Improvement is a learning endeavor: an active process of testing changes to learn what does and does not work to make care better. Learning from improvement activities begins with documentation of what the team has tried and learned. To learn from its improvement effort, a team needs to be able to record information from a test or multiple tests of changes, derive insights on the effectiveness (or lack thereof) of tested changes, and plan next steps.
Documentation may take many forms, but the most basic documentation requirement is that teams have a record of what they have tried, both successfully and unsuccessfully, to test change ideas to improve care. In its simplest form, this may be notations on a time series chart. Team notes are another simple way of keeping track of what has been tried.
This documentation also serves to help improvement teams communicate their results to others, including what changes yielded improvement, what changes did not, what evidence supports these conclusions, and how to implement the changes. Such communication could be verbal, such as sharing results through conversation; visual, such as storyboards or drawings of annotated time series charts; or written, such as a case study or entries in a documentation journal. The Tools for Presenting Data page offers advice on a number of formats for displaying results of improvement activities.
The USAID Health Care Improvement Project developed a generic documentation journal which can be adapted to guide a team in documenting any improvement activity. The journal is organized around one improvement objective (aim) and guides the team is recording when specific changes were introduced and the measurements over time of a key indicator. The Ministry of Health of Uganda has adopted a similar tool for use in all improvement work in the health sector.
Another common way to support document learning is to have coaches support the documentation of what is happening at a given site during coaching visits. This strategy is especially useful in low-literacy settings where it may be challenging for teams to record what changes they have tested. Two other advantages of involving a coach in documenting team-level improvement work are: 1) it helps the coach to integrate information from multiple teams, and 2) the coach can more easily pass that knowledge to higher levels, so that learning from multiple teams can be consolidated and synthesized for the collaborative improvement effort as a whole.
Coaching guides developed for the Maternal and Newborn Health in Ethiopia Partnership and for the Ministry of Health of Uganda provide examples of how coaches can elicit information from teams on changes tested and the results of these tests.