The keystone step - testing your best ideas for improvement and learning whether they work. We want to change equipment, but did that new equipment actually reduce errors? We want to adjust our approach to fall prevention management, but did that change in process actually increase our reliable coverage of patients with high fall risk? People have many ideas to try, but if we don't learn whether they work we can spin our wheels. The simple step of writing down what you plan to change and how you'll measure if it works allows you to later assess if it worked or not.


  • "use soap when required for C. diff" is only occurring 60% of the time
  • Spent time root causing and interviewed frontline staff, determined the issue was contact precaution signage is often missing
  • Discuss possible solutions with frontline staff and infection prevention team and it seems likely that implementing a new type of permanent contact precaution signage will fix the root cause
  • Hypothesis: If we [use a new type of permanent contact precaution signage] we expect ["use soap when required for C. diff" adherence will be > 90%]
  • Implement in Unit 5E and continue to monitor process steps

How Qualaris supports this:

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We’ve added details on each step with examples and advice. Read the next article in the series or jump to any topic.

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