Hold the Gains and Spread Improvement

Holding the Gains

Once you have redesigned the process of heart failure care delivery, it may be tempting to move on to other issues and stop monitoring the process. If you don’t want all your hard work to go to waste, you need to resist this temptation. If you don’t hold these gains, they will be subject to erosion. Although you may be able to reduce the intensity of the monitoring and modification process, some ongoing assessment of how the process is functioning is absolutely necessary. In addition, new literature, new therapies, and new patient situations arise frequently. The team should remain responsible for monitoring these issues, updating your protocols/order sets, and revising the intensity of scrutiny based on the stability of your metrics.

TASK A
Schedule regular assessments to trend your metrics. Schedule interval reviews of the literature. Schedule sessions to update the protocol/order set.

Spreading the Improvement

Creating breakthrough levels of improvement is hard work, but it also can be exciting and rewarding. Ideally, others will learn from your experience and implement your interventions in their own environment at an accelerated pace while still allowing for customization to account for their own unique setting.
The IHI Web site has a detailed discussion of a framework to enhance spread of innovations throughout an organization.

TASK B 
Identify the priority areas to “spread” the improvements you have achieved. Review the framework for spread on the IHI website.

Don’t overlook this significant opportunity.
Download the Holding the Gains Task Sheet