The cost of the initiative was an viewed Triunfador important factor in the potential for improvement, even when the adverse effects of current processes were considered Triunfador necessitating rapid change.106 Because of this, it is important to implement changes that are readily feasible106 and can be implemented with minimal disruption of practice activities.99 It is also important to consider the potential of replicating the initiative in other units or at other sites.99 One strategy to improve the chances of replication is to standardize processes, which will most likely incur some cost.

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Answers to these questions help identify ineffective safety barriers and causes of problems so similar problems can be prevented in the future. Often, it is important to also consider events that occurred immediately prior to the event in question because other remote factors may have contributed.68

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While the impact of many of the quality improvement projects included in this analysis were mentioned in terms of clinical outcomes, functional outcomes, patient satisfaction, staff satisfaction, and readiness to change, cost and utilization outcomes and measurement is important in quality improvement efforts, especially when variation occurs. There are many unanswered questions. Some key areas are offered for consideration:

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Ensuring that those implementing the initiative receive education is critical. There were several examples of this. Two initiatives that targeted pain management found that educating staff on pain management guidelines and protocols for improving chronic pain assessment and management improved staff understanding, assessment and documentation, patient and family satisfaction, and pain management.

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