Institute for Healthcare Improvement: Testing Changes

Example: Select appropriate communication methods to provide technical information to those in the target population who are willing to adopt the improvements

Plan:
The spread team predicted that setting up an open hotline between the experts and the adopters in the target population would be a way to provide the adopters with information while not overburdening the experts by taking up too much of their time.
They decided to test the hotline with one expert (Dr. X) and one group of adopters (Site A) for one week. Dr. X agreed to the test, and the spread agent notified the adopters in the target site and set up the phone number. They developed a plan to document the number and types of questions asked and the time commitment for the expert, and follow-up with the clinicians requesting information to determine their satisfaction with the responses and the response time.

Do:
Dr. X received three questions during the week from two different physicians in the target site. He was able to respond to two of the calls within an hour. The third call was placed while he was in his weekly management meeting and wasn't able to return the call until after 5:00 PM. Each call was about specific information relating to the changes the target sites were testing. The adopters were pleased with the information they received and said having access to Dr. X gave them confidence to try the changes.

Study:
The predictions of the team were upheld — the adopters used the hotline for questions about the changes they were testing and Dr. X was able to respond to each question. However, the team realized that sometimes the adopters might call at a time when Dr. X was not available.

Act:
In order to increase the timeliness of the responses, the team decided to test having the hotline available during designated hours (when Dr. X would be able to answer the calls). The spread agent agreed to notify the adopters of the new hours and Dr. X agreed to test the new process the following week.

Cycle 1: Use a telephone hotline between experts in the topic area from the successful site and a group of willing adopters in the target population.

Test using an open hotline (expert available at any time) between one expert and a group of adopters in a specific site for one week. Document the number and types of questions asked and the time commitment for the experts, and follow-up with the clinicians requesting information to determine their satisfaction with the responses and the response time.

Test using the hotline with designated call hours (e.g., 3:00 to 5:00 PM each afternoon) between one expert and a group of adopters in a specific site for one week. Document the number and types of questions, time commitment for the experts, and satisfaction of the adopters.

Depending upon the results of Cycles 1a and 1b, test one of the hotline types with one expert and adopters from two additional sites; document the number and types of questions, time commitment for the experts, and satisfaction of the adopters.

Expand the test to include additional experts and adopters from all the targeted sites; document time commitment and satisfaction of the adopters.

Cycle 2: Use a listserv to connect experts from the successful site to willing adopters in the target population.

Arrange to have each of the experts monitor the listserv for one day each week for two weeks; document the number and types of questions asked and the time commitment for the experts, and follow-up with the clinicians requesting information to determine their satisfaction with the responses and the response time.

To generate activity on the listserv, test having one of the experts post at least two discussion questions on the listerv for one week; document the number and types of questions, time commitment for the experts, and satisfaction of the adopters.

To generate activity on the listserv, test inviting specific adopters to post questions for one week; document the number and types of questions, time commitment for the experts, and satisfaction of the adopters.

Continue use of the listserv incorporating the results of Cycles 2a, 2b, and 2c into the design and management of the listserv.

Cycle 3: Organize "site visits" to the sites in the target population that are ready to adopt the improvements.

Organize one or two of the experts from the successful sites to visit (for two hours) one site in the target population that is ready to adopt the improvements; include presentation and question and answer format; document time commitment of the experts, perceived benefit by the target site, and post-visit adoption of the improvements by the target site.

Test using a half-day visit to an additional target site; include formal presentations and time for peer-to-peer small group discussion (e.g., nurse to nurse, physician to physician); document time commitment of the experts, perceived benefit by the target site, and post-visit adoption of the improvements by the target site.

Test using a "group visit" concept by conducting half-day visits with two to three target sites; include formal presentations, site-specific team exercise, and time for peer-to-peer small group discussion.

Continue to use site visits until all sites in the target population have been reached, using the best methods identified in Cycles 3a, 3b, 3c.

	Home > Topics > Improvement > Spreading Changes > How to Improve