Implementing and refining changes

Implementation begins by identifying the initial changes the service development team will make to the system.  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 service development teams make to implement Team Service Planning. Change ideas are grouped by the primary drivers of the driver diagram.  Follow the links below to get a more detail on change ideas for each primary driver:

• Intelligence on Demand, Capacity and Activity

• Service Infrastructure

• Flexible Capacity

This change package does not contain an exhaustive list of change ideas. Teams can also generate their own change ideas that will help drive change in the secondary drivers.  The Scottish Access Collaborative's Team Service Planning toolkit contains more information that may also help you generate or refine your own change ideas.

If your team have created new change ideas that have contributed towards the successful implementation of Team Service Planning, then please let us know through the feedback form or by emailing us at his.accessqi@nhs.scot and we can include your change ideas in this change package to help other teams benefit from your learning.

Using Plan Do Study Act to implement changes

Change ideas should be implemented using Plan Do study Act (PDSA).  This will make it easier for the 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 implemented and agree how, when and where it will be implement. Agree who will implement the change idea and by when.  Ideally, this will be before the next scheduled team meeting.  Record the decisions in the action tracker.
• Do: Follow through with the agreed actions to implement the change idea.  Keep a learning log to record any observations or issues and share this with the team to help troubleshoot.
• Study: Use the process data related to the change idea and observations to determine if the expected changes have occurred.  You may wish to refine your driver diagram and measurement plan as new learning emerges.
• Act: Review the implementation of the change idea as a team and decide if the change idea is:
  • ready to be adopted and become the new standard process and move to stage five to sustain the 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.

If you are new to using PDSA you may find the PDSA template helpful to guide you through the process.

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