Change Ginna Crowe, RN, MS March 2008

Models for change Org: schon senge bridges kotter Personal: prusci kublar ross Both Kubler ross

Our Iceberg is Melting John Kotter Holger Rathgeber Fable describing Kotter change work …use his work as a fram to discuss and change together r Our Iceberg is Melting John Kotter Holger Rathgeber

Think back … Think about a change project in which you have been involved. You could have been the leader, a team member or a person experiencing the change. It comes to mind easily because it was very memorable… and you learned a lot—either from the successes or the un-successes (failures) of the project. Who was involved? What happened? What did you learn? What did you do well? Do better? Make a few notes: What was the change What was the rationale What worked? What got in the way ? What did you learn

Set the Stage Create a sense of urgency See the need for change and the importance of acting immediately Pull Together the Guiding Team powerful group guiding the change Leadership skills Credibility Communications ability Authority Analytical skills A sense of urgency Page 130 On a 1 to 10 cycle with 1 being the worst and 10 being the best: How did your project rate in setting the stage Learnings? Debrief both their experience and how the campaign has done this ( the are one of the guiding teams) – lives and harm measurement

Decide What to Do Develop the Change Vision and Strategy Page 130 On a 1 to 10 cycle with 1 being the worst and 10 being the best: How did your project rate in deciding what to do Learnings? Debrief both their experience and how the campaign has done this platform – lives harm

Platform of change Lives and Harm Improve Leadership for Quality Reduce Healthcare associated infections Improve critical care Improve medicine management Reduce surgical complications Improve general medical and surgical care Development sites

Make It Happen Communicate for Understanding and Buy In Understand and accept vision and strategy Empower Others to Act Remove barriers Produce Short-term Wins Visible, unambiguous successes ASAP Don’t Let up Press harder and faster Page 131 On a 1 to 10 scale 1 being the worst and 10 being the best: How did your project rate in making it happen Learnings?

Model For Improvement Remove Barriers Quick Wins Act Plan Study Do What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Act Plan Study Do Remove Barriers Remove barriers to removing barriers Quick Wins Testing Changes with a pedigree Two things campagin has done

Changes That Result in Improvement Hunches Theories Ideas Repeated Use of Cycle Changes That Result in Improvement A P S D Learning from Data Very small scale test Follow-up tests Wide-scale tests of change Implementation of change A P S D D S P A A S P Difference between tests D Hunches Theories Ideas

Known Changes Improve Leadership for Quality Reduce Healthcare associated infections Improve critical care Improve medicine management Reduce surgical complications Improve general medical and surgical care Development sites Getting started kits Measures

Drivers Interventions Content Area Drivers Interventions Reduce complications from: Ventilators Central lines Severe Sepsis HCAIs Reliable processes of care: Ventilator management Central line management Identification and treatment of sepsis Hand hygiene Reliable processes are contained in the NICE guidance (50) on identification and treatment of acute illness and include Establishment of and training for a whole hospital early warning system Development of and training in graded risk based response to acute illness Audit process and outcomes Inclusion of Trust board management, referring medical teams and ward staff in audit feedback process Rapid response to acutely ill patients (Shared with medical/surgical improvement, surgical complications and leadership) Improve Critical Care Processes Inclusion of patient/ public representation on local critical care improvement team Integrate patient/family into improvement work Promote open communication among team and family Provide patient and family driven care Processes Multi disciplinary rounds and daily goal setting Ensure staff have knowledge and expertise in improvement work Ensure communication and collaboration within a multi disciplinary team Appropriate infrastructure: intensivist led model Create an environment of collaboration and culture of safety Involve Leadership in safety Integrate leadership into improvement efforts

capacity

Make it Stick Make It Stick Create a New Culture Page 131 On a 1 to 10 cycle with 1 being the worst and 10 being the best: How did your project rate in making it stick? Learnings?

The extent of failure-free operation over time. David Garvin Reliability The extent of failure-free operation over time. David Garvin Product Details 200$ Paperback: 704 pages Publisher: Wiley-Interscience; Subsequent edition (March 1994) Language: English ISBN-10: 0471571733 ISBN-13: 978-0471571735

Reliability Concepts Phrased as questions: Do you have a system (process) in place? Does it fail? Do you catch the failures? Do you use that information to fix the system?

Design Strategy Prevent Initial Failure Identify failure and mitigate Segmentation Using intent and standardization Identify failure and mitigate Human factor changes Redundancy function Redesign from failure modes Identify critical failures and then redesign

Final Thoughts Our Iceberg is Melting John Kotter Holger Rathgeber Fable describing Kotter change work …use his work as a fram to discuss and change together r Our Iceberg is Melting John Kotter Holger Rathgeber

Closing Most people don’t mind change….. they mind being changed (especially without notice or purpose)