Implementation strategies

Our implementation projects were realized by using the “breakthrough” methodology, developed by the Institute for Healthcare Improvement (www.IHI.org).

While using  this methodology we brought together a number of teams from hospitals who were seeking improvement in the screening and treatment of malnutrition.  We started with 6 hospitals in a pilot project and then expanded our project to 54 hospitals all over the Netherlands.

Each team typically sent three of its members to attend a kick-off meeting. From that point on, project leaders and additional members worked on improvements within their local organizations. The project leaders were supported by the Dutch Malnutrition Steering Group through Project Leader Workshops (2 or 3 per year) and continuous online support. After 1-1.5 years we organized a closing conference where hospitals could present their achievements and exchange ideas. Click here for a schematic outline of our project organisation

• Use the model for improvement: set aims, establish measures, select changes
• Create teams with enough authority in the organization to institute a change. Make sure that the team includes members familiar with all the different parts of the process: managers and administrators as well as those who work in the process itself including physicians, nurses, dietitians, cooks and diet aides. It is essential to get the board of the institution to sign a contract to support the implementation project and the team. Tasks then have to be allocated between members of the team. Click here for an example of a multidisciplinary project team and agenda for action. 
• Measure the improvements during the implementation project, we used a system of process evaluations. We defined 6 measurements that had to be made at the following times


• • after the start of the implementation project
  • 2 weeks later
  • 6 weeks later
  • 3 months later
  • subsequently every 6 months
• Provide the teams with downloadable tools that can be used immediately. These can include tools for analyzing the process, gathering the data, working effectively in groups, documentation material for patients or other team members, powerpoint presentations, information material