VALUE
IMPROVEMENT
LEADERS
TOPIC #22
553 words + 1 activity  | 11 minutes (3 to read, 8 minutes for video)
IMPLEMENTATION AND PILOTING
PRINCIPLE
Logistical skills are needed during implementation and piloting. But that doesn’t mean you can relax your value improvement principles.

SKILLS
•  Project planning
•  Project management
•  Observation 
•  Communication 

APPLICATION
Watch the brief video (8:20) .
You’ve put a lot of work into your analyses and development of a solution. It’s time to implement. Recall that improvement design and improvement implementation are different phases characterized by distinct types of activities. Specific interventions follow a design then build then introduce sequence. Today we’re focused on building and introducing.
What Could Go Wrong

Let’s say you’ve revised an important clinical protocol and even developed the details about how it should appear in the EMR. In fact, let’s say the EMR changes have already been made. You’re ready to go live. Lots could go wrong at this point: Your communication of the coming changes may not reach all the stakeholders. You could have missed something important in the protocol design or programming. There are too many ways an implementation can go off the rails to list them all here and each could cause confusion and frustration, and in extreme cases, endanger patients.
Don’t Shortchange Implementation Planning and Execution

It may be trivial to your team which tasks are design and which are implementation. In fact it may be a sign that your project is going smoothly. Regardless of which phase a task belongs to, as project leader, it’s likely your job to make sure they get done. That’s not the same as doing them yourself. It’s a matter of project management.

Just as designing a house is different from building a house, as you shift from design phase to implementation phase, you’ll notice the types of tasks you’re engaged in also shift: You move from architect to general contractor. 

Planning your implementation is similar to planning any other part of your project.

  1. Define the tasks to be carried out and the deliverables they produce
  2. Sequence the tasks in terms of predecessors & successors 
  3. Estimate the duration of the tasks and establish target dates
  4. Assign the tasks 
  5. Follow-up
  6. Plan for contingencies

That’s the logistics challenge, but there’s also the towering task of communications. You will find yourself dealing with many more people, including ad-hoc team members with specialty skills, and of course, stakeholders. For any given individual or group, you will be managing communications and expectations. You’ll be repeating your long-term vision, sharing your near-term plans, asking for participation, taking questions, and listening to complaints. 
Piloting

The pilot is your first PDSA cycle and it’s your most important because there may be skeptics just waiting to say, “I told you it wouldn’t work.” Perfect is the enemy of great and clearly there is a tolerance for imperfection on the first try, but there has to be some sign of progress. You, as project facilitator, must be watching and listening closely during the pilot for signs of success and trouble. You need to celebrate the successes and remediate the trouble spots.
Here’s the Video

This video (8:20) goes a little deeper into planning and executing a pilot. It discusses setting the tone and how to promote success by defining it. It also defines the role of the project leader during the pilot. 
LINKS

Quickly locate all course videos, slides, and previous emails here .
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Questions? Email:  kim.mahoney@hsc.utah.edu