Holding Your QI Gains without the Pain

Posted October 06, 2015 by Cindy Hutter

QI Tips: Holding QI GainsYou are nearing the end of an 18-month long learning collaborative in which your team made a lot of changes at your facility. You have new processes and renewed energy—and it shows in the data you are collecting. Now, in just a few weeks, the learning collaborative will officially end, along with the dedicated resources it included. How does your team keep from backsliding on the progress it’s made?

The answer: A sustainability plan

Ensuring sustainability is not something you do at the end of a project; it should be built in from the start. If you are panicking and thinking, “But we haven’t done that!” Don’t worry. Your project most likely has a sustainability focus without you even realizing it.

The idea behind sustainability is to ensure an improved outcome from a specific change effort goes from being a temporary enhancement, which needs strong oversight, to the permanent way that work is done. In “Sustaining Improved Outcomes: A Toolkit,” Scott Thomas, PhD, and Deborah Zahn, MPH, describe 12 sustainability factors (see table below) as a menu to consider for building out a project’s sustainability plan.

“The secret is people are already doing sustainability work, but if you don’t have a framework of how to go about doing it, you aren’t focused on it,” says Thomas. “This just pulls out the factors and highlights them.”

Thomas and Zhan say the 12 factors are a menu, not a to-do list, because some areas may be more important or relevant to different people.

“People can look at the menu and say, ‘this is where we are weak, this is where we are strong, or we couldn’t do this even if we wanted,’” explains Thomas. “It helps to get people to start to work on places where they can strengthen.”

It is never too late to think about sustainability planning. When you do, Thomas and Zahn recommend considering two questions:
  1. How important is this factor to your particular improvement project?
  2. To what degree do we believe that you will be able to influence this factor?
“What the two questions do is help you sort through which of the factors to work on, with the idea being you are trying to strengthen sustainability, not figure out a magic formula for which this ends up being sustained,” says Thomas. “Knowing what is important and what will have an impact will save you from wasting time. It’s best to work on a sustainability factor you do have the ability to influence.”

12 Sustainability Factors (Definitions and Examples)
  1. Perceived Value – acknowledged value by those affected by the new ways of working and improved outcomes. Examples include project activities being considered potentially beneficial by clients, service providers, or community members.
  2. Monitoring and Feedback – monitoring is conducted on a regular basis and feedback is shared in easy to understand formats. Examples include information-gathering calls to monitor the project, and feedback provided to key staff using easy-to-understand formats (e.g., graphs).
  3. Leadership – the degree to which leaders (including decision-makers and champions) continue to be actively engaged beyond the implementation stage. Examples include ongoing attendance at meetings focused on the new ways of working and ongoing monitoring of outcomes.
  4. Staff – staff has the skills, confidence, and interest in continuing the new ways of working and improved outcomes. Examples include staff being able to use a new referral system capably or thinking that a new curriculum is more effective in achieving better outcomes.
  5. Shared Models – continued use of a shared model among those involved in the new ways of working. Examples include the Chronic Care Model, the 40 Developmental Assets, the 5As, or Plan-Do-Study-Act (PDSA).
  6. Organizational Infrastructure – degree to which organizational operations support the new ways of working and improved outcomes. Examples include rewriting job descriptions to support the project activities and channeling resources to project activities through the organization’s business plan.
  7. Organizational Fit – degree to which the new ways of working and improved outcomes match the organization’s overall goal and operations. Examples include project activities becoming part of the organization’s strategic plan.
  8. Community Fit – degree to which the new ways of working and improved outcomes match community interests, needs, and abilities. Examples include an expressed desire for new or improved services and outcomes.
  9. Partners – involvement of partners who actively support new ways of working and improved outcomes. Examples include partners who continue to contribute staff or resources after the implementation phase.
  10. Spread – expansion of new ways of working and improved outcomes to additional locations. Examples include expanding activities planned for one community agency or department to new agencies or departments.
  11. Funding – funding beyond original project period. Examples include extensions of original grant funding or funding to expand project activities to additional populations or communities.
  12. Government Policies – degree to which new ways of working and improved outcomes are supported by government policies. Examples include reimbursement for a new service or incorporating outcome measures into surveillance systems.
(Source: Sustaining Improved Outcomes: A Toolkit)

View and download a variety of free sustainability planning tools at www.sustainingoutcomes.comExternal Link


Add your comment





sickle cell disease SCD advocacy Baby-Friendly breastfeeding Pediatric journal Best Fed Beginnings infant health safe sleep IM CoIIN QI quality improvement flexibility family partner parent partner vision screening nichq perinatal quality measures sustainabilty preterm birth tips PDSA cycle baby box infant mortality family engagement eccs coiin immunizations health equity health disparities accreditation astho onboarding collaboration engagement partnerships larc nashp new york wic new york state hospitals mom mother partners epilepsy data AAP early childhood pdsas texas community support learning session children's health new technology engineering transgender collaborative learning planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke toolkit e-module dental care oral health underserved populations health inequity public health Maternal and Child Health Journal leadership engagement indiana medicaid perinatal regionalization sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series access BQIH exclusive breastfeeding long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media leadership Berns Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Cross-Sector Collaboration Knowledge Sharing Child Health