Scaling success: Six steps for nurse-led care delivery transformation

One of biggest paradigm shifts for many health systems is IHI’s approach of starting small with rapid-cycle testing. The Plan-Do-Study-Act (PDSA) cycle is a powerful approach to innovation, enabling teams to test changes on a manageable scale, learn quickly, and adapt solutions for greater impact.

Here’s how to do it:

• Focus on feasibility: Begin by identifying a single unit, shift, or patient population where the change can be tested with minimal disruption. For instance, trialing virtual nursing during night shifts or implementing a new workflow on a single medical-surgical unit can provide valuable insights without overwhelming staff.
• Iterate and improve: Rapid-cycle testing allows teams to refine their approach based on real-world feedback. Each cycle builds on the previous one, ensuring solutions are both effective and practical. Adjustments can be made to address unforeseen challenges or maximize benefits.
• Involve frontline staff: Engaging the nurses who will use the new processes ensures the changes are realistic and meaningful. Their input helps identify potential barriers and opportunities, increasing the likelihood of success.
• Expand gradually: Once a small test demonstrates promise, scale up incrementally. Testing under varied conditions – such as different shifts, units, or patient populations – provides a deeper understanding of the solution’s applicability and impact.

Actionable Tip: Ask “What can we do by next Tuesday?” This mindset fosters a sense of urgency and momentum, encouraging innovation without overcomplicating the process.

Scaling nurse-led innovations requires robust support from senior leadership. Leaders play a critical role in:

• Setting a clear vision: Define measurable goals aligned with organizational priorities, such as improving nurse retention or enhancing patient outcomes.
• Allocating resources: Ensure sufficient staffing, time, and funding for testing and implementing changes.
• Promoting continuous engagement: Regularly communicate progress and celebrate successes to maintain momentum.

Actionable Tip: Partner with finance and operations teams early to identify potential cost savings and demonstrate the value of proposed innovations.

Nurses working directly with patients have invaluable insights into care delivery challenges and opportunities. Actively engaging them in designing and testing innovations ensures solutions are practical and impactful.

• Gather input: Use surveys or focus groups to identify “pain points” in workflows, such as repetitive tasks or documentation burdens.
• Co-design solutions: Include frontline staff in brainstorming and pilot testing to build buy-in and ownership.
• Recognize contributions: Acknowledge staff who contribute to improvement projects to foster a culture of innovation.

Actionable Tip: Host a “listening session” with bedside nurses and support staff to identify the most pressing daily challenges – what the IHI project calls the “pebbles in their shoes.” Use their feedback to prioritize improvement ideas and invite them to co-lead small tests of change to foster ownership and enthusiasm.

Data is essential for evaluating success and gaining support for scaling innovations. Use a mix of quantitative and qualitative measures to capture the impact.

• Outcome Metrics: Track key goals, taking into consideration ones that are aligned to organizational priorities, such as reductions in nurse turnover or improvements in patient satisfaction.
• Process Metrics: Monitor adherence to new workflows or protocols.
• Balancing Metrics: Ensure changes do not create unintended consequences elsewhere in the system.

Actionable Tip: Develop a simple data dashboard that tracks both process and outcome measures, such as nurse satisfaction and workflow efficiency. Share updates during staff meetings or in newsletters, celebrating incremental wins to maintain momentum and reinforce the value of the changes.

Scaling success often requires collaboration beyond the nursing department. Include stakeholders from various disciplines to ensure comprehensive planning and execution.

• Key partners: Engage IT, human resources, quality improvement, and finance teams – anyone who can help achieve the goal or benefit from it.
• Champions: Identify leaders and early adopters who can advocate for change.
• Governance structure: For larger projects, consider forming an executive steering team to oversee progress and address barriers.

Actionable Tip: Assemble a “change champions” group with representatives from nursing, IT, HR, and quality improvement. Schedule regular check-ins to align on progress, troubleshoot challenges, and ensure every department feels their expertise is valued in driving the project forward.

Sustainability planning is critical to ensure innovations remain effective over time. Additionally, health systems should prepare to spread successful solutions across units or facilities.

• Create a Checklist: Develop a sustainability plan addressing resources, staff training, and monitoring processes and results.
• Leverage Technology: Use tools such as electronic health records or dashboards to streamline implementation.
• Document Lessons Learned: Capture insights from pilot projects to guide future efforts.

Actionable Tip: Use IHI’s Sustainability Planning Worksheet, found in the toolkit, to identify key activities that make changes part of routine operations.

By embracing structured improvement methodologies like PDSA cycles and leveraging nurses’ unique expertise, leaders can transform the care delivery environment in a way that benefits patients, nurses, and health systems.

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The lessons from IHI’s project provide a proven framework to inspire and guide these transformative efforts – download the free toolkit today!