A change is ready for implementation when the improvement team has completed the following:

• Tested the change, typically starting on a small scale and increasing the scale based on the learning of each PDSA cycle
• Tested the change under varying conditions in order to adapt to the local environment
• Established a causal relationship between the change and the desired outcome through appropriate data collection and analysis

Implementation is a permanent change to the way work is done and, as such, involves hardwiring the change into the workflow or standard work within an organization. It may affect documentation, written policies, hiring, training, compensation, and aspects of the organization's infrastructure that are not heavily engaged in the testing phase. Implementation also requires the use of PDSA cycles.

Example

• Testing a change: Three nurses on different shifts use a new medication reconciliation and order form.
• Implementing a change: The new form is made standard practice, the old form is removed from the department, the new form is added to relevant manuals and computer files, including orientation and training materials for new staff.