Now, let's get talking about sustainability and spread. Our learning objectives for this section of this week are going to be around really enhancing engagement, continuing to think about ways to enhance engagement throughout the entire quality improvement project, and describing ways to make your investment of time and improvements in patient outcomes last forever. We don't want to input all of that effort in and then not actually have something to show for it two or three years down the road. You're also going to critically assess potential areas of failure in sustaining your improvement program outcomes and develop a plan to make sure that all of the patients in your institution have access to the same level of safety in their care. Finally, we'll also be talking about how to envision new realms of quality improvement activity that you can move into. So, let's take a look at the Armstrong Institute Model to Improve Care. Here, when you look at the far left side of the slide, you can see that there's discussion of the translating evidence into practice model. And this is how you take a piece of evidence and then, turn it into something that people can actually implement in the real world setting. A key piece of this are those six E's that you see there in the fourth step. And this is really around giving you instruction about how to implement a quality improvement or patient safety improvement within a real clinical setting. So you have to think about engaging, educating, executing, evaluating, and then, I like to talk a lot about the last two E's, which are enduring or making it so that it endures and expanding. And those last two are the ones that we'll be talking about now. Although, you can see that we talk about those as supporting the technical work, in fact, they also support some of the cultural or adaptive work that will be going on within your setting. And when we put all of these pieces together, you can see that they really create the best outcomes. The six E's implementation framework starts out with engaging, and we've already talked about that a little bit in this particular week. Here, we say to ourselves, "how does this make the world a better place?" And that's what we need to communicate to the people who are trying to implement some kind of an improvement. Then, we focus on education. "What do I need to do here?" That's the question that everyone's asking, and so, you need to have an answer. You want to convert evidence into behaviors and you want to evaluate awareness and agreement with the particular intervention. And make sure that everyone knows what their specific piece of this process is, what they're expected to do. In addition, we have execution. This is the question, "How can I do it broadly?" And so, during this phase, it's important for you as an implementer to listen to resisters, listen to the people who are saying there's a problem here because that's what you need to know in order to make it better and to respond to people's concerns so that they stay engaged. And during this phase, you'll want to be looking for things to standardize ways to create independent checks on your process so that it becomes more sustainable over the long term and have people learn from mistakes that occur as you roll this out. That's how you make it the best program that it can be. And then, you'll need to evaluate. And this valuation actually goes on continuously. It's not at the end stage. It's actually during the length of your project. How do we know that we're making a difference? This is an important piece. And then finally, we are moving into the area of the embedding or/and making it so it endures, as I mentioned before, as well as the last area, which is expanding the program. So, embed is important because here, this is how you make sure that it will last over time. How do we make this business as usual and how do I know it will last? So policies, procedures, training new people, walking the process to make sure that things are working as you think they should and continue to do so. And then, expanding is where we start to think about 'who else needs to know what we've done here? What's next? What are the next things that we need to take our new quality improvement skills and apply them to?' And so, it's important to pass whatever your intervention is on to other practices, other units, other businesses, other places of a business, and it's important for you to also figure out what the next challenge is in patient care and make sure that you're addressing that next challenge.
