Setting the Stage for Sustainability in Quality Improvement Projects

Posted June 21, 2017 by Elizabeth Barker



In all types of quality improvement efforts, sustainability is a vital consideration that often goes overlooked until the project’s final stages. With the right balance of foresight and strategy, however, team leaders can plan for sustainability as a project gets underway. This lets teams seamlessly support sustainability and a create quality improvement projects with truly powerful impact.

“One of the key things in quality improvement is to develop plans for sustaining the gains into the start of the project,” says Pat Heinrich RN, MSN, CLE, an executive project director at NICHQ. “Instead of getting to the end and asking, ‘Now that we’ve made some great improvements, what can we do to continue them?’, you need to think about that aspect from the very beginning.”

For improvements with enduring effects, Heinrich advises aligning each project with the larger organization’s strategic objectives. By way of example, she points to NICHQ’s recent work in helping nearly 90 hospitals across the country achieve Baby-Friendly designation.

“If a team’s purpose was simply to become Baby-Friendly, a new administration could easily come in and cut the budget for that,” says Heinrich. “It’s much more robust if you can say, ‘We are carrying out this improvement project as part of a larger goal to provide the highest-quality patient care, and as a result to become the only Baby-Friendly hospital in this community.’”

Connecting an improvement project to your strategic goals also helps secure resources and leadership’s attention—both key to project success.

In building project support for sustainability, it’s also crucial to fully engage the employees and stakeholders involved in holding the gains or who benefit from the gains. In every project, there are always people who are willing to try new things, and there are always others who may resist change. To overcome that resistance—and inspire the commitment needed for long-lasting change—Heinrich suggests enlisting the most willing employees in the early stages of testing.

“If you can start by making very small tests of change and collecting some data to show improvement, then your early volunteers can go back and talk it up to the ones who might be interested or even resistant,” Heinrich says. “Once the others hear that the changes weren’t too difficult and that families were happy with them, they’ll be more likely to want to try it themselves.”

Building off those small tests of change can further promote sustainability as projects move forward with testing, according to Jane Taylor, EdD, MBA, MHA, an improvement advisor for NICHQ. To that end, Taylor recommends incrementally increasing the scale of testing while continually varying testing conditions.

“A wide range of conditions is so important for understanding how the change will actually work,” says Taylor. “You want to learn how a change works with experienced staff and with new staff, when you’re busy and when you’re not busy, with English-speaking families and non-English-speaking families, with families who have high health literacy and low health literacy. The point is to try all these conditions and provoke the change to fail, so that you can learn from that failure and design around it before going to implementation.”

A gradual approach can also guide teams toward sustainability during the implementation stage of quality improvement.

“Implementation is a social enterprise,” says Taylor. “If you scale up slowly, you’ll bring to the surface any of the barriers that might prevent change from being successfully implemented and later the gains held. Then you can tackle those barriers incrementally, which increases the chances of the implementation being successful.”

Once quality improvement teams start to see success, spreading the word about the project’s progress can help maintain momentum and set the stage for sustainability. Taylor advises collecting iconic stories from staff and families and use them to illustrate the benefits of change.

“Create a constant drumbeat by creating a communication plan with multiple communication channels,” advises Taylor. “Use emails, site visits, newsletters, professional meetings and gatherings, interested publications, face-to-face interaction, small meetings. Create a webpage so that stakeholder can observe the project as it develops and spreads.”

Engaging with leadership is another key factor in sustaining improvements because making changes to the organization’s system is usually necessary to uphold improvements. Such changes typically include amendments to organizational policies and procedures, updates to staff training modules, integration of new resources and equipment, and upgrades to the IT system.

In every stage of the quality improvement process, moving toward sustainability means keeping sight of the project’s ultimate goal.

“The reality is that change is difficult, and people can get overwhelmed by the effort,” says Heinrich. “So it’s important to remember that it’s not about making people work harder—it’s about changing the system and creating a new way of doing things, so that we’re better able to serve children and families.”


Share:

Add your comment

 
 

 

Archive

Tagcloud

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