Table 2

Long-term success factors: purpose, statement for rating and questions to consider

FactorPurposeStatementAdditional questions to support reflection
1. Commitment to the ImprovementTo reflect on both own personal commitment to the initiative and impression of commitment across the team as a whole to the initiativeMy team understands what the project is trying to achieve and believe this work will lead to improved processes and outcomes.Do you feel committed to the project? Do you understand what the project is trying to achieve?
Do you believe that this work will improve processes and outcomes? Do you believe there is reliable evidence (eg, from literature, guidelines, etc) that the project will produce the desired benefits? Do you think there is commitment across the team as a whole?
Has a shared aim been established for your project?
If you think commitment is lacking, what do you think is the reason for this? What do you think should be done to address this?
2. InvolvementReflect on who has been involved and who may need to be engaged further for the initiative to achieve long-term success. Asks about personal involvement and contribution and explores the involvement of patients, carers and members of the public who are impacted by the changes being made
  • I have the opportunity to input into the project and I feel a sense of ownership towards the work. I am able to express my ideas freely which are openly considered by the team.

  • There is wide breadth of involvement from stakeholders including patients and members of the public who regularly feed into the project. t

Do you personally feel involved in the project? Are you given the opportunity to express your ideas and recommend changes to the project when necessary?
Do you think the project has involved the right people? Does your project involve patients affected by the improvement? Is there involvement from staff who will be delivering the improvement as part of their day-to day practice? Are the views of these groups taken on board?
Does the project have a good spread of views, skills and expertise? Do you believe involvement can be improved? Are there groups of people you still need to involve?
3. Skills and capabilitiesExplores whether the staff and other people delivering the change have the skills to do so successfully and whether training of new members of the team has been planned forStaff have the necessary skills to deliver the improvement. Training and development opportunities are available to all staff, volunteers and other people involved.Do you feel able to fulfil your role within the project? Do you require further training or education? Do staff who will be delivering the improvement (eg, front-line or support staff) have the skills to do so consistently and effectively?
Are new staff informed about the project and their role in it?
Do you think there are training needs associated with the improvement that should be addressed? What should be done to address to these needs?
4. LeadershipAsks if there is strong leadership in place and if the leaders are approachable, available and able to garner support for the initiativeMy project has supportive and respected leaders and/or champions who advocate for the improvement, communicate the vision and effectively manage the process.Do you believe your project has strong leadership?
Are your project leaders actively involved in the project?
Are they able to garner support and enthusiasm for the work?
Are they available and approachable to members of the team if necessary?
Do the project leads effectively communicate the need for the change?
How do you think leadership could be strengthened?
5. Team functioningExplores the accountability and responsibilities for the workload involved in the initiative and ask if the team is working well togetherMy project team is working well together. There are clear responsibilities for individuals and the work is shared across the team and does not rely on particular individuals.How well do you feel your project team is working together? Does the project team meet and communicate on a regular basis?
Have clear roles and responsibilities for project team members been established?
In your opinion, are team members fulfilling these roles and responsibilities?
Are skills and expertise of team members considered and put to use? What do you think can be done to improve team functioning?
6. Resources in placeExplores if the necessary resources such as staff time, equipment and facilities have been dedicated to the initiativeMy project has financial support that will allow the improvement to achieve long-term success. We have the necessary staff, material and equipment and I am given sufficient time to dedicate to the improvement.In your opinion, have enough resources been dedicated to support the project?
Do you believe the financial support provided will allow the improvement the project is trying to achieve to become part of normal working practice in the long term?
Does the project have enough staff to achieve the project aims? Do staff have enough time to spend on the improvement?
Are the materials needed (eg, physical facilities, sites, equipment, etc) available to staff when they need them?
Are resources needed discussed by the team on a regular basis?
What resources do you think are lacking?
7. Progress monitored for feedback and learningEncourages teams to consider what systems are in place to monitor the initiative over time and how this information will be used to inform staff of further changes neededThere is a monitoring system in place that allows the team to collect, manage and regularly review data. Feedback from the project is shared with me and other stakeholders on a regular basis.Have measures to enable continuous monitoring for your project been defined by the team?
Do you think these measures are able to assess the impact of the improvement? Can you suggest any changes to improve this?
Are these measures regularly assessed? Is this information used to make changes and improve project progress?
If the measures show lack of progress are the causes for this investigated?
Are project members and staff regularly informed about what is working well and what could be better?
8. Evidence of benefitsAsks if and how the benefits of the initiative are communicated to both staff and patients over timeThere is evidence of benefits emerging from the project and this evidence is regularly communicated and visible to staff and patients.Does the evidence for your project include both the impact on physical and mental well-being of patients? Is there evidence (process and outcome measures) that the project is producing the desired impact on patients?
Is evidence of the projects’ impact regularly shared with staff, patients and other stakeholders?
If evidence shows lack of progress, does the team investigate reasons for this?
9. Robust and adaptable processesReflects on the need for initiatives to be adapted to local processes and emerging needs. It also asks about the process for recording successes and failures of changes madeThere is the opportunity to adapt the project to reflect local needs, setting and emerging evidence. Adaptations are documented and the successes and failures of changes are reported.Is there regular review of how the project is working?
How well does the project fit within current practices?
Do staff and team members need to adapt how they implement the improvement in response to challenges or changing care needs?
Does your team use Plan Do Study Act cycles, Statistical Process Control and other quality improvement methods to test and document the changes made to the improvement?
10. Alignment with organisational culture and prioritiesEncourages teams to consider the need to align improvement initiatives to organisational strategies to gain executive buy-in and support as well as have the initiative become part of organisational policies and proceduresThe improvement my project is trying to achieve is aligned with the strategic aims and priorities of the organisation(s) we work within and our work contributes to these aims. Our work is supported by the policies and procedures within the organisation.Is the improvement your project trying to achieve aligned with the organisational priorities?
Has this been promoted as something to help further the organisation’s aims and priorities?
From your perspective, how well is the work of the project being integrated into the everyday operations of the organisation?
Does the project conflict with any other changes taking place within the organisation?
What could be done to better align your improvement to these priorities?
11. Support for improvementExplores the values and beliefs held within organisations related to continuous improvement and looks at the support given to staff and patients to be involvedThere are values and beliefs in my organisation(s) that emphasise the need to improve. Staff and management are supportive of improvement initiatives and continuous improvement is a priority for the organisation, staff and patients.Do you feel continuous improvement is a priority within your organisation?
Are staff and senior management receptive to improvement initiatives?
Are you supported by your leaders to participate in the improvement initiatives? Do senior leaders actively participate in improvement projects?
12. Alignment with external political and financial environmentLooks at the need for teams to be aware of the potential political and financial changes that may impact the initiativeMy project exists in a supportive economic and political environment. My team is aware of external pressures and incentives that may influence the project.Has your team considered the impact of the external environment on the project? For example, are there economic pressures or political developments that may impact the project?
Is there political support for the implementation of your project?
Does your project help address external political or economic concerns? Does it contribute to the achievement of political objectives?
Are there plans to mitigate risks due to the external environment?