5 Tips to Sustain the Gains

After an improvement has been made, sustaining it is important but can be challenging.

5 Strategies to "Sustain the Gains" :

1. Standardization

Reducing variation through standardization helps to ensure new processes are followed. Establishing consistent tasks by role helps to create clarity around who is responsible and has been shown to improve outcomes.

Example: A team may standardize a process where the Medical Office Assistant (MOA) is responsible for taking each patient’s height, weight and blood pressure when they come into the clinic for a particular type of appointment.

*It’s not to say that someone else on the team couldn’t help out if needed, but the whole team knows the MOA will reliably complete the tasks and they don’t need to repeat them.

2. Accountability

Team members need to be accountable to each other. Team members being responsible for different tasks does not rely on hierarchical structures, rather it promotes camaraderie amongst the team.

Example: Hold frequent, but short, team meetings. At these meetings successes can be highlighted, failures analyzed, and course corrections made as necessary. These team meetings should happen frequently (weekly, monthly, quarterly) and be predictable.

3. Visual Management System (QI Board)

It’s well known that people play differently when they’re keeping score. 
Develop and continually update a compelling scoreboard to keep team members engaged and energized.

Suggestion: Keep the scoreboard simple, visible, show both outcome and process measures and be able to tell immediately if you’re achieving your aim or not

4. Daily Communications

Ensure you communicate your process change beyond just the Quality Improvement team. Daily communications ensure everyone on the team is aware of the change and understands why it’s being made.

Example: Having brief huddles (ideally daily) can help teams to sustain their gains. Try huddling around your QI Board and/or EMR. Try using a checklist to ensure your huddles remain brief and on track.

5. Have a Problem-Solving Technique

Inevitably a problem will arise where it seems simpler to scrap the improvement and revert to the old way of doing things. Resist this temptation and instead employ a problem-solving technique.

Example: The Plan-Do-Study-Act (PDSA) cycle is one of the most common problem-solving methods used by teams to test new solutions. Solutions are evaluated using small tests of change.