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TRIP Plus 2

In this module, learners will develop an understanding of what project sustainment is and why it is important, the potential risks to project sustainment, the importance of planning for sustainment from project inception, types of measures used in quality improvement projects and the attributes of each, how strategies for improvement were developed in two successful large-scale quality improvement initiatives. Learners will become familiar with the issues impacting sustainment and how they may be successfully addressed across the life span of a quality improvement project.

Designing for Sustainment: Keeping Improvement Work on Track (Patient Safety IV)

Johns Hopkins University

Course 4 of 7 in the Patient Safety Specialization

Keeping patient safety and quality improvement projects on track, on time, and on budget is critical to ensuring their success. In this course, students will be introduced and given the opportunity to apply a series of tools to guide and manage patient safety and quality initiatives. These include tools for defining what success looks like, developing a change management plan, and conducting a pre-mortem to identify risks for project failure. This course will also provide tools for engaging stakeholders to ensure key players are invested in your project’s success.

Skills You'll Learn

Change Management, Project Planning, Staff Engagement

Taught By

Lisa H. Lubomski, PhD
Assistant Professor

Transcript

[MUSIC]

I wanted take a few minutes to describe how sustainment fits into the model for

translating research into practice, or translating evidence into practice.

Here again is the strategy which was initially described by Peter Provost and

colleagues.

You received a lecture from Sean Berenholtz earlier,

who is one of the co-authors of this paper in the British Medical Journal in 2008.

It is still one of my favorites.

I think that this formulation describes many of the essential

actions for taking something which we know works,

which has been shown to be efficacious in a previous setting,

and translating it, and then sustaining it.

The four Es of this formulation are engage,

educate, execute and evaluate.

It is important to engage people's attention.

And even their emotions so

that they care about the success of your project initially.

People then need to be educated and trained about the importance,

the impacts of the problem, and what they need to do to help fix it.

They need to execute the necessary steps.

They need to be able to do them with high fidelity.

And they of course, need to do them reliably,

repeatedly, ideally for every patient, for every situation.

And finally, it is important to evaluate how it's going.

The best laid plans often go astray and without

early feedback, and continued feedback, one doesn't know how you're doing.

The four Es are supplemented at times by additional elements.

And sustainment is really what we're talking about today.

This figure shows the progress of implementation and

sustainment, as well as on the horizontal axis.

And on the vertical axis is the amount of effort that is needed to sustain.

And on the vertical axis is the amount of effort that is

needed to perform a step and to move on to the next stage.

The first state is two engage and educate the healthcare workers that are needed

to perform the tasks that are planned.

You can see that initially not much is happening, but

soon after there's a great increase in the amount of energy that

is needed by the team to get this off the ground.

The next phase is to execute and evaluate the program and

there is a lot of effort that is needed.

But gradually once you get over the hump,

the amount of additional energy to inject falls off.

In the sustainment phase, energy is still needed, but

if it is possible to institutionalize those improvements,

the amount of energy to sustain gradually decreases and

returns to a relatively low baseline.

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