Work on maintenance and continuous improvement


Remember that you are working towards the continuous improvement of your institution's practices. In real life, you will be selecting certain priorities
to work on.


Once implementation is completed and you pass on to the maintenance phase, you will be faced with other priorities and you will have to start a new cycle of improvement. This likewise applies to new knowledge coming from new evidence-based guidelines that you would like to implement in your institution.

  • This is why CDM Quality Care has to be seen as a continuous loop.



Another very important aspect of the maintenance phase is accountability. Accountability is a form of trustworthiness; it means being answerable to someone else for something or being responsible for one's conduct.

  • This should apply not only to people in the medical field but management as well; it's also why the team has to buy into the entire process right from the beginning.
The best way to ensure accountability is by having an independent organization to follow-up on the targets that you have previously defined. For example, this could be done by presenting your process improvement program as part of the Hospital Accreditation (at the provincial or national level).


Without accountability, it is almost impossible to ensure the sustainability of your improvement process. This dimension is often missing, rarely planned for, or truly implemented.



The importance of developing and implementing a system of continuous improvement of COPD medical practices that will remain in place at your institution is evident.



  • Interventions: By engaging different actors in the system to intervene, we will not depend exclusively on the work of one specific improvement team.
  • Evaluation: By introducing indicators of quality into the day-to-day practice of all the health care professionals, since they need constant feedback with respect to their practice.


Closing the Loop

It is important now to take advantage of the momentum generated by your efforts and to play a role of coordination vis-à-vis all the improvement strategies in place. Presenting the results of your improvement process back to the health care professionals involved in the care of the COPD clientele is an excellent strategy to open the door to additional interventions.


Key people may realize that there are problems and they will be motivated to become a part of the solution; which in turn will make it easier to get approval for future training initiatives, reorganizations and additional resources, among
other things.


Other meetings and follow-up include:

  • Nurse clinicians and other health care professionals: follow-up on the implementation of processes and tools, quality indicators, and continuous evaluation of their performance. It is also important to assure continuity in terms of training and support.
  • Management should be informed about developments, successes and obstacles to the clinicians' new mandate on a regular basis.

It is important to follow-up on the implementation of the improvement process in a sustainable way. However, accountability is essential, and a continuous evaluation of the team's performance and quality indicators is mandatory.