Setting the Stage for Sustainability in Quality Improvement Projects

In all types of quality improvement efforts, sustainability is a vital consideration that often goes overlooked until the project’s final stages. With the right balance of foresight and strategy, however, team leaders can plan for sustainability as a project gets underway. This lets teams seamlessly support sustainability and a create quality improvement projects with truly powerful impact.

“One of the key things in quality improvement is to develop plans for sustaining the gains into the start of the project,” says Pat Heinrich RN, MSN, CLE, an executive project director at NICHQ. “Instead of getting to the end and asking, ‘Now that we’ve made some great improvements, what can we do to continue them?’, you need to think about that aspect from the very beginning.”

For improvements with enduring effects, Heinrich advises aligning each project with the larger organization’s strategic objectives. By way of example, she points to NICHQ’s recent work in helping nearly 90 hospitals across the country achieve Baby-Friendly designation.

“If a team’s purpose was simply to become Baby-Friendly, a new administration could easily come in and cut the budget for that,” says Heinrich. “It’s much more robust if you can say, ‘We are carrying out this improvement project as part of a larger goal to provide the highest-quality patient care, and as a result to become the only Baby-Friendly hospital in this community.’”

Connecting an improvement project to your strategic goals also helps secure resources and leadership’s attention—both key to project success.

In building project support for sustainability, it’s also crucial to fully engage the employees and stakeholders involved in holding the gains or who benefit from the gains. In every project, there are always people who are willing to try new things, and there are always others who may resist change. To overcome that resistance—and inspire the commitment needed for long-lasting change—Heinrich suggests enlisting the most willing employees in the early stages of testing. 

“If you can start by making very small tests of change and collecting some data to show improvement, then your early volunteers can go back and talk it up to the ones who might be interested or even resistant,” Heinrich says. “Once the others hear that the changes weren’t too difficult and that families were happy with them, they’ll be more likely to want to try it themselves.”

Building off those small tests of change can further promote sustainability as projects move forward with testing, according to Jane Taylor, EdD, MBA, MHA, an improvement advisor for NICHQ. To that end, Taylor recommends incrementally increasing the scale of testing while continually varying testing conditions. 

“A wide range of conditions is so important for understanding how the change will actually work,” says Taylor. “You want to learn how a change works with experienced staff and with new staff, when you’re busy and when you’re not busy, with English-speaking families and non-English-speaking families, with families who have high health literacy and low health literacy. The point is to try all these conditions and provoke the change to fail, so that you can learn from that failure and design around it before going to implementation.”

A gradual approach can also guide teams toward sustainability during the implementation stage of quality improvement. 

“Implementation is a social enterprise,” says Taylor. “If you scale up slowly, you’ll bring to the surface any of the barriers that might prevent change from being successfully implemented and later the gains held. Then you can tackle those barriers incrementally, which increases the chances of the implementation being successful.”

Once quality improvement teams start to see success, spreading the word about the project’s progress can help maintain momentum and set the stage for sustainability. Taylor advises collecting iconic stories from staff and families and use them to illustrate the benefits of change. 

“Create a constant drumbeat by creating a communication plan with multiple communication channels,” advises Taylor. “Use emails, site visits, newsletters, professional meetings and gatherings, interested publications, face-to-face interaction, small meetings. Create a webpage so that stakeholder can observe the project as it develops and spreads.”

Engaging with leadership is another key factor in sustaining improvements because making changes to the organization’s system is usually necessary to uphold improvements. Such changes typically include amendments to organizational policies and procedures, updates to staff training modules, integration of new resources and equipment, and upgrades to the IT system. 

In every stage of the quality improvement process, moving toward sustainability means keeping sight of the project’s ultimate goal. 

“The reality is that change is difficult, and people can get overwhelmed by the effort,” says Heinrich. “So it’s important to remember that it’s not about making people work harder—it’s about changing the system and creating a new way of doing things, so that we’re better able to serve children and families.”