The design element of quality improvement consists of a continuous cycle of trial and error. "If at first you don't succeed, try, try, and try again." (W.C. Fields) A basic example is the PDSA cycle. (Plan, Do, Study, Act) In this example, it is important to first prepare for the changes and establish the QI goals. Once a strategy is developed, it may be implemented on a smaller scale and monitored/studied. In the final stages, the solutions can be reassessed and responses with adjustments or new interventions can be made and again tested. A good approach to QI begins with flexibility and facilitation as QI is an iterative process. Encourage participants to take ownership and communicate constructively about the process and any concerns or barriers those involved in or affected by the QI changes may be facing. This benefits in gaining support and collaboration for a smooth implementation