System-Level Toolkit

Maintaining Momentum

There are two aspects to maintaining momentum: spread and sustainability. Even though we will discuss them as though they are separate processes, the success of each is linked to the other. Without spread beyond your initial Change Project, your sustainability efforts will fail. Without an effort to sustain improvements, there is no momentum for spread. They are intertwined, but it is easiest to describe each separately.

Sustainability

It is easy to slide back into old habits, whether in our personal lives or at work. Once you feel that you have adequately addressed an issue through a series of PDSA Cycles, you need to find a way to institutionalize the change. There are several different ways to do this. One of the most effective at the treatment agency level is to continue to collect the data that was collected to measure the improvement. Any fallback in the measure requires a review process to identify why the measure is slipping and to make a change to improve on the measure again. For example, if you have made an administrative change to reduce the amount of time it takes to get a contract to a provider, you would continue to measure the length of time it takes and if it begins to take longer, then you pull your Change Team back together. Keeping track of key data points becomes the job of all managers or supervisors responsible for sustaining the change. Data can also be shared regularly so that everyone feels it is part of their job to sustain improvement in key measures.

A second method of ensuring that an improvement is sustained is to include the new process in a written document like a policy or procedure manual. This only works if the manual is a living document that people refer to when they have a question about how a particular process is done. If you create a manual that sits on a shelf unchanged and unused for long periods of time, then adding new policies or procedures to it will not help sustain change.

A third way of sustaining change is to build it into the culture of the organization. As staff are engaged in Change Teams, they will see the improvements that they have made and will experience pride in their work. When people expect that their job includes identifying and suggesting improvements, participating on Change Teams, and reporting successes, it becomes part of their job, not extra work. Make early changes reduce work so that people have time to participate in Change Projects. Write into job descriptions the expectation that people will participate in process improvement projects. Reward participation, improvement, and attempts at improvement if they are unsuccessful but lead to greater knowledge. Allow others to play the role of Executive Sponsor so that when leadership changes, there will be people ready to assume the role and keep process improvement efforts going. When hiring new employees include process improvement as a part of their job description and hiring questionnaire.

A useful tool for assessing your ability to sustain changes is the British National Health Service’s Sustainability Model. The model identifies ten key dimensions that must be addressed to ensure that changes are sustained. You may assess your own efforts to sustain changes against the dimensions of sustainability outlined in the model, and consult the training manual that accompanies the model to identify possible remedies for deficient areas.

Sustainability and Spread Plans from STAR-SI States