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U.S. Department of Health and Human Services
Health Resources and Services Administration
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Breast Cancer Screening

Part 1: Introduction

Part 2: Characteristics for Success: Breast Cancer Screening

Part 3: Implementation of Quality Measure: Breast Cancer Screening

Part 4: Improvement Strategies: Breast Cancer Screening

Part 5: Holding the Gains and Spreading Improvement

Part 6: Supporting Information

Part 5: Holding the Gains and Spreading Improvement 

Holding the Gains

Once an organization has redesigned the process for breast cancer screening, 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. 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:

  1. Change the procedure book to reflect the new care process.
  2. Include key tasks in the new process as part of job descriptions.
  3. Adjust the expectations for performance to include attention to quality improvement and teamwork to improve care.
  4. Re-align hiring procedures to recruit individuals who are flexible and committed to quality improvement.

The case study continues...

The Case Study: Sustaining Improvements

Spreading Improvement

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 breast cancer screening but also include other or all providers that provide care to women. 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. Once it has successfully reached its goal for Breast Cancer Screening, an organization may choose another measure to improve other aspects of care for women or cancer screening. Good sources for cancer screening measure sets include:

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 Breast Cancer Screening 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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