Step 5

Develop a Plan, Implement and Monitor Progress

“I allow our medical providers to ease into these changes by supporting them with a team-based approach and offering internal and external resources and within the next 6 months I will make these guidelines mandatory”

Once your practice has defined your goals and selected the relevant recommendations, the next step is to develop an implementation plan – ideally focusing on initial implementation, then go through a Plan-Do-Study-Act (PDSA) cycle. If your practice has an established, structured improvement approach, you should use that approach.

Develop a plan for implementing selected Guideline recommendations

Develop a plan that outlines the following:

  • Who will spearhead changes (Step 1)?
  • What are the areas for your system to improve upon (Step 2)?
  • What are the goals (Step 3)?
  • What are the Guideline recommendations to be implemented (Step 4)?
  • What associated practice-level changes are needed (Step 4)?
  • What is the order of priority for changes (Step 4)?
  • What is the timeline for each recommendation being implemented?
  • When and how will the necessary components be implemented?
    • EHR changes?
    • Changes in workflow?
    • New tasks for specific staff?
    • Communication to staff?
    • Training of staff?
  • How will progress be monitored (Step 5, below)?
  • How frequently will leadership and other stakeholders be updated? By whom? How?

Implement the changes

Difficulties in implementing practice changes can be minimized by thoughtful planning and by understanding in advance the concerns of stakeholders whose interests and work will be affected. In Exhibit 3 under Step 4, alongside each Guideline recommendation there are considerations for implementation, which should be considered as your system implements the chose recommendations.

Monitor progress using QI measures and other data

An essential element of any practice improvement effort is monitoring progress towards the goals outlined. Your system should monitor progress using existing data and approaches outlined in Step 2. For example, completing the self-assessment questionnaire (see Appendix A) to assess your practice before you implement changes, and periodically to reflect on progress on each step and selected change. Your system should select the QI measures to measure your system’s baseline and monitor progress on a quarterly basis on any of the 16 measures that align to the Guideline recommendations your system has decided to pursue. See the following section “Clinical Quality Improvement (QI) Opioid Measures” for details on the 16 potential QI measures your system can use to monitor progress on the CDC Guideline recommendations.

The results of monitoring should be reported on a regular basis by the champion or change team to leadership and other stakeholders. These results can be discussed with the change team to identify any mid-course adjustments that may be needed.

Self-Assessment for Step 5

Develop a plan, implement and monitor 1 2 3 4
System uses a structured QI process to set goals, implement and test changes, and progress towards achievement of goals. Leadership, change team, and champion work together to make decisions and use data to evaluate progress. No plan has been established.
No QI measures have been selected.
Change team has developed a plan. QI measures may have been selected. QI measures have been selected. Practice or system has begun implementation. Progress is being measured regularly. System has gone through PDSA cycle, making changes or adjustments as needed. Change team has reported out to leadership and other stakeholders. Continued scale up.
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