If an organization has a small number of prenatal patients, it may focus its initial improvement efforts on care for its entire prenatal population. Once it has successfully reached its goal for HIV Screening for Pregnant Women, it may choose another measure to improve other aspects of prenatal care. Another option is to target a different topic or another population of patients. An organization may evaluate organizational priorities as it did when initially choosing the HIV Screening for Pregnant Women measure and begin to plan for its next improvement effort.
Additional information on Holding the Gains and Spreading Improvements, including specific resources and tools to support an organization's improvement program, can be found in the Redesigning a System of Care to Promote QI module.
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