8 Translation 177
support. Finally, estimation of and feasibility to secure dissemination costs, such
as travel and other costs associated with presentation or poster development,
should be discussed.
Implement the Action Plan
After an action plan is created and support is secured, implementation begins.
The first step is a small test of the change, or pilot. The implementation plan is
communicated to all team members who are affected by the change or who are
caring for a patient or population affected by the change. This communication
can take the form of an agenda item at a staff meeting, an inservice, a direct
mailing, an email, a bulletin board, or a video, for example. Team members must
know who the project leader is, where to access needed information or supplies,
and how to communicate to the project leader any issues as they arise. The team
obtains staff input along the way to identify problems and address them as soon
as possible. Changes are then implemented and evaluated.
Evaluate Outcomes
After the change is implemented, the next step is to evaluate its impact and prog-
ress toward the desired outcomes. Outcomes identified when formulating the
PICO are the measures used to evaluate the success of the change. Collaborat-
ing with the organization’s QI staff is important during the evaluation process
for guidance on the tools and the appropriate intervals to measure the change.
Selecting and developing outcome measures includes defining the purpose of
measurement, choosing the clinical areas to evaluate, selecting and developing
the metrics, and evaluating the results (Pronovost, Miller, Dorman, Berenholtz,
& Rubin, 2001 [adapted from McGlynn, 1998]). Measures may include process
measures (focus on steps in the system), outcome measures (focus on results of
system performance), or balancing measures (focus on impact on other parts of
the system) (Institute for Healthcare Improvement, 2011). Data collected are
compared to baseline data to determine whether the change should be imple-
mented on a wider scale. Descriptive data, such as frequencies or means, can be
graphically displayed in bar, line, or run charts.
