| Course | NURS 8301 Effectively Leading Organizations in Quality Improvement Initiatives |
|---|---|
| Week | Week 9 |
| Paper type | Discussion post with two peer replies |
| Length | About 660 words, 4 pages |
| Format | Discussion post, APA 7 citations |
| School | Walden University |
| Program | Doctor of Nursing Practice (DNP) |
| Updated | September 2026 |
Free sample paper for NURS 8301 Week 9
Week 9 Discussion: Initial Post
Holding It Here, Carrying It There: Why Sustaining the Readiness-Call Gain and Spreading It to Orthopedics and Gynecology Need Different Owners
Our readiness-call pilot met its aim in general surgery and urology: avoidable patient-readiness cancellations, in the project's illustrative data, fell from 3.8% to 1.4% of scheduled cases and stayed below the target for three months. That proves the change can work in those services, with those surgeon offices and those nurses. It proves nothing else yet. I want to argue that holding the gain in the pilot services and spreading it to orthopedics and gynecology are two different problems, and that they need two different plans with two different owners.
Sustainment in the pilot services. The risk here is decay. Wiltsey Stirman and colleagues, pulling together studies of what happens to programs after launch, found that programs often continued only in part and that whether they lasted depended on factors such as the fit of the innovation, organizational context, capacity and processes that embed the change (Wiltsey Stirman et al., 2012). In our pilot, the gain rests on three things that could quietly erode: the evening call hours, which are paid as extra time; the shared instruction sheet, which depends on surgeon offices continuing to use it; and the monthly feedback of cancellation counts to the calling nurses. The sustainment plan should build each into routine structures: evening hours written into the preoperative staffing template, the instruction sheet built into the scheduling system so it is sent automatically and the cancellation count added to the department's standing monthly dashboard. The owner should be the preoperative nurse manager, because sustainment is an operational responsibility inside the unit.
Spread to orthopedics and gynecology. The risk here is poor fit. Orthopedic patients are older, more often on anticoagulants and more often need medical clearance; gynecology has more patients who work evenings and prefer text. Greenhalgh et al. (2004) describe how adoption in a new setting depends on the innovation's fit with that setting and on its capacity to be adapted. Spread should therefore not copy the pilot but test it: start with one orthopedic and one gynecologic surgeon, run short PDSA cycles to adapt the call and checklist to their patients and expand from there, as the Model for Improvement recommends for changes moving into new conditions (Langley et al., 2009). The owner should be the project's clinical lead working with each service's office manager, because spread requires relationships outside the unit and authority across surgeon offices.
The two plans need different owners because they need different kinds of authority: sustainment needs someone who controls staffing and routines inside the department, and spread needs someone who can negotiate with surgeon offices outside it. Giving both to the same person usually means one gets neglected, and in my experience it is sustainment, because spread is more visible.
I would like to hear from others: once a pilot team disbands where you work, whose job is it to keep the change alive?
Reply to Priya
Priya, you suggested spreading to all services at once to save time, since the pilot worked. I understand the pressure, but the orthopedic patients differ in ways that matter for the checklist, especially anticoagulant management. Greenhalgh et al. (2004) emphasize adaptation as part of adoption. If we spread without testing and the orthopedic cancellation rate does not move, we will not know whether the change failed or simply did not fit.
Reply to Samuel
Samuel, I agree that a sustainment plan needs a measure, and your idea of a quarterly audit of ten calls is a good one. I would add a trigger: if the monthly avoidable cancellation rate in the pilot services goes above target for two months in a row, the nurse manager reconvenes the original team. Wiltsey Stirman et al. (2012) note that programs often continue only partially, and a clear trigger helps catch that drift before it becomes a return to baseline.
References
Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581-629. https://doi.org/10.1111/j.0887-378X.2004.00325.x
Langley, G. J., Moen, R. D., Nolan, K. M., Nolan, T. W., Norman, C. L., & Provost, L. P. (2009). The improvement guide: A practical approach to enhancing organizational performance (2nd ed.). Jossey-Bass.
Wiltsey Stirman, S., Kimberly, J., Cook, N., Calloway, A., Castro, F., & Charns, M. (2012). The sustainability of new programs and innovations: A review of the empirical literature and recommendations for future research. Implementation Science, 7, Article 17. https://doi.org/10.1186/1748-5908-7-17
NURS 8301 Week 9 instructions, in plain terms
The ninth week's thread generally asks how an improvement that worked in a pilot will be sustained and spread. Budget roughly five hundred words for the opening contribution and leave time to answer two peers. Start by saying exactly what the pilot has and has not proven. Treat sustainment and spread separately: name the main risk for each, the plan that answers it and the owner who has the authority to carry it out. Show how the new settings differ from the pilot and why that matters for the change. Explain why the two plans need different owners. End with a question about who owns changes after pilot teams disband in your classmates' organizations.
How the NURS 8301 Week 9 example is put together
The opening paragraph states the pilot result and what it proves. The sustainment paragraph names three things that could erode, evening hours, the instruction sheet and feedback, cites Wiltsey Stirman and colleagues and builds each into routines owned by the nurse manager. The spread paragraph describes how orthopedic and gynecologic patients differ, cites Greenhalgh and colleagues on adaptation and Langley and colleagues on testing under new conditions and assigns the clinical lead. A highlighted paragraph explains why authority differs for the two plans. The reply to Priya argues against spreading everywhere at once. The reply to Samuel adds a two-month trigger for reconvening the team.
Reading the NURS 8301 Week 9 rubric
Sustainment and spread posts are usually assessed on a clear distinction between the two, specific plans, named owners and engagement with peers. Distinction credit rewards naming different risks for holding and spreading a gain. Plan credit goes to concrete steps such as building a change into staffing or scheduling. Owner credit depends on matching each plan to someone with the right authority. Replies score well when they question a shortcut a classmate proposes or add a rule for responding to drift. Citations and punctual posting account for the rest. Faculty often reward posts that anticipate which plan tends to be neglected when one person holds both. Graders also look for a clear trigger that tells the owner when to reconvene the team.
NURS 8301 Week 9 help from the desk
Sustainment posts lose marks when they treat spread as simply doing the pilot again elsewhere. Another common loss is a sustainment plan that depends on the original champion staying. Some posts name no owner, or give both plans to the same person without noticing the conflict. Others ignore how new settings differ. Say what the pilot proved, separate sustainment from spread, match each to an owner with authority and plan adaptation for new settings. The desk can draft a post about sustaining and spreading your own pilot. List every part of your change that depends on extra effort or a single person, since those are the parts most likely to decay.
Get a NURS 8301 Week 9 example written to your instructions
Summarize your pilot's result in a sentence, name the services or units it might reach next, and bring the thread prompt and rubric. A custom spread and sustainment post, replies included, reaches you in 24-48h, first one free, with holding mechanisms, owners and a spread sequence argued rather than assumed.
More NURS 8301 papers and DNP samples
- NURS 8301 Week 1: Improvement History Post
- NURS 8301 Week 2: QI Framework Comparison Paper
- NURS 8301 Week 3: QI Problem and Aim Statement
- NURS 8301 Week 4: QI Culture and Readiness Post
- NURS 8301 Week 5: QI Framework Selection Paper
- NURS 8301 Week 6: Driver Diagram Paper
- NURS 8301 Week 7: Stalled Adoption Post
- NURS 8301 Week 8: PDSA Cycle Plan
- NURS 8301 Week 10: Executive QI Proposal
- NURS 8301 Week 11: QI Leadership Reflection
- NURS 8310 Week 9: Causal Inference Post
- NURS 8250 Week 9: Framework Justification Paper
- NURS 8512 Week 9: DNP Project Drift Audit
- NURS 8211 Week 9: Small-Sample Limits Post
NURS 8301 Week 9 questions, answered
What is the difference between sustaining and spreading an improvement?
Sustaining keeps a gain in place where it was achieved, usually through standard work, ownership and a response plan for drift. Spreading carries the change to new settings, which raises questions of sequence, adaptation and leadership sponsorship. The two fail for different reasons: sustainment erodes when ownership lapses, spread stalls when the new setting was never engaged. The sample treats them in separate paragraphs with separate owners for that reason.
What is a control plan?
A control plan belongs to the last step of Six Sigma's DMAIC cycle, the control phase. Its central idea is that holding a gain requires a planned response to drift: a threshold that signals a problem, a named person who responds, and the actions they take. The sample adapts it simply, naming the pre-op manager as responder when on-time starts fall below a set level for two consecutive weeks.
Where can I find a free NURS 8301 Week 9 sample paper?
The post on sustaining and spreading the readiness-call gain and both replies, with three references, are free to read here. A post about your own pilot can be requested.
Who owns sustainment in the NURS 8301 Week 9 post?
The preoperative nurse manager, because holding the gain depends on staffing templates, scheduling routines and a dashboard inside the department.
Why does spread begin with one surgeon in each new service?
Orthopedic and gynecologic patients differ from the pilot, for example in anticoagulant use and evening work hours, so the change must be adapted through small tests before it expands.