The first step in implementation of your quality improvement initiative is to assess your institutions current reality. You must have a good understanding of current needs, urgent needs leading to quality improvement initiative, and the existing staff working conditions. If your initiative does not cover important and urgent needs, the chances that you fail increase. People need to feel a need for a change and a need to abandon traditions and routine.

The success or failure of your initial quality improvement efforts and projects can greatly affect the ease in which your institution is able to adopt quality improvement ideas. It pays to choose these early efforts carefully, looking for opportunities that (1) have a good chance of success; (2) are visible throughout the institution, and preferably, to important external stakeholders; and (3) can significantly improve the lives of staff and managers alike. The trick is to find something that is neither so large that you are doomed to failure nor so small, that no one will notice if improvements are made. Be aware that administration does not take over the energy of an initiative! Among others additional attention areas are:

• Address anxiety and resistance
• Address critical issues that are also important to stakeholders
• Start with processes you own and work to improve the system
• Start the process of improvement at the highest level possible