Implement and sustain where tested

Implementing a change means making it a permanent part of how things are done day-to-day. Implementation requires a different approach to testing. Once the team have demonstrated that testing has resulted in improvement, consideration should be given to permanent support structures that may be required.

This section focusses on outlining practical tools and considerations that will support implementation.



Implementation should be carried out using PDSA methods. We shouldn’t expect to see failures when we move to implementation. Implementation cycles usually require more time than testing cycles.

There are a variety of approaches to implementation depending on the complexity and the risks involved. The PDSA cycle is required for all approaches to implementation.

An implementation plan (or checklist) will play a big role in the success of your improvement. It is important to communicate both your overall plan at the beginning, but also your implementation plan as soon as it is ready. This will lead to:

  • increased cooperation 
  • help buy-in, and
  • ensure you stay on track.


Support structures

Standardising, or creating more formal processes should be considered to support implementation and sustainability of the changes you have tested.

This is one of the key ways of reducing variation in the system and ensuring staff have relevant information to support decision making.

Consider what changes may be required. Such as training, job descriptions, standard operating procedures and documentation. These will increase the chances of any changes being sustained.

A standard operating procedure (SOP) is a step by step document created to help staff carry out routine tasks. They help achieve efficiency, quality outputs and uniformity, while reducing the chance of mistakes. Consider the changes you are implementing, do they require SOPs to be updated or created?


Ongoing measurement

Ongoing and visible measurement of the process is a useful approach to ensure that the changes are being carried out consistently. Information and learning can be gleaned from measurement during and after implementation.

Some measures used in testing may be used to support implementation and beyond to demonstrate sustained improvement. As a team decide which measures you want to review, how regularly and who else may need this information.

What new measures are needed to support implementation? If you have updated and created training, you may want to measure the % of staff who have completed the training.