In improvement science, we build knowledge about how changes work sequentially, one test at a time.  Usually this starts off small, with a single test, such as trying something out on the next visit, the next discharge, or the next start of care (see my QI-Tip, “Try It On Before You Buy It”).  Going to implementation after just one test would be folly.  But when is a good time to actually implement a change?

1. Test the change under a variety of conditions

• Has each test built you and your staff’s confidence that the change really is an advantage?
• Have you tested enough to learn when the change cannot work or might not work?  If so, make sure you make adaptations or tweaks that make the change work even under these conditions.  For example, will a revised assessment for risk of readmission work when a new hire does it? Will it work for a patient experiencing confusion or cognitive changes?  If not, before you implement, figure out what adaptations need to be made to the change so that it will work each and every time.

2.  Make sure your staff (and anyone else who needs to be) is prepared for the change

• Share your ‘local’ evidence or data (see my QI-Tip, “Data, Data, Data”) that shows how well the change is working as you test it.
• Invite staff comments, suggestions, and concerns early.  Then test after applying their suggestions too.
• Make a communication plan. Who is your audience? Who else needs to know about the change (and then, who else)?  What is the best way to communicate with your various audiences?

3.  Make it easy to do the right thing

• Test around any barrier that might emerge when you get ready to ‘scale up’ the change.  Is the IT system capable and flexible enough to adapt to the change?  What changes need to be made to your IT system so that the new change works there too? It is a burden to go back after implementing a change in your EHR.
• Will training be needed for staff?  What about for new hires?
• What policies and/or procedures need to be developed or revised?

4.  Follow up to see how implementation is going!

• Make data your friend; it is for learning not judgment. After you’ve implemented a change, you should no longer experience failures. So if they occur, go after them!  Do a mini root cause analysis.  Make corrections.

Follow these tips and I promise you a smoother transition from testing to implementation!

Jane Taylor, CHAMP Improvement Advisor