Service Redesign ResourceWhat happens when we get there?Reaching the end of a process redesign project doesn’t signal the end of process redesign. Like your home renovation project, a good outcome may make you aware of other areas that could benefit from improvement. You may also have acquired a few new skills along the way and be keen to test these out on other projects. Importantly, you want to care for and maintain your improved environment – you don’t want it to look worn and dirty after just a few months because no one has bothered to clean off the new scuffs and fingermarks that inevitably appear along the way. At this point in your process redesign activity, two important questions to ask are:
The first question can be answered through measurement. If you have been using SMART targets, you can compare the pre and post implementation measures to determine whether or not you have reached the set targets. Some of the measurement tools you might use will be those used in earlier phases of the process redesign/improvement cycle such as Pareto charts, Flow charts or Run charts plus any other data collection tools you have enlisted or developed for the project. If you have not achieved your targets, further analysis of your data will help you to understand why eg Were the set targets unrealistic? Did the process redesign implementation go according to plan etc? An evaluation of the process redesign activity itself may be helpful to answer these questions if the targets weren’t reached. Even if the targets were reached and the project is considered to be a success, there may be lessons learned through evaluation that could be useful if rolling out a pilot project on a broader scale or if you plan to replicate the project in other areas. This section contains links to information about evaluation tools including Program Logic which is often used in health care settings and an improvement leaders’ guide on evaluation. The next key issue to be faced at this point concerns sustaining the gains that have been made. Ensuring that the redesigned or improved process becomes standard practice takes effort and planning in much the same way as implementing the improvement. It is the responsibility of the whole process redesign team to ensure the process is sustained. This may involve anticipating which parts of the process are vulnerable to reverting back to pre-improvement practice and allocating tasks to team members to ensure this doesn't happen. A simple example of this is ensuring that it is part of one person's ongoing role to check there are enough copies of a new referral form you have implemented. If busy staff can't find copies of the new form and revert to using the old one, your improvement gains could be lost on the basis of a simple administrative task. Sustaining gains may involve training or engaging additional staff in the new process and may also involve spreading the word so that the improvement doesn’t become an anomaly that only happens in one ward, unit or department. Importantly, sustaining change shouldn’t involve entrenchment. It shouldn’t become the new “way we do things around here” but should involve continuous redesign and improvement in response to good data collection and ongoing analysis. It might be possible to modify the data collection so that it is less onerous than in the improvement phase but if you stop collecting the data altogether it won’t be as easy to tell if you are sustaining and spreading the gains or if you are reverting back to the old ways. Continuing to use the PDSA cycle can help with sustaining and spreading improvement gains. |
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