Step 6:

Evaluate changes and implement and spread as appropriate

Key Point

Use your data to evaluate whether to adopt, adapt, or abandon change.

• Talk to staff as you test your changes. Use their feedback to determine whether to adopt your change, adapt it, or abandon it. Remember, the worst thing that happens is you can go back to the way that it was yesterday!

• Use your run chart to see if your changes are making a difference. Share your run chart results with team members and leaders. Consider posting it someplace where the team can get immediate feedback on their efforts.

• Run chart rules: Things that indicate that something has happened that is not just random variation — it’s not just happening by chance! This could be good (you implemented a change and it’s having a positive impact) or bad (flu season has led to a rise in ED census).

  1. Shift — 6 or > consecutive data points all above or all below median.

  2. Trend — 5 or > consecutive data points all going up or all going down.

  3. Too few or too many runs — A run is one or more consecutive data points on the same side of the median.

  4. Astronomical data point — A data point that is far out of line with all other data points in your run chart. Again, this could be good (the first patient of the day whizzed through clinic) or bad (a blizzard led to staff shortage which dramatically slowed turnaround time) but suggests that something unusual is the cause.

• Based on pilot results, design final change package for implementation.

• Review final package with local executive and operational sponsors for sign off and support. Consider creating an executive summary in addition to a more detailed report out for front-line staff and managers. You can see samples of executive summaries here and here. You can see an example of a more detailed report out here.

• Do you need help with this step? Drop us an email at QualityQuestions@upmc.edu and Wolff Center staff will be happy to help you.