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Step 6: Identify individual projects and improvement teams

In this step, the working group for each care experience takes all the information they have collected, selects projects for action and recruits teams to embark on the improvement work.

In this step, the working group for each care experience takes all the information they have collected, selects projects for action and recruits teams to embark on the improvement work.

To select improvement projects, draw up a list of aspects of care where there is evidence of some discrepancies or common themes that have arisen through the different data collection methods, with a particular emphasis on shadowing. This provides you with a list of potential projects. The next stage is to articulate why each potential project is a priority and describe what success for that project would look like. Then agree an order in which to tackle them.

For each active project, you need to identify two named co-leaders. They then draw in other staff to form a project improvement team. These teams are responsible for delivering successes on individual projects, and need to provide weekly updates to the working group on the goal, time frame and progress, as evidenced by measures. Compared to the guiding council and the working group, the project improvement teams may be quite small-scale and time-limited.

For the improvement projects themselves, the teams adapt the six PFCC steps as follows:

Step 1: Select a project based on the perspectives of patients and their families

Step 2: Assign project team co-leaders

Step 3: Evaluate the current state

Step 4: Recruit members for the project team

Step 5: Create a shared vision by writing up the ideal care experience

Step 6: Get to work.

To implement the changes, we recommend that you use the model for improvement, with small tests of change evaluated using Plan, Do, Study, Act (PDSA) cycles. This approach enables you to begin testing changes on just one bay, one ward, one shift, or for one day. Here is an example of how the team at RUH Bath approached this:

Key points

  • The group needs to provide the guiding council with a regularly revised list of active projects, completed projects and future projects.
  • When reporting back on the projects, all changes must be evaluated. This can only be done by using measures that are credible and meaningful for you and readily available.
  • For initiatives to improve services, use the model for improvement, using PDSA cycles.
  • PDSA offers the major advantage of enabling you to try things on a small scale and getting feedback before tweaking or rolling out more widely.
  • Managing a range of projects at varying stages of development can be overwhelming. Make sure the co-ordinator has enough protected time for this task, split the work up into manageable chunks, and share it out so it does not all fall to one person.
  • When recruiting teams, make sure you enable a range of different people, from different roles, to get involved in the parts of the project that best suit their skills and interests. When you are testing initiatives, value the opinions of the dissenter. There’s often a kernel of truth in what they say, and powerful dissenters often have a really good reason for being so. If you can succeed in persuading a strong dissenter of the value of what you are doing, they can end up being your most powerful advocate.
  • When selecting participants and leaders within your groups, formal status within the organisation is not the critical thing. Instead, look for people with enthusiasm and energy who are well connected across the organisation – whether informally or formally.
  • Throughout the project, make a point of thanking people and acknowledging their contribution to the process – it is this, more than anything, that keeps the momentum going.

It was clear from one experience of shadowing patients that the whole experience could have been much better if someone had sat down for five minutes to describe the key events over the next 24 hours.