Phase Three: Sustain

Steps

• Step 9: Evaluate Progress toward Goals

  Hold weekly sustainment meetings to discuss how the strategies that you implemented are working and how to make improvements as needed. The goals of the meetings are to …

  • Discuss challenges and approaches to addressing them
  • Review measurements of progress toward attaining goals
  • Identify missed opportunities for screening, assessment, treatment, monitoring, and follow-up

  See the sustainment meeting template (DOC) for a sample agenda for your meetings. Use the same document and add to it each week to capture your practice QI team’s discussion and plans so that it can serve as a reference for your progress and as a reminder for items you put aside for later consideration.

  Include a routine agenda item at each sustainment meeting for the practice QI team to systematically review the status of changes related to each goal. In the first few meetings, it may be easy to find areas that need to be improved based on group discussion and obstetric care clinician feedback. In later meetings, we recommend collecting information from patient charts or practice-designed internal logs to monitor the degree to which changes are taking effect. This data can help your staff adapt to the new procedures and identify strengths and areas for improvement. You can use results from the baseline assessment and chart spot check form for comparison with new information.

  We recommend that you ask one of your practice QI team members to complete routine spot checks of charts to collect this information. This information may include, for example, the number of perinatal individuals who received an educational handout about perinatal mental health conditions, have a chart containing documented screening, were referred for therapy, or began pharmacotherapy.

  Discuss the information you gather with your obstetric care clinicians and staff to get their insights on how things are going and ask for their suggestions for improvements going forward.

  For a formal measurement of progress, repeat a practice self-assessment about three months after implementation begins. This comparison can shape ongoing work and serve to motivate the QI team, practice staff, and obstetric care clinicians. Please see the steps summarized below:

  • Complete the baseline practice self-assessment instrument (PDF). Ideally, the same obstetric care clinicians and staff who filled it out the first time would complete it again.
  • Repeat a spot check of 10 to 20 charts using the chart spot check form (DOC) by selecting charts of perinatal individuals who have completed their final postpartum visit.
  • Enter the chart spot check form data into the tool to schedule implementation meetings and create practice goals (XLSX). This time, use the “Follow-Up Chart Data” tab.
  • Enter the practice self-assessment instrument responses in the “Follow-Up Practice Info” tab.
  • Use the “Follow-Up Comparison” tab to see how your practice currently compares to baseline.
• Step 10: Revise Procedures Based on Lessons Learned and Continue Iterative Improvement Process

  As you identify ways to address obstacles, make changes in the workflow and practice procedures. As this happens, you will need to …

  1. Establish a systematic approach to informing your practice as changes are made. Information can be relayed through individual instruction, practice group meetings, email, staff bulletin boards, or wall postings.
  2. Identify challenges and approaches to overcoming them, evaluate the approaches implemented, identify new approaches, and repeat until goals are accomplished.
  3. Discuss each goal with your group to determine if each goal remains attainable at present or needs to be revised or deferred.

  Communication with your obstetric care clinicians and staff is vital. To sustain change, it is essential to continue to provide feedback about progress until your new workflow is running smoothly and becomes standard practice.