The fourth step of change is to prototype and test the change. This is within the “Improving for Quality” domain of the Quality Management System.

Why: The purpose of this step is to test change ideas to understand what works and what doesn’t work. This enables the change ideas to be continually improved and refined until the aim is achieved.

What: The change ideas co-designed in step three should be tested in a structured and planned way, involving clearly measuring the impact and value of change through a combination of qualitative and quantitative data. Data can be derived from measuring processes, such as counting the number of events or outputs; and from engaging with service users, providers and enablers to understand the value of the change. Both types of data should be used to demonstrate whether the change has achieved its aim and if there are any unintended consequences.

This step involves a process of continual improvement as each change idea is tested and the learning from that test informs a refinement and further testing of the change until the aim is achieved or the change is abandoned.

How: Examples of tools that support prototyping and testing a change

• PDSA cycles: Plan Do Study Act cycles are a structured method to test changes in a way that minimises risk, uses data to understand the impact and build understanding of whether the change led to an improvement.
• Run charts: are a line graph over data plotted over time to identify trends or patterns in a process.
• Lessons Learned Log: capture knowledge about what has worked well and what could have been done differently.
• Focus groups, Expert reference groups and Discovery conversations (listed in earlier steps of change) help understand the impact of the change.