What’s Next?

a. What Have You Learned from Your Test Data?

Working on systematic improvement is an ongoing learning process. This becomes especially apparent when looking at test data. At times you will find it necessary to collect data on an ongoing basis as the project unfolds. At other times, you will need to have collected data only following your specified period of implementation. Either way, the most interesting part of the QI process can be looking at your change and post-change to determine how things went and what it means.

You may be looking at the results of a follow-up survey to patients (with a random sample and using the same survey collected at baseline) or at what emerges from another quick review of medical records looking for post-intervention outcome data. As you identify how the intervention went, be sure to note what worked especially well and what contributed to that. Consider whether these things can be strengthened in any way.

If something did not go well, discuss the barriers and plan to address them by revising your intervention or subsequent improvement cycles appropriately.

Remember that in most cases sticking to the process is just as important as your results. For example, if you only see a slight change in your data, you want to be careful not to allow yourself to be too easily or too quickly discouraged. Many factors may be affecting the outcome. Some interventions can be difficult to measure without a significant amount of time elapsing. In other cases, one small aspect of how the intervention is conducted can be blocking the desired outcome. In these situations it’s better to slow down and analyze than to speed up and too hastily jump to conclusions and/or act.

b. Where Do You Go from Here

At the end of each short change/intervention test cycle you need to ask:

Do we want to continue doing this?
If so, how do we continue doing this?
Should we continue but make some changes (enhancements, refinements or, perhaps, significant changes in direction)?
Should we stop making this particular intervention and should we try another?
Should we take steps to fully implement and maintain this intervention, to build it in to our procedures and systems so that it is sustained?
Are these results good enough to warrant expansion and dissemination of this intervention to other practices we might be working with? And if so, what can we do to improve the odds for wider and sustained adoption?
Sometimes, it will take two or three rapid cycle tests, or even more, to attain the result you’re shooting for. Your first intervention may give you just the sort of improvement you are looking for. But often enough you will need to tweak your initial intervention one or more times to get things working the way you want. Or you may need to try something else altogether.

Depending on what you discover and decide, you may want to take another look at your Improvement Planning Worksheet or draw up an entirely new one, once again considering what you want to accomplish, who needs to be involved, what you need to measure, which resources you need, barriers you are likely to encounter, etc.

Finally, remember that it is preferable that your care team have positive experiences in their first few systematic change efforts. You want them to come to see genuine value in this way of working for improvement.