Exploration of two different strategies for the implementation of a care bundle
| Lesson | Strategy 1 | Strategy 2 |
|---|---|---|
| 1 Find opportunities to learn about and practise PDSA | The team have limited opportunity to learn and practise their approach to implementation of the care bundle – everything rests on the ‘big launch’. | The team have opportunities to apply the PDSA approach in simulations and on a small scale tests. This supports learning and builds competence and confidence prior to more complex and larger tests of change. |
| During the launch event, colleagues raise a lot of valuable questions and issues that could improve the care bundle – but the team, having not run an event like this previously, have no means of capturing these issues and can only recall some of these issues after the meeting. They are disappointed the idea wasn't better received after all of the work they had put in. | After one of the initial small scale tests, the study phase reveals only 2/10 forms have been filled in. Only by asking the people doing the test did they understand the reason why: it was difficult to obtain the information to complete the forms. The team learnt the importance of getting feedback from staff and of building good relationships with them. They also realised the test had been too large, and the same conclusion could have been reached from one or two patients rather than 10. | |
| 2 Stop doing what isn't working and start spending more time on PDSA | A significant portion of work undertaken by the team prior to the launch may be wasted if it turns out that the care bundle is not fit for purpose. | By devoting time to developing the intervention through PDSA cycles, the team are able to avoid extensive rework of the care bundles later on, and can build engagement with more staff as they go. |
| Following the launch event they realised that they need to redesign the form and have to recall the hundreds of forms they had printed. The project has already been running for 6 months and only 2 months remain, staff morale is low and no new people have volunteered to get involved. | In an early PDSA cycle, the team realise that junior doctors will play a bigger role than they had thought at the start. At this point, they engage a junior doctor as a project champion and plan PDSA cycles testing out the care bundle with them. | |
| 3 Encourage clinicians to learn safely from failure | By undertaking the ‘do’ stage as one big launch, the team deprive themselves of the potential to incorporate related learning into the design of the care bundle (‘study’ and ‘act’). This means the first point of failure in practice is the launch itself, resulting in a high profile, high cost failure. | Being involved in the testing and development of the care bundle increases buy-in and allows failure of the care bundle to occur on a small scale in a safe and contained manner. This enables rapid learning without using up physical and emotional resources of other staff unnecessarily. |
| They discover after the launch that the clinical information needed is not available in A&E at the time it is required, and have limited time and resource left to remedy it. | The team test the care bundle with one patient and realise that the clinical information that they need is not available in A&E at the time it is required. They are then able to modify the information flow through several more tests of the bundle to eliminate this problem. |
A&E = accident and emergency department; PDSA = plan-do-study-act