Learn form Variation in the Process

Monitoring and Learning from Variation in the Process

After the Launch of Your Interventions: Just the Beginning!

At this point you should have launched your interventions to improve the discharge transition at your center. What you do after this point is equally critical to the long-term success and sustainability of the initiative. The team needs to devise a way to track barriers and issues encountered during the implementation process. Practice that varies from your expectations of the intervention process may occur for any of several reasons:

• The new interventions do not adequately address the special needs of a given patient.
• Old habits/ignorance/unwillingness to change.
• The new interventions are too hard to use.
• More familiar, well-known, or simpler routes of providing care are available.
• End users may not agree with a standardized approach to care.

As you track variation, it will become important to determine which variation is appropriate variation and which is not. There will be patients who do not fit into your intervention process. If you are finding that this is occurring more frequently than expected, it may be worth building in methods for end users to clearly document why these patients are “different.” This documentation will allow you to more easily identify appropriate variation as well as to assure that the reasons given for being “different” are appropriate. If you find that some of the tools are difficult to use or that some processes are cumbersome, your team may need to reexamine the intervention and determine what components may need to change. Some behaviors, though, will require incentives to bring care into compliance with your standardized approach. A combination of positive and negative incentives may be required to improve compliance. Improving appropriate use of the intervention also may require increased educational efforts by your team to improve understanding of the rationale behind the standardized recommendations.

However, if you do not look for variation, you will not find it. Similarly, if you do not determine why there is variation, you will not be able to adequately address issues that will improve compliance. With ongoing monitoring of the intervention, you will be able to better respond to valid issues by adjusting your tools and processes and reducing inappropriate variability by a combination of correction methods.

TASK

Devise methods to track deviation from your intervention bundle. Revise your intervention on the basis of feedback from users and patient needs.

Download the Task Sheet