Ensuring success and sustainability of a quality improvement project

Abstract

Explain the crucial nature of the human element in successful quality improvement. Identify some of the methods that can be used to communicate the focus of a change project. Illustrate the importance of sustainability and spread in ensuring success in a quality improvement project.In the third article of this series on quality improvement (QI), we discuss how to avoid some of the pitfalls and ensure the success of the project.All QI projects designed to improve healthcare involve change. This requires not only a change to the physical structure and processes involved, but also an emotional element that is crucial to the successful implementation, spread, and sustainability of that change. Without considering all aspects of the local context and culture, it is likely that any improvements will flounder. This paper will address these three areas of the human dimension of change, sustainability, and successful spread.Lauren Weekes FRCA is a final year specialty registrar in anaesthesia in the South West Peninsula Deanery. She has undertaken an advanced module in quality improvement and is a member of The Health Foundation's Q Community.

Multifaceted strategies to improve blood pressure control in a primary care clinic: A quality improvement project

“…Sustainability in any quality improvement remains a significant challenge. We incorporated factors that affect sustainability in the design of the QI project [ 33 , 34 ]. At ECMC, the organizational leadership is supportive and fosters a patient safety and quality culture.…”

CT Abdominal Tomography Indications: Are We All Sticking to the Plan?

“…We feel this demonstrates successful implementation of an organizational change in practice, which is significant given that up to 70% of attempts at this result in failure. 13…”

“…We feel this demonstrates successful implementation of an organizational change in practice, which is significant given that up to 70% of attempts at this result in failure. 13 In order to improve the number of ULDCT referrals adhering to indication guidelines, we presented our findings to the relevant stakeholders and service users at our hospital's emergency medicine monthly Grand Rounds. The indication guidelines were reinforced and feedback regarding the utilization of ULDCT from ED physicians was sought.…”

Improving documentation of prescriptions for as-required medications in hospital inpatients

“…This weakens our project’s sustainability as it renders us unable to benefit from spreading our project beyond our local area through word-of-mouth (diffusion) or poster redistribution (dissemination); these are key elements of a sustainable QI project according to the diffusion and dissemination paradigm. 27 28 As the ward contains a high volume of surgical patients, many Kardexes were with the patient in surgery at the time of data collection or were missing. This meant the sample size of Kardexes was low, with an average of seven available each week for audit.…”

“…Around 70% of planned organisational change fails, and this is most often a result of design flaws in the planning stage of a project. 27 NHS Improvement divides this into three areas: staff, organisation and process. 29 More effort should have been made to involve our target group in the design of our project; this could have been done by conducting interviews earlier in the year during our preintervention stage.…”