A PRACTICAL GUIDE TO QUALITY IMPROVEMENT FOR BURN CARE in Low-Resourced Settings
STEP 8: BUILDING ON SUCCESS
When you have introduced and implemented your changes, and you can see they are making a difference, take a moment to congratulate yourself and the team! But you have to think about how you will MAINTAIN and SUSTAIN these changes – and you need to do that at the planning stage. It is important that you consider how to maintain the change from the start of your project, because if your change is not sustainable, you will have worked hard for nothing. Consider the following points: • Engage others – if you motivate your team and stakeholders to change and involve them in each of the steps, it is much more likely that they will want to keep the changes in place. • Communication – share data and knowledge to show the effects, and try to create commitment to the project. • Formalise and standardise the changes – once a new process is implemented it must be monitored to ensure it is working well. • Training – training should not only happen when a new change is implemented, but it should be an ongoing process that supports those affected by the changes made. • Evaluation & monitoring – evaluation is important at every stage of the change. • Sustainability & control plans – when your change has been integrated into routine practice rather than being considered as an extra thing to do, you really need to make sure the team doesn’t slip back into the old way of doing things. This means monitoring key measures and having a plan to take action if things start to go backwards. You can keep using the PDSA cycle to monitor this.
Example: Ephrem found both expected and unexpected effects of his change:
Getting your unit or hospital management on board can result in even bigger changes than you were planning for!
• The intended change was to give more privacy to the patient during dressing changes. After the screen was implemented in the ward the patients felt more comfortable. • An unintended side effect of this change was that it gives more confidence to the patients to express their feelings towards their privacy and dignity issues and it enhances the interaction between the nurse, doctor and patient.
• Another entirely unintended change is that after discussing the problem with the management, they provided an extra screen for another ward and repainted the walls of the ward to clean up the room and minimise infections!
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