Model for Improvement - Implementing interventions

This step implies moving beyond testing. After testing a change on a small scale, learning from each test, and refining the change through several PDSA cycles, the intervention is ready for implementation on a broader scale (for example, include an additional grade or the entire school). Implementation results in a permanent change to the way work is done and, as such, involves building the improvement into the organization. To ensure success, implementation should not be initiated before testing is done across a wide variety of conditions. Implementation requires changes in documentation, written policies, hiring, training, compensation, and aspects of the organization's infrastructure that may be minimally engaged in the testing phase. It may require more resources to be invested. Implementation can also use the PDSA cycles. Multiple test cycles reduce the probability of failure during the implementation phase.

Information from Institute of Healthcare Improvement's Improvement Methods: Implementation

County Team	Improvement Sought	Test and Implementation Results
Clinton	To achieve a 5 percent increase in the sales of fresh fruit, vegetarian options and healthier alternatives as part of a reimbursable meal in three different school cafeterias by June 2010.	Test Results: Sales of fresh fruit went up 567 percent as compared to sales of canned fruit which went up by 20 percent. Among the vegetarian options offered, the two items: Mexican Pasta and Vegetable burger were introduced into the school menu, and time line of the project did not allow for measuring whether it increased the sales of vegetarian options by 5 percent. Sales of the vegetable burgers decreased, while the sales of vegetable pizza increased over the two months that it was offered, and the test will be conducted again. Example of Implementation: Fruit placement practices will be implemented in the cafeteria, and if the test of these of the vegetable options and vegetable pizza prove to be positive, the menu items may be included regularly in the menu.
Franklin	Increase overall number of lunches sold by 10 percent at Petrova School by the end of 2010-2011 school year. Increase number of free and reduced lunches sold by 10 percent by the end of 2010-2011 school year. Increase the number of adult lunches sold at Petrova School by at least 10 percent by the end of the 2010-2011 school year. Replace at least 10 percent of the monthly menu with healthier items by the end of the 2010-2011 school year.	Test Results: Data collected did not show improved sales and the tests of healthier items were not measured. More tests of changes are needed prior to implementation.
Schenectady	The Martin Luther King Elementary School will develop an indoor walking track and increase the physical activity of at least 50 percent of fourth grade students and teachers/staff by at least 20 minutes per week for six weeks over a 10-week period. The results will inform the feasibility of increasing the physical activity of students and teachers in the other grades during the next school year.	Test Results: The active time in minutes of 75 percent of the fourth graders increased on average by 9.33 minutes per day and 18.66 minutes per week Implementation: The program is still in the testing phase because the school decided that while the students and teachers enjoyed the program, it would be more feasible to sustain the physical activity program if it was integrated into the regular class period.