Step 7: Implement and Evaluate

Implementing the Screen

You’ve decided to screen, formed your team, chosen a screen, mapped out the screening flow, prepared the referral process and parent education. Now you’re ready to screen! But how do you do it?

Approaches to Implementation:

• Do a practice run: If you are able to, it’s a good idea to do a “dry-run” of the screening process to make sure that the planned workflow is feasible, and make changes as needed.
• Start slow: Some practices choose to implement screening in a “stepwise” fashion. For example, if there is already another assessment you’re administering at 18 months, perhaps it is good to add a developmental screen for those age visits. This allows time to adjust and improve before full-scale implementation.   However,  low volumes of patients to be screened  can inhibit the team from learning and makes the project lose momentum.
• “Wholesale”: Some practices decide to implement all of the different screening ages at once. This is a great way to make sure that everyone gets a chance to try out the new process. However, it is a lot of change at once, so patience is key!

Tips for Implementation:

• Communicate early and often: Make sure that your team has plenty of notice about changes, and that reminders are given regularly before and after the start date
• Check-in individually with staffers: You may have trained everyone on their role, but don’t assume that they are completely prepared or confident in their new tasks. Give them ample opportunity to ask questions or review the steps they are responsible for, and continue to elicit their feedback during implementation
• Celebrate!: Kick-off screening with a staff breakfast/lunch; finish the first week with an announcement of how many screens were given; recognize team members for a job well-done. The more the excitement about this new initiative is maintained, the more success you’ll have!

Included in this Step:

• SAMPLE Implementation Materials that have been used in Docs for Tots partner clinics
  • Implementation Checklist: a practical list of all materials needed for implementation
  • Exam Room Reminders: These cards were placed in easy view of staffers in each exam room
  • Tally Incentive Initiative: In order to improve clerical administration of the screen, one clinic had clerks tally every time they handed out a screen. When the clerical staff collectively reached 10 screens, they were given a prize. This incentive worked to train the clerks to incorporate screening administration into their regular flow.
  • Stop Sign Reminders: Placed at frequented locations, these “stop signs” were used to train staff to incorporate screening into their regular flow.
  • Cabinet Reminder: A reminder to screen placed at a frequented location.
  • Mousepad: Reminder about when to give out screens used by all staff with access to a computer; the information was hard to ignore!
  • Motivational Card: Used to remind staff why taking a small extra step to administer a developmental screen will count in the long-run
  • PDSA Process Map: A template graphic for completing a PDSA cycle
  • PDSA Worksheet for Testing Changes: a worksheet to use with the QI team for PDSA cycles
  • SAMPLE PDSA: A completed PDSA Worksheet for a hospital clinic implementing developmental screening for the first time
  • SAMPLE QI Presentation: for training on the QI/PDSA Process