After a test of change is planned, tested, and studied, a QI team summarizes and communicates what it has learned. The summary helps an organization decide whether to implement, modify, or discard the process tested. This decision is based on the data that measured the impact of the test cycle. Two questions determine the next steps in a test cycle: 1) Did the intervention yield improvement, and if so, 2) was the improvement sufficient? An improvement is considered sufficient when it achieves a benchmark level or the level of performance is satisfactory to the team or leadership. If the test leads to improvement and the improvement is sufficient, an organization can implement the intervention as a permanent part of the system. Since implementation is a permanent change to the way work is done and builds change into the organization, it can affect documentation, written policies, hiring, training, compensation, and aspects of the organization's infrastructure not engaged in the testing phase. Implementation may not look the same in every area of the organization. It is important to take what was learned from previous change cycles and adapt it to the current environment. Therefore, implementation often requires the use of the PDSA cycle. Once an organization redesigns a process using effective PDSA cycles, ongoing monitoring ensures it holds the gains over time.
If an organization monitors the process less, some measure assessment is necessary for an organization to meet its goal. Processes that work well now may need to change as the environment shifts. Once an organization moves to implementation, it needs to revisit the improvement. Many organizations review the process measure quarterly and think this frequency provides the necessary insight that the new process still causes improvement. The review process, whether it is monthly, quarterly or semi-annually, needs to become part of the organization's quality improvement strategic plan. This commits resources and time to continuous improvement on the process or measure and ensures the organization reaches its threshold of success. Constancy of purpose means every individual understands the organization's purpose and his or her role in accomplishing that purpose. Linking the QI team's work to the organization's purpose and strategic vision maintains its long-term focus on improving clinical quality. Additional information on developing a quality improvement plan is in the Developing and Implementing a QI Plan module.
The case study continues with RHC QI team's results of its test of change.
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