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Accelerating improvement means acting quickly. Most improvement efforts fail because so much time is spent considering, studying, and meeting that nothing ever changes. Organizations that want to improve can simply begin small-scale tests right away. Running small-scale tests sooner improves patient care much more surely and quickly than does running large-scale cycles later. Even an ambitious and innovative change can be tested first on a small scale - for example, with only one or two physicians, with the next five patients, for the next three days. In general, make the strongest change that the team can do quickly, on the smallest sample that will be informative. When a team can show improvement, then expanding the scope will be much easier. But don't be timid about how substantial the change should be. Too trivial a change ruffles no feathers - but it inspires others to accept the status quo.
Each completed PDSA cycle, properly done, provides valuable information and forms the basis for further improvement. If a change that works on a small scale is improved in successive PDSA cycles, it can then be implemented with assurance on a larger scale.
Teams should ask, "What is the largest informative change we can make by next Tuesday?" This will not be the only change a team should make, and probably will not be the most important one, either. But by making an informative change "by next Tuesday," teams can break the inertia that keeps many improvement efforts from getting off the ground.
It is easy to become comfortable with the status quo. What is easy and routine is what happens. By showing practitioners that another way actually works better, you help them to see just how limited and suddenly archaic their routine practice has been.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ]. |
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