Having investigated, planned and delivered the improvement plan you then need to communicate with your  colleagues inside and outside the organisation.

The measurements that were taken before the change now need to be repeated. (see Investigation)

You also need to sustain the improvement as well as check and adjust it  so you can keep getting better.

The tools for this stage described below include

• Plan, do, check adjust (PDCA) cycle.
• Milton Keynes Communications strategy
• Sustainability
• Case study development

Plan Do Check Adjust cycle.

Plan = deeply understand the problem and its root causes. Define the key measures that will tell you if you are making an improvement

Do = actually carry out the experiment / improvement

Check = observe and assess the results. Use the data to understand the effects of the experiment / change / improvement

Adjust = reflect on what has been done, learn from it and begin a new PDCA over again.

Constantly going through the PDCA cycle leads to continuous improvement.

Sustainability

Sustainability can be defined as holding the gains, evolving as required, definitely not going back to the old way and embedding in current practice.

As much effort needs to be put into planning for sustainability as is put into planning for the change itself..

To improve our chances

• consider engagement - What's in it for me WIIFM
• need relevant clinicians - powerful winners help sustainability, powerful losers inhibit sustainability
• indirect influence can be effective e.g. peer-to-peer.
• strong project leadership with experience in project management and good influencing and communication skills.

There should be a triangle of engagement between Project lead / Clinician/ CEO or Senior Leader.

Innovators and early adopters can appear 'flaky' from the point of view of the majority
Laggards may only be so because of a lack of understanding
Chances can be improved by doing a 4Ns with the 'laggards' to explore their scepticism and 'WIIFM', go for a bold new approach and do things differently.

What else can we do to improve our chances?

• Give high priority to organisational development
• Equip people with the tools and techniques of change
• communicatre, communicate, communicate why the change is necessary.

More information can be found in the NHS Institute for Innovation and Improvement Sustainability Model  This is an easy-to-use diagnostic tool which aims to help NHS improvement teams

• self-assess against a number of key criterion for sustaining change
• recognise and understand key barriers for sustainability, relating to their specific context.
• identify strengths in sustaining improvmement
• plan for sustainablity of improvement efforts
• monitor progress over time

Case study development

The importance of documenting an improvement piece of work and examples of how they are done at HEFT.

Develop the format

• front cover
• introduction
• initial areas for improvement
• outline of what was done
• results - qualitative and quantitative
• where next
• what is LEAN
• contacts for further information

Before starting

• interview the people who were involved
• get qualitative results before and after
• collect quantitative data before and after
• before and after pictures!

When writing

• remember the audience
• easy to read
• remember the purpose
• congratulate thise who made the improvements
• get someone else to proof read