Once all the hard work in planning and then implementing an improvement project is behind the team, the improvements keep “rolling in!” But what happens when the team moves into sustainment? Are the hard battles still being fought every day to maintain the gains? How can you ensure that your hard work will continue paying off and move your team and hospital to becoming a high reliability organization? There are two major questions:

1. How are improvements hardwired into the system to Hold the Gains?
2. Who is the process owner/leader designated to monitor the data/gains?

Here are some additional tips:

1. Ensure Reliable Processes
   • Were there processes, policies & procedures that you improved?
   • How have you been able to standardize those?
   • How are you auditing these improvements?
   • Who maintains ongoing implementation of the new procedures, policies, processes?
   • Who is responsible to train new staff?
   • Who receives ongoing communication?
   • What process is in place to monitor your gains? How often will this group meet?
2. Keep up the Attention
   • Keep measuring, getting feedback, may be able to reduce data collection and have one person for continued monitoring as long as sustaining.
   • Re-train, re-educate and re-campaign (people forget or get into bad habits).
   • Put visual reminders in place.
   • Recognize or celebrate maintaining the gains.
3. Manage the Politics
   • Don’t let those who haven’t bought in yet stop the practice.
   • Make sure leadership is supportive.
   • Work with outside departments to support the process.
   • Communicate with senior leaders about the project, providing data & demonstrate how this enhances the department.
   • Find your allies… may be your families!
4. Use the attached Survey to help your team organize these areas into accountable action points.

Information adapted from Hannah King, VON NICQ 2009 Meeting, Austin, TX & Ohio Perinatal Quality Collaborative.