Successful quality improvement efforts aspire to be sustainable: having the new ways of working become the normal ways of working for the team, organization, systems or facility. However, sustainability does not happen automatically; it requires planning and ongoing effort.
Multiple factors can threaten the sustainability of your project’s outcomes—staffing changes, lack of support from administrators or executives, lack of measurable results and data, overreliance on additional funding and many others. To keep factors like these from derailing your improvements, you must plan ahead.
Tip #1: Think about all changes through the lens of sustainability.
When selecting an idea to try, consider if it works on a small scale and if it can be expanded to a larger scale. If there is no room for expansion, a team should consider testing a different idea. Amanda Norton, an improvement faculty advisor for NICHQ, cautions that “sometimes, in pursuit of the aim, a team establishes a system or process that is inherently not sustainable. They may have accomplished the aim, but at what cost? If you cannot sustain the gains over the long term, you haven't truly succeeded.” Always think about whether and how a proposed change can be sustained over the long-term.
Tip #2: Nurture and revisit sustainability during and after the project’s official end.
“Even when you think you’ve got it built in, you need to go back and stoke that fire,” says Jeanette Webb, follow-up coordinator for the Louisiana Early Hearing Detection and Intervention Program, a participant in NICHQ’s newborn hearing screening project, which officially ended in 2013. As part of her project to improve newborn hearing screening follow-up care, Webb’s team developed a fax back reply form that is sent to physicians’ offices whenever a newborn fails a hearing test at the hospital and follow-up testing has not been reported by three weeks of age. Physicians’ responses back on the form indicate whether and where an infant received re-screening. The fax back communication also emphasizes the importance of medical home staff discussing early follow-up with the family and assisting with scheduling follow-up appointments.
After having great initial and ongoing success with the fax back program, Webb recently noticed that response rates were slipping. Her team decided to try a new small change and added a sobering CDC data point (8.7 percent of babies who failed their newborn hearing screening are diagnosed with permanent hearing loss) as a new visual “sticky note” to the fax back form. Slightly changing the form was enough to triple the response rate within a week. Webb also makes a point to constantly educate others about the importance of follow-up, the need for the information and her office’s work to ensure that physicians, audiologists and others will remember and continue to communicate even though the fax back process is considered fully implemented.
Tip #3: Measure, collect data, report and REPEAT.
When executives and administrators do not understand the value of your project and outcomes, you need to demonstrate the benefits, cost-savings or increased revenues related to the changes so that you will enlist and ensure their ongoing support. The best way to do this is through data. After the project’s end, keep collecting and monitoring data about your outcomes and report your continued and maintained successes. Webb only noticed that responses rates were slipping because she was monitoring the data. “Data becomes my carrot on the stick,” Webb explains. “Stakeholders like to see data, and we also use data to engage new partners.”
Tip #4: Celebrate your project’s sustainability.
It’s easy and natural to celebrate the positive outcomes that your project has enabled. As time goes on after the project’s end, however, be sure to periodically also laud the fact that the outcomes are continuing. Post visual reminders to staff about sustainability to encourage their work and to make them proud of their efforts. Never underestimate the human factor and how having people’s support for sustaining changes can make or break success.
By following these tips, you will be better prepared to sustain the changes and positive outcomes from your quality improvement project. Please share with us how you are addressing sustainability at firstname.lastname@example.org