Sustaining improvement gains

A "system" as described by W. Edwards Deming, the father of the quality movement, is a set of interdependent components - structures, people, and processes - working together towards a common purpose.¹ Within health systems, the primary intent and common purpose is to promote, restore, and maintain health by focusing on safety, effectiveness, and efficiency. For these reasons, many organizations devote substantial time and resources to build their improvement capability, but these hard-earned improvements fade as the focus changes to other priorities and workers revert to the old system of doing things. To counter this, many health systems are incorporating methods that ensure initiatives continue to help patients in the short term but also become embedded in the system to help future patients. The Institute for Healthcare (IHI) in their 2016 White Paper suggests that the key to sustaining improvements in systems is to "focus on the daily work of frontline managers, supported by a high-performance management system (HPMS) that prescribes standard tasks and responsibilities for these managers at all levels of the organization."² Both these factors are interconnected. An HPMS can be categorized into several areas; quality management, quality control, quality improvement, and a culture of high performance. As a practical example, this paper describes how the IHI framework can be employed to achieve sustainability for quality improvements, using an example of improving problem list utilization at discharge for patients.