Quality Tip: How do we “Sustain the Gains?”

With several projects finishing a year or more of work, it is important to reflect not only on what you have accomplished, but also on how you can maintain those hard fought improvements.  Of course everyone hopes that once the work is done, the improvements keep “rolling in!”  But what happens when the team moves into sustainment?  How can you insure that your hard work will continue paying off and move your team and hospital closer to becoming a high reliability organization?   Experience, change management studies and reliability science suggest there are two critical questions every organization must consider to successfully sustain improvements:

A.     How are improvements hardwired into the system to Hold the Gains?

B.     Who is the process owner/leader designated to monitor the data/gains?

Here are some additional tips, and questions to consider:

1.  Insure Reliable Processes:

·    Were there specific processes, policies & procedures that you improved?

·    How have you been able to standardize the changes that led to improvement?

·    How are you auditing these improvements?

·    Who maintains ongoing implementation of the new procedures, policies, processes?

·    Who is responsible to train new staff?

·    Who receives ongoing communication about whether sustainment is working?

·    Approach backsliding as an opportunity to further refine your improvements.

2.  Keep up the Attention

·     Keep measuring to provide objective feedback- measure only critical components, and ensure at least one person is responsible for reporting results of ongoing monitoring.

·     Re-train, re-educate and re-campaign (new people arrive, others revert to old habits).

·     Put visual reminders in place.

·     Recognize and celebrate sustained improved performance- just like the original gains.

3.  Manage the Politics

·     Don’t let those who haven’t bought in yet stop the practice.

·     Make sure leadership is supportive.

·     Work with outside departments to support the process.

·     Communicate with senior leaders about the project, providing data & how this enhances the department.

·     Find your allies… it may be your families!

* Information adapted from Hannah King, VON NICQ 2009 Meeting, Austin, TX & Ohio Perinatal Quality Collaborative

Project Updates

All current project updates can be found on our Projects Page at www.TIPQC.org.

OB—Reducing Elective Deliveries before 39 Weeks

Monthly webinars continue to allow teams to share local data and success stories as collaboration spreads across the state.  New teams are welcome to join, please come to the workshop at the annual meeting or contact the TIPQC office if interested.  http://www.tipqc.org/projects

OB—TN Breastfeeding Promotion

Pilot testing continues with: OBGyn Specialists PC, Memphis TN, ETSU Physicians and Associates OBGyn, Johnson City, TN, Obstetrics at St. Francis, UTHSC, Memphis, TN, and Medplex Clinic, Memphis, TN. They are beginning to have project data, with 192 women at their 6-week postpartum visit captured. Preliminary results are expected at the March meeting.  http://www.tipqc.org/projects

NICU—Human Milk for NICU Infants Project

Sixteen teams are participating with over 6000 infants enrolled state-wide, with the teams showing a 20% increase in the rate of initiation of feeding.  For more information, please visit:  http://www.tipqc.org/projects

NICU—CLABSI Reduction

About half of the teams went into sustainment in December 2011.  State aggregate data continues to show a sustained 75% reduction in NICU CLABSIs. For the 12 month update please see:  http://www.tipqc.org/projects.  Please join the teams as the annual meeting as they determine the future of this project.

ABP MOC approval has been granted this project; please visit the CLABSI Forum for details!   http://www.tipqc.org/projects

NICU–Admission Temperature Project

This project continues in sustainment having cut hypothermia on admission in half.  Please see: http://www.tipqc.org/projects/temp-project/after-one-year-sustainment/

ABP MOC approval has been granted this project; please visit the Temperature Forum for details!   http://www.tipqc.org/projects

NICU–Golden Hour

Draft toolkits and data forms are being reviewed by development teams:  The Med, Baptist-Nashville, Methodist-Germantown.  http://www.tipqc.org/projects

NEW PROJECTS FOR 2011-2012

NICU—Follow Up Network

Development teams are finalizing their data form and toolkit, and hope to submit to their IRB and begin pilot testing soon. http://www.tipqc.org/projects

NICU—Undetected CCHD Registry

Eleven babies were found in 2011 throughout the state who were initially discharged without a diagnosis of CCHD.  We will continue keeping track of these undiagnosed infants in 2012 prior to the implementation of pulse oximetry screening. For more information on the HHS screening requirements and this project, see: http://www.tipqc.org/projects

NICU—Neonatal Abstinence Management

This toolkit is nearing completion of assembly and teams are reviewing data strategies.  Development teams include: East Tennessee Children’s Hospital, UT Knoxville, and St. Mary’s. http://www.tipqc.org/projects

OB—Maternal Mortality

The development team has zeroed in on post-partum hemorrhage as a first target for a statewide QI effort to address contributors to Maternal Mortality in Tennessee.  Please plan on joining the team at the state TIPQC meeting in March in Franklin to learn more, and find out how you can participate in this important initiative! http://www.tipqc.org/projects

Hospital/Delivery Centers—Breastfeeding Promotion

Potential pilot centers are being recruited across the state to develop and pilot this project based on the USBFC toolkit and the JC perinatal core measures under the state leadership of Julie Ware, MD and Karen Schetzina, MD. http://www.tipqc.org/projects

NICU—Family Involvement

An interest webinar will be held on February 10, under the direction of state leader, Rochelle Nelson- see December e-zine lead article for more information.  http://www.tipqc.org/projects