Implementation of Systems Redesign: Approaches to Spread and Sustain Adoption

The widespread gap between evidence and practice for clinical and preventive services argues for a deeper understanding of effective quality improvement (QI) and system change. Using implementation and system redesign sciences, we have developed and used an effective strategy to enable robust implementation of QI initiatives, including clinical practice bundles, within a health care setting. Our program, which applies Lean and systems engineering methodologies, is specifically designed to exploit the five characteristics of effective innovations, as outlined by Berwick. This strategy has been applied in over 21 hospitals (six hospital systems) throughout the State of Indiana and is currently being used as part of the Radically Reducing methicillinresistant Staphylococcus aureus (MRSA) initiative funded by the Agency for Healthcare Research and Quality (AHRQ). The benefits of the process redesign activities are detailed at the business level through a business case analysis. Additionally, benefits at the personal level are quantified through workflow analysis (prior to and following the interventions). The intervention strategy is integrated into the current quality framework for each organization to ensure compatibility with existing organizational programs. Our staff engagement, training, and educational programs make systems engineering methodologies and principles readily accessible to frontline staff. Additionally, each project session requires immediate application of tools and techniques. This article will discuss our implementation strategy, provide examples of Lean and systems engineering tool applications, and provide an assessment of spread adoption and sustainability as a function of this implementation strategy.