The Quality Improvement journey

The first step is to create conditions that will support improvement in your team. To do this you should:

• get organisational support
• be able to explain the problem you want to solve 
• be able to communicate a clear vision around a shared purpose
• get your team in place. 

As palliative and end of life care professionals, we work in complex systems. Before we can make changes, we need to understand these systems from a variety of perspectives. We also need to understand the interactions that take place within them.

One example of how you can get a better understanding of the system you work in, is to look at feedback your organisation has received. You could look at feedback from both patients and staff who work there. This can help you identify areas for improvement.

Teams undertaking improvement projects need to be able to articulate exactly what they want to improve, including what ‘better’ looks like. As such, developing an aim statement and theory of change is a vital step.

The theory of change is a tool to help address how your team will make changes and what measures you will use. In short, it is the plan for your quality improvement (QI) project.  

A driver diagram is a useful tool that can help teams develop and communicate their theory of change. Download our free driver diagram template to help you get started in developing your aims.

All improvement requires change but not every change results in improvement. A useful framework for your project is the Model For Improvement™.

It is recommended to start small, testing change ideas in a specific context to understand what works and what doesn’t work. In QI, a change idea should be specific and actionable, rather than a general concept. For example, “improve communication in the team” is a concept, whereas “introduce a weekly huddle” is a change idea.

The Plan-Do-Study-Act (PDSA) cycle is a good map for testing changes, and with each cycle your learning will be increased. Our PDSA template can be a helpful starting point to test your change ideas.

Implementation happens when a change idea becomes a permanent change. At this point the change idea has become ‘business as usual’. This should only happen once the change idea has been tested in a variety of contexts. 

After implementing new changes, organisations need to establish a range of practices to ensure that the change becomes the new way of doing things. Without a focus on standardisation, documentation, training, measurement and resources, people will find it easy to resort to the old way of doing things.

We have created an implementation checklist to help you ensure your change ideas are implemented properly.

Spread describes the process of applying change ideas beyond the initial area of testing to new areas or teams. Spread normally takes place once a change idea has been successfully tested, implemented, and sustained under a variety of conditions. 

When spreading your change idea, think about exactly what you are spreading, and what the essential ingredients of the improvement are.

The 3 golden threads