Identify specific change ideas, test and refine

Change ideas are defined as the things you can specifically test to see if they make a difference. Now that the team are clear on the aim and change theory, it is time to identify change ideas.

This section puts forward changes that have been tested and proven to show improvements in access and flow across care pathways. Alongside these ideas are some practical tools that can be used to generate further change ideas in the event that more are required.


Identify specific change ideasFigure 3. an example of Access QI change concepts for improving planned care pathways

If you have tested the change ideas detailed in the above section and your pathway requires further improvement, there are different approaches you can use with the team to help them come up with change ideas to test. Often a combination of approaches is needed, as you will need to develop changes to address most or all of your drivers.

Cause and Effect is a diagram-based technique that helps the team to identify all of the likely causes of the problems you're facing.

Benchmarking is learning from how others do things. This can be informal by simply observing another team’s or organisation’s approach and processes.  A formal process provides a structure to support this and can be used to compare how things are done differently (practices) alongside key process measures so that the impact can also be compared.

It is recommended that the benchmarking process is conducted as a PDSA so that you learn about, and continuously improve the process.

In any improvement project there will be several different change ideas that could help achieve the desired outcome. A Prioritisation Matrix can help you decide which change ideas to test first. They come in many different forms, but the simplest and easiest to use is the 2 x 2 matrix. Each axis is labelled to enable you to categorise the priority of each change idea. Usually the horizontal axis is labelled with a concept such as ‘effort’ or ‘willingness to adopt’ with the vertical axis usually being ‘impact’ or ‘value’.


Test and refine

Testing changes helps you build your knowledge about what works in your system, and why. The most important thing about testing is that you have a theory. Each time you do a test you need to make a prediction about what will happen. If the prediction is wrong, then you need to adjust your theory.  Simply trying changes without a prediction is not testing and does not help build knowledge.

As you build your knowledge about a change you will want to test it under different conditions to see if your theory still holds with different people, shifts, or circumstances.  As you build your testing you will get more confident in your predictions, develop the change within your context and increase your degree of belief in the change.

The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change — by planning it, trying it, studying the results, and acting on what is learned. This is the scientific method, used for action-oriented learning.

Using the PDSA cycle involves testing new change ideas on a small scale and building knowledge iteratively. A test does not equate to a change idea. You will likely need several PDSA tests about each change idea to really understand whether and why it works.

A PDSA tracker tool is a method to display your change theory and change ideas. It contains summary information on change theory, links to driver diagram, measures, tasks that need to be done and PDSA learning.

Lessons Learned Logs are used to capture and share knowledge about what has worked well and what could have been done differently during the planning, management and delivery of an improvement project. They help others learn from the project team’s experience. All members of the project team should contribute to the Lessons Learned Log.