How can we make improvement happen

One important way to unlock the potential for faster improvement in patient care is for organisations and individuals to understand the profound relevance of these four areas to their own improvement work, and to know about the tools and techniques that are proven to help. This paper helps address the broad and recognised need across the NHS and wider health service to build service improvement capacity, capability and will.

It clarifies the priority areas where organisations, clinicians, health care professionals and improvers at all levels need to develop, and it offers practical steps to help ensure this happens. Crump, B. Emerald Group Publishing Limited. Report bugs here.

Please share your general feedback. You can join in the discussion by joining the community or logging in here. You can also find out more about Emerald Engage. These data are very revealing to this team, who felt, like others, that no improvement was needed in their pain management program.

What changes can the team now do that will lead to improvement? The team begins a second improvement cycle and decides to measure "Pain as a Fifth Vital Sign. Ongoing data collection will help them determine whether the team has reached its goal of percent of patients being routinely assessed for pain and the appropriate intervention for pain relief being undertaken.

All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www. Staff at Unique Hospice and Palliative Care Unit might think that they outperform the national average on pain management. After all, they reason, families and loved ones never complain.

Even so, the group's Grade A Improvement team decides to examine the unit's performance, with the aim of showing that all patients on one unit are assessed for pain and that pain intensity levels will be at or below a 3 on a scale of 0 to The PDSA model provides a framework for beginning changes on a small scale and increasing their scope as they prove successful.

If you have a quality improvement department ask for their help. Use tools such as a driver diagram or segmentation to help make the project more manageable and to help engage different teams and define their roles. For example, a brain health improvement project could be broken up or segmented into preoperative actions, intraoperative actions and postoperative management.

Within each area there are small and distinct projects that can be worked on. For example, preoperatively one project may be to improve screening of patients, another group could work on better information for patients and families.

Dividing the work and the change concepts this way can help make the project seem less daunting and can allow different teams to work in different areas while aligning to the common goal.

The Model for Improvement used by the Institute for Healthcare Improvement and the improvement approach with which I have the most experience asks three questions key to your work: What are we trying to accomplish? How will we know whether a change is an improvement? What changes can we make that will result in improvement? Patients are becoming more aware of the incidence of postoperative confusion and delirium. Families may be concerned that it has happened to a relative before and they do not want it to happen again.

One well-known orthopedic hospital with an active project in reducing delirium is telling potential patients about their success, and the local community is talking very positively about it—older patients are choosing to go there.

Consider forming a patient advisory council for your delirium reduction project, get patients and their families input on your ideas, and ask for their suggestions. This project is unlikely to be successful if it is solely dependent on anesthesiology input.

We can make significant changes by modifying our sedative and anesthesia management for at-risk patients, but for this program to be very effective we will need to engage with nursing and surgical colleagues, as well as ambulatory clinic staff. All colleagues in the multidisciplinary team need to understand our aim, what we are trying to accomplish, what changes we are trying to make happen, and how we will measure our success.

Our project will be much more successful if we engage with colleagues early on see Top Tip Three and harness their ideas and input. The use of visible prompts and measurement charts, such as run charts demonstrating improvement over time, can be very inspirational for teams, and can act as a focus for discussion on what is going well and what could be improved. Team members should feel empowered and be given the chance to come up with better ideas or new suggestions as the project evolves; this would fall in line with the learning step in the improvement process.

Improvement work is tough. I have found food, especially cakes, to be a great improvement aide. It is amazing what a small token of support and fun can do to enhance a project! Ensure that you call out the progress that is being made, encourage more junior team members to discuss their successes, and write up these progresses and successes or present them at meetings. Create a sense of fun and regularly provide feedback and show the data. Do not underestimate the power of healthy competition, especially amongst doctors.

Sharing data and progress between different units is a way to accelerate learning and spreading good ideas. Ask patients or families to share how they have seen improvement or how they have had a different experience of surgery since your changes. Make everyone proud to be part of the team that achieved these changes! Once you have started to see progress and a reduction in postoperative cognitive dysfunction and delirium, do not let up.

Ensure you understand what has achieved the change.