Sharing your lessons learned
Share the lessons learned with other departments and teams – whether this is a successful change or not. It’s important that you share your learning so others can learn from your efforts and apply that learning in their own areas. You could include your project outcomes and top tips in your department’s monthly newsletter or share your lessons learned at other departmental, regional or national meetings.
Newcastle Improvement host regular Learning & Sharing Events, which are a platform where you can present and share your improvement project and where you can hear about projects being delivered by other frontline teams.
Sustain your change
This can be the toughest part of improvement as it’s really easy for people to go back to how they have always worked. Sustaining improvement requires a team to change its working habits. It is important to think early in your improvement about how you will stop things reverting to how they were before the change.
- When a project has finished, how will you ensure the new way of working continues?
- Will people just go back to working how they have always worked?
TOP TIPS for sustaining improvement
- Think about sustainability right from the start!
- Encourage team participation in the change early on, particularly from those who are most affected by it.
- Take the time to understand all parts of the problem with the team before making a change.
- Show the evidence about why improvement is needed.
- Measure and test your change ideas using PDSA cycles – you can adapt and scale up during each cycle to reach the best version of the change.
- Incorporate new ways of working into existing workflows – this helps build new habits.
- Write/update operational procedure – it ensures consistency and eliminate variation.
- Communication – share the outcomes of your improvement widely to help with continued engagement.
- Leadership – a leader, either clinical or non-clinical, can help ensure your improvement is sustained – by promoting the improvement and helping to break down any barriers.
Tools for sustaining improvement
Human factors is the study of all the factors that make it easier for people to do work in the right way and harder for them to make mistakes (ergonomics). If you want to sustain a change, think about how to make it easier for the team to get the work done the right way. Nudge theory can help this – encouraging people to behave in an expected way by prompting them with simple, attractive messages at the right time. Alerts on eRecord are an example of nudge theory.
Having well-timed visual cues about expected behaviour means that team members don’t have to rely on their memory about what is expected. There are several benefits: •Conveys information quickly and accurately •Creates shared and immediate understanding •Highlights dangers, problems and issues •Clarifies expectations •
We saw a huge increase in visual management during the pandemic – constant reminders about the need to stay away from one another and wear a mask. Think about what messaging and formats worked well during the pandemic to encourage you to change your behaviour – could you adapt these methods in your own area?
Nudge theory uses these kinds of visual cues all the time – these are simple messages that have been made attractive, using images and colours, and are well-timed – conveyed at the point when we need to make a decision (nutritional information on food packaging, think about using the lift, etc.)
Checklists are a great way to ensure that all tasks or decisions are completed, and help to reinforce an improved way of working. Depending on the improvement, one checklist may be completed for each patient or task. Using checklists is a way of incorporating a new way of working into our existing routines, especially if we work in an area that uses checklists all the time.
30, 60, 90 day reviews
Once the project team has finished meeting regularly, set aside some time to review whether your improvements have sustained. This allows you to check what has happened when everyone has shifted their focus away and whether the change has been sustained. Reviewing at 30, 60 and 90 days after the point of implementation allows you to revisit your measures for success and discuss barriers to sustaining change. The timing of the reviews isn’t important, the important thing is that you have a review.
Measurement allows you to monitor whether your change has been sustained. Ideally, if you keep measuring, this should be automated, rather than creating additional work for a member of the team. If the data for your measures of success is not routinely collected, remember to set aside some time to collect and analyse the data before your review meetings. Review your measures at your 30, 60, 90-day reviews. By continuing to measure, you can make a decision to intervene when it looks as though things are going off track.
NHS Sustainability Model
The Sustainability Model is a predictive tool developed by the NHS. It is used to identify strengths and weaknesses in implementation plans and predict the likelihood of sustained change.
It is made up of ten factors, which fall under three main themes: process, staff and organisation. By answering the questions linked to each of the ten factors, the tool allows you to see the likelihood that your improvement will be sustained over the long term.
The team should use this tool before they test any changes. The tool can identify areas that require strengthening right from the start, and after the improvement has been implemented, in order to sustain the change.
The highest scoring sections relate to senior clinical and leadership involvement, as well as team participation. Having senior leadership support means that, although your testing cycle may have come to an end, the thing you were trying to improve will remain a priority in your department.