Implementing and refining changes

Implementation begins by identifying the initial change ideas that the project team are looking to test. Throughout implementation you should regularly review the process, outcome and balancing measures to ensure changes are occurring without impacting on the wider system and to identify when the aim has been achieved.


Change ideas

Change ideas are specific practical changes project teams can test to maximise the number of outpatient appointments while physical distancing. Change ideas are grouped by the primary drivers of the driver diagram.  Click the links below for further details on change ideas for each primary driver:

Project teams should select change ideas to implement based on what they learned whilst understanding their current system. A range of change ideas will be needed to ensure there are changes to all primary drivers. Care should be taken not to test  several change ideas from the same primary driver at the same time or the project team will not be able to determine what changes are leading to improvement.  

This change package does not contain an exhaustive list of ideas. Project teams can help generate their own ideas that will help drive improvement. If your project team have identified new change ideas that have contributed towards maximising the number of outpatient appointments while social distancing, then please let us know through the feedback form or by emailing us at and we can include this in our change package to help other teams benefit from your learning.


Using Plan Do Study Act to test changes

Change ideas should be tested using Plan Do Study Act (PDSA).  This will make it easier for the project team to refine the change idea to the local conditions to maximise its impact. This will involve:

  • Plan: Identify the specific change idea to be tested and agree how, when and where it will be implemented. Agree who will test the change idea and by when.  Ideally, this will be before the next scheduled project team meeting.  Record the decisions in the action tracker.
  • Do: Follow through with the agreed actions to test the change idea.  Keep a learning log to record any observations or issues and share this with the project team to help troubleshoot.
  • Study: Use the process data related to the change idea and observations to determine if the expected improvements have occurred.  You may wish to refine your driver diagram and measurement plan as new learning emerges.
  • Act: Review the change idea as a project team and decide if the change idea is:
    • ready to be adopted and become the new standard process and move to Stage Five: Sustaining change
    • needs refined and the PDSA repeated, or
    • unlikely to work in this situation, then log the reasons why in the learning log and abandon the change idea.

Using a PDSA template will provide a structure to carrying out your test of change and also act as a record of what happened. 

Select the next change idea and repeat PDSA until the outcome data demonstrates clinical capacity is being managed to meet demand without negatively impacting on the balancing measures.