Keeping patient safety and quality improvement projects on track, on time, and on budget is critical to ensuring their success. In this course, students will be introduced and given the opportunity to apply a series of tools to guide and manage patient safety and quality initiatives. These include tools for defining what success looks like, developing a change management plan, and conducting a pre-mortem to identify risks for project failure. This course will also provide tools for engaging stakeholders to ensure key players are invested in your project’s success.
Change Management Introduction
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From the course by Johns Hopkins University
Designing for Sustainment: Keeping Improvement Work on Track (Patient Safety IV)
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From the lesson
Change Management 101
In this module, learners will develop an understanding of: what is meant by change management, reasons for change initiative failure, change as a process, frameworks and processes for change, the differences between technical and adaptive work and the role of each in a change effort, leadership skills necessary for addressing adaptive change, identifying and engaging change effort stakeholders, managing conflict, developing a communication strategy for a change effort, applying a systems approach to change efforts.
Meet the Instructors
Lisa H. Lubomski, PhDAssistant Professor
Department of Anesthesiology and Critical Care Medicine
[MUSIC]
Thank you for your 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 mastered in order
to make use of the skills, and tools and knowledge that you've been learning.
This is where we take the ideas, our plans, our notions of how we can get
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 a quality to it.
It can be retrospective based on our experience and
things that have happened to us, or can be prospective, that we're planning before
any one specific event has triggered that learning.
There's also the idea the 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 over a very,
very long period of time, too?
Also an important thing to think about when it comes to change.
And the last one his 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 we need to consider, is the scale or
the scope on that change.
Even a very small projects, even a very large transformative projects as well.
These all are types of organizational changes though.
And by that, we mean something 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 are process is for making those things happened is very important and
encompasses all of these things.
The retrospective versus the perspective change,
the discrete versus continuous change, or the large scale versus the small scale.
Very different and all of those things matter, but there are some commonalities.
There are 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 projects you've worked on, you've participated in, or
things you've even read about.
What percentage of these change efforts do you believe fails?
What has 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 payoff.
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 paid attention to.
We rush a certain aspects of the project, we over simplify.
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 are many common reasons that change initiatives can fail.
Here's a list of some of them.
By no means is this an exhaustive list.
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, the 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.
And many times, we'll go to prebuilt solutions, a training program, a protocol,
a bundle, things like this, because the works been 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, we're not get us where we want to go.
We can also over simplify 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 a hospital will 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 the 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 resistant,
why they're 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'll 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, whether this is a skill, whether this is a new work process,
whatever it is people need to understand what's 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 it a little bit 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 in
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 differences in these two phrases I'll ask you to think about.
When you read the 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?
Do 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.
And we think about the next sentence,
which is a change that's 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 are 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 run into many times in health care.
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 an opportunity to voice their
concerns and that those concerns have been listened to and addressed.
And open is completely transparent.
The rationale 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 the structured approaches to change,
having a framework or a 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 we're likely to see.
The idea of adaptive versus 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 in a change,
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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