In coming up with changes, remember this: All improvement requires change, but not all changes result in improvement. Be sure to focus on changes that are most likely to result in improvement. Ideas for change can come from a variety of sources: critical thinking about the current system, brainstorming, observing the process, a hunch, an idea from the scientific literature, or an insight gleaned from a different but analogous situation.
This book makes recommendations for change, based on general ideas about changes likely to work. Changes have proven merit and a basis in scientific or medical research. Many ideas are accompanied by stories from the efforts of other Breakthrough Series teams, describing the changes made and their effect on patient care. These stories and ideas are "rated" according to the following key:
| Complete cycle (P-D-S-A) | Ideas tried and tested with some evidence for usefulness |
| Partial cycle (P-D) | Ideas tried but evaluation not done or incomplete |
| Plan only (P) | Good idea, but little or no implementation (yet) |
One way to decide whether an idea has merit is to ask front line staff what they think of it. Their knowledge of the care process, with its inherent problems and feasible solutions, can be trusted as a screen for good ideas.
In the Breakthrough Series Collaborative, teams found ideas for change from several sources for changes. These included:
Teams selected areas in which they most needed to improve, then talked to their own staff for ideas and relied on some of the resources just described. Good ideas for improvement can be found everywhere—the challenge is for a team to select the ones that will be most effective in its organization.
This text is derived from the book Improving Care for the End of Life : A Sourcebook for Health Care Managers and Clinicians.