Sustaining momentum on QI projects

Sun, 06/07/2015 - 10:12 -- gkroberts

We have just finished our first year of QI projects based on the PDCA model. For completed QI projects, does anyone have a suggestion on how to make sure the results are sustained and accomodate continuous QI? We had planned on adding a 1-year follow-up to all completed projects, but were just curious to see if anyone else had a better idea.

Thanks!

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Submitted by tkane on

Good thinking to schedule a follow-up review for all completed projects. That's an excellent idea. “How do we hold the gains?” might be another way to frame your current challenge. “Holding the gains” is a different way to describe the “sustained improvement” that your team is pursuing.  The opposite of “holding the gains” is returning to the status quo.

Take a look at the article, Holding the Gains in Quality Improvement, published in 1999 in Family Practice Management. The article was written for a healthcare audience but the general QI concepts and advice are applicable outside of that field, including public health practice.

Here is a link to article: http://www.aafp.org/fpm/1999/0500/p29.html

The author says, "the best way to hold past gains is ... to keep moving forward" and "the plan-do-study-act (PDSA) cycle is nothing more than a formalized way of saying 'keep moving forward.'" The author also writes: "to hold the gains, you must work through the PDSA cycle again and again."

Important considerations to accomplish CQI are also discussed in the article, including: understanding of human behavior (change management), leadership, and momentum.

If you have a chance to read the article please reply to this post to share any “lessons learned” – and - good luck!

- Ty Kane

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Submitted by gkroberts on

Hi Ty,

Thanks for sharing this article with me. It was an easy and very practical read! I agree that the PDCA/PDSA cycle is a simple and effective QI model to help project teams move throught he process and not get stuck in the "p-p-do-do" phases (quoted by my colleague K. Pfirman).

A few lessons learned that I can relate to this article include:

- Decreasing variance - This has had its pros and cons. When this is possible to do, the data clearly reflected the effect of the improvement. However, when there are many people involved in the process, and it may not be possible to include all of them on the project team, it has helped us to at least get one-on-one input from those not on the team but are still directly affected by the improvement. That makes them feel that their oice is heard. This is time consuming but does help reduce resistance to change. This then leads to the possibility of standardization, which is the ultimate goal for "holding the gains."

- Getting user feedback - This is important for sustainability! It can be difficult to figure out why an improvement truly worked or didn't work because user feedback is sometimes sugar-coated in fear that it may be used against them. It has helped us to try and continually reinforce the safe environment around a QI project in which feedback will only be used to improve the process.  It also helps to have a facilitator/team lead that is not upper management.

- Sharing best practices - It has helped us to research the process we are trying to improve on the PHQIX website and also at other health departments/districts within our state. Sometimes, this helps provide direction towards a local solution, and a good starting point. We have had projects that have failed simply because our health department dynamics are different and this can be discouraging. When this happens, we have tried to do another PDCA cycle and focus on the planning phase to try and find a more suitable improvement.

Currently, at the conclusion of all of our projects, we have a final meeting to discuss user feedback, present final data, and decide how to move forward (ACT phase of PDCA). For those projects that are completed, perhaps it would help to do this same type of meeting 1-year after the official completion. At this 1-year follow-up, the team lead could present a new data point to the existing project data. For example, for patient wait times in June 2014, the follow-up meeting could include data for patient wait times in June 2015 to see if the original implentation is being maintained and/or additional improvements need to be made.

- Gurleen Roberts

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Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA
gurleen.roberts@dph.ga.gov

Submitted by ahensleit on

My experience with holding onto your QI gains post-project is to anchor them into your performance management system.  Out of every QI project there are typically 1 or 2 additional performance measures that are essential to monitor and track-a type of early warning signal. At the beginning every year, you evalate your PM system and adjust desired year-end targets.   This ensures  you continue to strive forward without sliding back -- and if the sliding does happen, you are aware of it early on and therefore able to take corrective actions as needed.

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Allison Hensleit
Fresno State University, Central Calif. Center for Health & Human Services

Submitted by gkroberts on

Thanks, Allison! That is a terrific idea and I'm glad that it is working for you. We are currently developing our PM system so I will make sure to add something regarding this. Do you mention QI project follow-up in general or do you state specific projects that you plan to follow-up on throughout the year? If you do the latter, do you only follow-up for 1 year?

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Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA
gurleen.roberts@dph.ga.gov

Submitted by johnsons013 on

Hi Gurleen. I think ideally, you will have performance measures in the performance management system that will serve as baseline data in the QI projects that are worked on. In these cases you can just continue tracking those performance measures (and possibly some additional measures) after the QI project to ensure that improvements are made and maintained. When a QI project is done that didn't arise from current performance measures in your system, then I think it is effective to put specific tracking performance measures related to that project than a general measure about following-up on QI projects. We participated in a PHQIX webinar back in February on our PM system and while we didn’t directly answer this question, the webinar may help you see how it could be done with the way we have set up our system. It is the 4th one down at this link: https://www.phqix.com/content/videos-and-webinars

I hope this is helpful.

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Stephen Johnson

Submitted by gkroberts on

Thank you, Stephen! That certainly helps to put things into perspective. Also, the webinar provided excellent information and although it didn't directly fit my organization, it did provide useful guidance. Well done :)

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Gurleen Roberts, MPH
Director of Quality Management
Cobb & Douglas Public Health
Marietta, GA
gurleen.roberts@dph.ga.gov

Grace Gorenflo's picture
Submitted by Grace Gorenflo on

Hi Gurleen,

I found the 12 steps in "Holding Your QI Gains without the Pain" a nice and easy way to think through some key issues related to sustainability.  Thanks for sharing!

Grace

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