1. Change
Ginna Crowe, RN, MS
March 2008

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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?

9. 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

10. 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

11. 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

12. 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

13. capacity

14. 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?

15. 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:
ISBN-13:

16. 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?

17. 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

18. 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

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