In this culminating course in the Patient Safety and Quality Improvement Specialization, you will apply the skills you have acquired across the previous six courses to address a realistic patient safety issue confronting Mercy Grace, a 500-bed urban hospital that is part of a larger hospital system. Based on the scenario provided, you will assess the situation and work through the problem using a variety of tools and strategies. You will have the opportunity to identify defects, root causes, and potential mitigation strategies; you will create a project implementation plan for addressing the issue in the form of an A3; you will identify risks of project failure and design a change management plan; you will identify means of converting the project from local to system-wide; and you will identify quality and safety measurements that will be used in evaluating the success of the project’s implementation.
Change Management Introduction
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Из курса от партнера Johns Hopkins University
Taking Safety and Quality Improvement Work to the Next Level (Patient Safety VII)
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Embedding and Expanding the Project
In this module, your focus will turn to embedding and expanding your project across additional units. You will review content on change management, sustainability, and the process of embedding and expanding your interventions. Finally, you will expand your work from Module 2 to create a first draft of a full, formal A3.
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David SchwartzInstructional Design Technology Manager
Armstrong Institute for Patient Safety and Quality
[MUSIC]
Thank you for interest in this module on Change Management.
Change is a critical piece of safety and quality improvement.
If we want to get better at something,
that means we have to do something different.
Getting a large group of people in a complex organization to do things
differently can be a challenge, to say the least.
So this is a critical and challenging piece of safety and quality improvement,
but it's really something that needs to be mastered in order to make use of all
the other skills and tools and knowledge that you've been learning.
This is where we take our ideas, our plans, our notions of how we can better,
and we actually make those reality in the organization, and that can be tough.
So let's take a minute and talk about what we mean by change.
There's lots of different terminology you'll hear in the industry
that all relate one way or another to change.
We can start thinking about learning and what that means.
And typically, when you hear learning around safety and quality improvement,
that means we've experienced something that gives us new
insight into how we're working.
How we're organized, and what we can do to be more effective in that, so
it can be a little bit retrospective so change has that quality to it.
It can be retrospective, based on our experience and
things that have happened to us or it can be prospective or
planning before any one specific event has triggered that learning.
There's also the idea, terminology you'll hear around continuous improvement,
this is a little bit different.
For continuous improvement projects,
we typically have a very specific goal in mind, a measure or a metric of process or
outcome that we strive to improve and get better and better at over time.
A great example of this is hand hygiene compliance, we're never as good as we
could be or very few of us are as good as we could be with that process.
So we're constantly in a mode of measuring, monitoring, and
trying to get better at that.
So this is a different aspect to it, too,
it has to do with the rate of change or the time frame of change.
Is it a very discreet thing, or is it something that plays out for a very,
very long period of time, too?
Also an important thing to think about when it comes to change.
And the last one is transformation.
You hear that a lot these days, and this really
involves larger scale change where we really redesign and reconfigure
ourselves to do something radically different than we've done before.
This could be the adoption of an electronic health record,
this could be moving how we organize ourselves from a fee for
service structure to a value based reimbursement model.
Those entail lots of large scale change done in concert.
So that's another aspect to change that we need to consider is the scale or
the scope of that change.
We're in a very small projects,
we're in very large transformative projects as well.
These all are types of organizational changes though.
And by that we mean something that we engage in purposefully
that's going to change our work processes our structures,
our practices or even our goals, what we're trying to achieve.
What our process is for making those things happen is very important and
encompasses all of these things.
The retrospective versus the prospective change,
the discreet versus continuous change, or the large-scale versus the small-scale.
Very different and all those things matter, but there's some commonalities.
There's some things we can think about to help us be more successful
in all of those areas together.
So, I'd like you to think about your experiences with change efforts.
These can be these can be things that project you've worked on,
you participated in or things you even read about.
What percentage of these change efforts do you believe fails,
what is your experience told you about this?
The literature tells us that on average,
across industries about 70% of organizational change efforts
fail to reach the goals that were set out for them.
People do not achieve the ends that they set out for themselves.
That's a little bit daunting and pessimistic, but there's some
good news of course we want our teams to succeed, we want ourselves to succeed.
But any change effort involves many, many people, lots of time,
lots of resources, lots of energy, we want that to pay off.
The good news is, that we can dramatically improve our odds
of success by paying attention to the change management process.
That's something we overlook,
we skip critical things we should have payed attention to, we rush certain
aspects of the project, we oversimplify many different factors we'll talk about.
But paying attention to the process we go through to be deliberate,
to be more structured in how we go about this can make our odds much, much better.
So there many common reasons that change initiatives can fail.
Here's a list of some of them, by no means, is this an exhaustive list, and
I would encourage you as you go about your career,
in your efforts to keep a journal or a log of these things.
What are some things you're experiencing as barriers?
What are some things that have derailed projects you've been on or
been a witness to.
This can help you be sensitive to these things
to see when they're going to come up in a project.
And to plan proactively to mitigate these risks, so
the first one is that a change solution did not achieve the desired goals,
and this is I think very, very common.
Basically the solution we're implementing is not solving the real problem that we
care about.
In many times we'd go to prevail solutions, a training program, a protocol,
a bundle, things like this because the works being already done to develop them.
So we can take them and implement them very quickly, but
they don't always align with the goals of our project, and
that of course will not get us where we want to go.
We can also oversimplify the solution, the nature of the problem,
or the process we go through to fix something.
Healthcare is massively interdependent, changing something in one area of
the hospital almost certainly have implications for
how people do work downstream or in other areas of the hospital.
If we don't attend to those kind of interdependencies or how things
are linked, we can come up with a solution that's not going to get any traction.
The level of resistance can be underestimated, and
understanding the nature of resistance.
We're going to talk a lot about this in our stakeholder analysis module, but
really understanding what's driving resistance.
Who is resisting, why are they resisting, and
what can we do to bring them on board, is a critical piece of this.
The pace of change can be too fast, change is effortful,
change fatigue is a very real thing, people can be burned out and
that can derail our efforts.
They don't have the energy or
the effort to put in to making new work habits come to life.
Another absolutely critical one is that our expectations are not clearly
communicated.
Many times when we see resistance it will be a lack of understanding or
we're not on the same page in terms of what we're actually talking about.
In terms of the nature of the problem or the solution being proposed.
We may offer too few experiences for people to learn what the new expectations
are, whither it is a new skill, this is a new work process, what ever it is.
People need to learn what is expected of them and
sometimes we don't give them that much opportunity to do that.
And the last one, which we'll talk about a little in more detail now,
is that people feel the change was forced upon them.
They don't feel a part of the change,
they don't feel that they were involved in it or participating in it.
And that gets at one of the key challenges of change and
change management around safety and quality, is that this change is personal.
It requires me to do something different,
healthcare is filled with very motivated, very intelligent,
very dedicated people, very passionate about the care they provide.
And there's big difference in these two phrases I'll ask you to think about.
When you read this sentence, change that is done by me is what?
And I'll ask you to fill in some terminology there,
what is it that you feel when you've been effective at making change?
You feel empowered, you feel a sense of pride, you feel a sense of accomplishment.
Something that you've done to change for the better.
Then we think about the next sentence,
which is a change that is done to me is what?
It's probably not the things that I just mentioned previously,
it may feel actually demotivating.
It may feel disrespectful if someone else's perspective is pushed on you, and
you're not given the opportunity to make those changes for yourself or
to have your voice heard or your perspective heard.
So that is what we're trying to avoid, and
what we've run into many times in healthcare.
And the solution of course is a fair, open, and
participatory process for change.
So fair people need to feel like they've been given opportunity to voice their
concerns, and that those concerns have been listened to and addressed.
And open is completely transparent, the rational for
the change, where it's coming from, and
that everyone has had an opportunity to participate to sit at the table.
And not just provide input and feedback, but to really own the process,
own some of these changes, and really be an agent of change and
not a passive recipient for change.
So in this module we'll be focusing on these following key aspects of change
management.
First we'll start with a structured approaches to change,
having a framework or process we can articulate and
map out will really help us both learn from experience as we do this work.
But also plan for and mitigate some of the barriers where we're likely to see.
The idea of adaptive vs technical change is critical.
We're going to spend some time differentiating those two, and
then really focusing on the adaptive work.
This is the social aspects of work, this is persuasion and
conflict management in these really tough skills, building a vision for people.
We'll spend some time talking about what that means and how to do it.
Then we'll talk about stakeholder analysis which is
a piece of this process we tend to gloss over in my experience.
But taking a little bit of time to think through who the groups and
the specific individuals are in our organization.
What they need, what they want, and what their perspectives
are on a chance can help us dramatically as we go through this process.
We'll also talk about some strategies for managing conflict within change efforts.
Change will almost inevitably produce at least the opportunity for
conflict to occur, we need to be proactive in how we resolve that.
We'll talk about communicating for change as well, and
some very specific methods of behavior change.
We want to think broadly about the types of things we can do to help people get to
that new desired, more effective, state of functioning as an organization.
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