Implementation and sustainability

Test your changes, measure their impact, and ensure the sustainability of your project's gains while considering their broader application.

Step 9: Test changes with PDSA cycles

Don’t be afraid of a PDSA cycle. It is simply a small test of your change idea. PDSA stands for Plan, Do, Study, Act. Start with a limited scope, such as one patient or one staff member, and gradually expand to include more participants as you refine your change idea.

Here’s how to structure your PDSA cycles:

Plan	Define what you will change. Predict the outcome of this change. Determine who will implement the change and who will oversee the process. Set when and where the change will take place. Decide how you will measure the effectiveness of the change.
Do	Implement the plan. Observe and collect data throughout the implementation.
Study	Analyse the data gathered. Summarise findings to understand what the data indicates.
Act	Based on what you learned, decide what adjustments to make for the next cycle to enhance the change process.

Example of a PDSA cycle: streamlining patient discharge process

Plan:

Objective: To reduce the time it takes to discharge patients from the paediatric ward.
Change: Introduce a checklist to be completed by nurses the night before a planned discharge to ensure all necessary paperwork and patient instructions are prepared ahead of time.
Prediction: Predict that this pre-discharge checklist will reduce the average discharge time by 20%.
Who: Nurse C will be responsible for completing the checklist for patients scheduled for discharge the next day.
Where and when: The test will be conducted in the general paediatric ward during one week.
Measure: The effectiveness of the checklist will be measured by comparing the average discharge times before and during the test week.

Do:

Implementation: Nurse C implements the pre-discharge checklist for all patients scheduled for discharge during the test week.
Data collection: Record the discharge times for all patients and note any issues or delays.

Study:

Data analysis: At the end of the week, calculate the average discharge time and compare it to the previous week’s average.
Findings: Review how well the checklist worked and gather feedback from Nurse C and other staff involved in the discharge process.

Act:

Adjustments: If the test showed a reduction in discharge times, consider adopting the checklist for the entire paediatric ward. If the results were inconclusive or the reduction was minimal, reassess the checklist items and consult with the staff for potential improvements.

The PDSA cycle 101

Step 10: Decide on overall measures for your project

How will you know your project has met its aim? Setting the right measures is crucial to answering this question.

Set the below measures up front and revisit them regularly to ensure your project stays on track and makes the impact you’re aiming for.

Outcome measures

What's the ultimate goal of your project? These measures should directly reflect the aims you've set, like reducing wait times by 20% by the end of the year.

Process measures

How will you track the changes you’re implementing? These are the steps that lead to your end goal, such as the percentage of patients seen within the first hour of arrival.

Balancing measures

What should you watch out for? These help you ensure that fixing one issue doesn’t cause problems elsewhere. For instance, speeding up discharge processes shouldn’t compromise patient care quality.

Example of setting measures

Aim statement: Reduce medication errors by 30% in the paediatric ward within six months through the introduction of a double-check system.
Outcome measure: Reduction in medication errors: track the number of medication errors reported before and after implementing the double-check system. The goal is to achieve a 30% reduction in these errors within six months.
Process measure: Compliance with double-check procedure: measure how consistently the double-check system is being used for each medication administration. Target at least 90% compliance with the procedure, ensuring that two nurses verify the medication, dose, and patient details before administration.
Balancing measure: Time to administer medications: monitor the average time taken to administer medications before and after implementing the double-check system. This measure will help ensure that the new system does not significantly delay medication administration, which could negatively impact patient care and throughput.

Establishing project measures

Step 11: Collect and analyse data

Gather the right data to see the impact of your project. Here’s how to organise your data collection process:

Data needs	Determine if existing data is available or if new data needs to be collected. Identify what type of data will best measure your project's impact.
Data types	Quantitative data: such as numerical values that can be measured and compared, including time durations, error rates, or number of interventions. Qualitative data: such as feedback from staff or patients, which can provide insights into the experiences and perceptions regarding the changes made.
Collection tools and methods	Tally sheets: Use these for simple, manual counting of occurrences or events. Run charts: To track changes over time and identify trends or shifts in performance. Pareto charts: Useful during the diagnostic phase to identify the most common sources of problems. Histograms: Help visualize the distribution of data points. Scatter plots: Explore relationships between different variables or factors in your project.

Tip for success

Before you start collecting new data, check if you already have relevant data that can be used.

Click here for more tools and templates that may be useful for your project.

Step 12: Sustain the gains and spread the success

Ensure the improvements last and extend their impact. After achieving initial success with your quality improvement project, it's crucial to maintain those gains and consider how you can expand their benefits to other areas.

Document the project	Write a detailed report summarising the project's process, outcomes, and lessons learned. This document serves as a valuable resource for future projects and for stakeholders who wish to understand the project's impact.
Inform key stakeholders	Share your findings and the project report with your Quality Manager and other key stakeholders. Their support can be crucial for sustaining improvements and garnering resources for further implementation.
Continuous measurement	Develop a plan to continue measuring the effectiveness of the implemented changes. Ensure that the tools and processes for ongoing monitoring are in place to prevent regression.
Scaling up	Test the improved process in different conditions and times, such as during evening and night shifts, to ensure it works under various operational scenarios.

Click here for more tips on how to document and share your project.