This is about clearly articulating the problem or challenge and describing the current situation, on any journey you must know where you are starting from. A patient will describe the symptoms they are experiencing to the healthcare professional, who will then start to build a picture of the patients' needs using various approaches and will be thinking about what the goals might be and who needs to be involved.

In an improvement project it is the same the problem is the symptoms, describing the current situation is like building a picture of the patients' needs (getting a measure of the system), setting the goals is about describing what good looks like and who needs to be involved is about identifying stakeholders, team members and communication.

In an implementation project, assess is very much a pre-project stage where a lot of the identification of the challenge happens, a lot implementation projects fail because they do not address the challenge due to a lack of pre-project understanding, using some of the improvement tools can help mitigate this.

This is about fully understanding the system in which the challenge lies and being able to describe cause-and-effect relationships within it, identifying the key factors that are having the greatest impact on the system and developing some ideas that might address those key factors, identifying potential solutions.

A clinician will have theories about what the underlying causes of the symptoms that the patient is experiencing and will carry out investigations that will help identify those causes and make a diagnosis, at which point the clinician can think about potential solutions.

In an improvement project, we use the same thinking. We carry out investigations using data and process analysis tools alongside experimentation to demonstrate those cause-and-effect relationships and identify the key factors and potential solutions. In an implementation project, diagnose is still very much at the pre-project stage where understanding is built and used to define the challenge, the potential solutions, stakeholders, and scope of the project, culminating in project initiation and start.

Plan is the point in a change journey where there is some clarity about what needs to be implemented to overcome the problem or challenge. In a patient journey a diagnosis would have been made, treatment options considered and discussed, and the treatment plan will be developed and agreed.

In an improvement project the solutions would have been identified, tested, and would now be looking to plan the sustainable implementation of those solutions. Very often the implementation is obvious and will require simple planning to ensure what needs to be done gets done, other times when the implementation is more complicated (e.g. there is cost or significant risks involved) a more structured approach is needed, moving from an improvement journey to an implementation journey would be beneficial.

An implementation project starts in earnest at this point, it is where the project is planned in detail through identifying objectives and goals, benefits, risks, and mitigations. Detailed project plans, timelines and milestones, resourcing, governance, and business cases might need to be approved.

All the actions identified in the plan need to be delivered, monitored, and regularly reviewed, addressing any issues that are preventing progression. In the patient journey the planned interventions, whether they are therapies, medications, education are delivered but also regularly reviewed by healthcare professionals and the patient.

In an improvement project, the actions, typically detailed process design, documentation, standard work, training is being delivered. There will be regular review and monitoring to ensure actions are having the desired effect. In an implementation project the plan is being delivered, with actions ranging from product testing to procurement, engagement to education, as well as those mentioned in an improvement project.

The review and tracking in an implementation project are more structured and the rigour used is to ensure that the project is delivered to requirements, budget and timescales using regular reporting and assurance mechanisms to track benefits manage risks, actions, issues, and decisions.

The change has been implemented; it now needs to become the way things are and we need to learn from it. This means shutting down the project, sharing the achievements, sustaining the new ways of working, and looking for opportunities to spread and scale the solution. In the patient journey, they might have a follow-up to make sure the goals have been achieved and what they need to do to sustain it is clear, they might be discharged, and the clinician might reflect on their practise.

In an Improvement project, there will be a final project review demonstrating the benefits, identifying any next steps, sharing the achievement, and looking for opportunities to scale the change or spread it further.

There would also be the option to carry out a follow up audit to ensure sustainability and review how the project went. In an implementation project, the plan has been delivered, the project would be closed, a project and benefits review would be undertaken as well as sharing the achievement and looking for opportunities to scale the change or spread it further.