Adapting or Adopting Promising Practices

Question: 
Our quality improvement (QI) team would like to build on the good efforts that others have already done on our topic. Do you have any suggestions about how to best use a proven or promising practice as our improvement strategy?
Reply: 

Response by Marni Mason

We have recently seen a growing body of promising and/or model practices Web sites with hundreds of potentially successful interventions, including those from many QI teams. But what is the most effective way to adapt or adopt these practices in our own work processes?

Definitions of Proven and Promising Practices: First, it helps to define what we mean by proven or promising practice. The following definitions are from the North Carolina Center for Public Health Quality Web site, available at http://www.ncpublichealthquality.org/ctr.  

Proven Practices: Successful programs or processes implemented in a local health agency or Division of Public Health (DPH) section which have quantitative data to show their effectiveness across multiple agencies or sections.  These practices are highly likely to be effective in your setting if implemented consistently.

Promising Practices: Successful programs or processes implemented in a local health agency or DPH section which currently do NOT have quantitative data to show their effectiveness across multiple agencies or sections.  However, they have qualitative or quantitative data suggesting their effectiveness in one local agency or section.  These practices could be effective in your setting, but their effectiveness should be evaluated closely before full implementation.

Process for Adapting or Adopting Practices: So how do we find and apply a proven or promising practice? Good question! The first, and most important, step is to identify what performance outcome or health indicator you want to improve. So the QI project team should first determine, based on its aim statement or QI project goal, what measure it will use to search for a practice that has achieved better results. For example, a team aims to improve its immunization rates, so the health indicator it may select to search for a promising practice will be one that shows better results in the outcome measure “the percentage of fully immunized (based on series XYZ) 2-year-olds.” By first identifying the health indicator or performance measure that you intend to improve, you will increase the likelihood of successfully achieving improved outcomes in your QI project.

The second step is to determine the level of evidence that you need to consider using the promising practice. The County Health Rankings & Roadmaps (http://www.countyhealthrankings.org/) and the Community Guide (http://www.thecommunityguide.org/index.html) Web sites both use a ranking system to identify the amount of evidence currently available for the effectiveness of the practice. The Wisconsin Health Roadmaps uses the following system to rank the strength of the evidence:

The third step is to use the available resources for proven practices to search for the practice that you want to adapt or adopt. We list many sources for promising and model practices in the references list (other sources exist as well).

The third step is to use the available resources for proven practices to search for the practice that you want to adapt or adopt. We list many sources for promising and model practices in the references list (other sources exist as well).

The fourth, and often neglected, step in the process to adapt a proven practice is to understand your own work process for the issue you seek to improve. Understanding your own work process means developing a process map or flowchart to understand how the proven practice may be different from the way you conduct the work process. For example, again using a QI team to improve immunizations, the team needs to map out its process for educating community providers, conducting school-based clinics, or whatever process the proven practice involves to understand how it needs to change its work process to apply the proven practice.

The fifth step is to test the practice in your program or agency to understand what aspect you need to adapt to suit your demographics or other unique aspects of your program or agency.

Sixth and finally, you need to measure the results you achieve through the test of the proven practice and determine if you have achieved better results than before. This measurement will determine if you move to full implementation of the proven practice or if you need to search for a different intervention or improvement action for your QI effort.

This simplified process to adapt or adopt a proven or promising practice is shown as follows:

Process to adapt or adopt a practice

References in addition to those mentioned in the text are as follows: