1. Session 6a: Interventions
Facilitator notes:
Application of interventions to control MDROs in health care settings
Session 6a: Interventions
Version: September 2017

2. Objectives Specific objectives of this session:
Understand the determinants of a change process
Understand how to manage or influence change
Facilitator notes:

3. With permission of University of Dundee
Video
With permission of University of Dundee

4. What will be your FIRST strategic initiative?

5. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right strategy 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

6. Data is the most effective resource we have to convince
Surveillance is critical!
If you cannot measure it, you cannot improve it (Lord Kelvin)
Information must be:
Relevant
Timely
Perfect is the enemy of good (Confucius)
Presented effectively...

7. Conveying the message Convey the message in a manner that is: Simple
Unexpected
Concrete
Credible
Emotional
Story

8. Next?

9. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right strategy 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

10. Successful leadership
Developed a culture of clinical excellence
produced a vision
successfully conveyed it to staff at all levels.
Solution oriented
did not throw up their hands & complain about how the system will not allow change.
focused on overcoming barriers
Inspired staff
Thought strategically while acting locally

11. Creating an effective team
Identify members who will contribute
willingness to face challenges,
situational reasoning,
collaborative attitude .
Define roles and be consistent.
Build trust and respect.  
Get direct access to the decision makers!

12. Proportion of hospitals where CEO
holds meetings to discuss infection rates

13. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right change process 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

14. Teach the driver how to turn around the elephant
Which do you think is the most effective way of getting this elephant to change its course and walk into a new path?
Teach the driver how to turn around the elephant
Put bananas in the right path to convince the elephant to change direction
Prod the elephant with a stick if it does not turn into the correct path
Block the wrong path to make sure the elephant follows the one you want.

15. Change process

16. Addressed central line related bloodstream infection through:
Educating staff;
Creating a catheter insertion cart;
Daily assessment if catheters could be removed;
Implementing a checklist to ensure adherence to evidence-based guidelines
Empowering nurses to stop the catheter insertion procedure if a violation was observed
Critical Care Medicine 2004; 32:10

18. Directing the rider Find the bright spots
Identify areas where change has already occurred
Why are they doing it differently
Try to extend more widely
Think specifics
Don’t think too big or too long
Point to the destination
Highlight the goals and why they are worthwhile achieving

19. Addressed central line related bloodstream infection through:
Educating staff;
Creating a catheter insertion cart;
Daily assessment if catheters could be removed;
Implementing a checklist to ensure adherence to evidence-based guidelines
Empowering nurses to stop the catheter insertion procedure if a violation was observed
Critical Care Medicine 2004; 32:10

20. Education
Level of concurrence was influenced directly by formal training and education
Competence assessment as opposed to didactic knowledge
Most powerful influence appeared to be direct vivid experience
Continual repetition was necessary in forming & maintaining appropriate habits.

22. Addressed central line related bloodstream infection through:
Educating staff;
Creating a catheter insertion cart;
Daily assessment if catheters could be removed;
Implementing a checklist to ensure adherence to evidence-based guidelines
Empowering nurses to stop the catheter insertion procedure if a violation was observed
Critical Care Medicine 2004; 32:10

23. Knowing is not enough to cause change

24. Health belief model
Hochbaum, Rosenstock & Kegels 

26. Addressed central line related bloodstream infection through:
Educating staff;
Creating a catheter insertion cart;
Daily assessment if catheters could be removed;
Implementing a checklist to ensure adherence to evidence-based guidelines
Empowering nurses to stop the catheter insertion procedure if a violation was observed
Critical Care Medicine 2004; 32:10

27. CHANGING OFFERS AN ADVANTAGE STATUS QUO OFFERS A DISADVANTAGE
Motivation
CHANGE
HAPPENS IF
(preferably both)
CHANGING OFFERS AN ADVANTAGE
OR BENEFIT
STATUS QUO OFFERS A DISADVANTAGE
OR LOSS

28. Motivating the elephant
Shrink the change
Break down the change process into small components
Cultivate a sense of identity
Instill the change as a valued initiative

29. Opinion leaders
Opinion leaders identified by peers using a simple scoring method
involved in the development of intervention and in undertaking the education

31. Addressed central line related bloodstream infection through:
Educating staff;
Creating a catheter insertion cart;
Daily assessment if catheters could be removed;
Implementing a checklist to ensure adherence to evidence-based guidelines
Empowering nurses to stop the catheter insertion procedure if a violation was observed
Critical Care Medicine 2004; 32:10

32. Shape the path Tweak the environment
Make the new behaviour as habitual
Rally the herd

33. Next?

34. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right strategy 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

35. Communication Inform Involve Engage What is the change initiative?
Why is it needed?
How can it be implemented?
Which benefits are expected?
Involve
Seek genuine consultation
Take on board all constructive feedback
Engage
Recognise champions
Address non-conformance

36. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right strategy 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

37. “Active resistors”
Personnel who vigorously and openly opposed change
“Organisational constipators”
Mid to high level executives who prevent or delay change without active resistance
Insidious barriers that increase work required to achieve effective implementation.

39. Next?

40. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right strategy 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

41. Short-term wins Short term wins: Add credibility to the change process
Maintain momentum
Retain support of decision makers
Undermine resistance
Provide inspiration
Build a power base to address greater challenges

42. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right strategy 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

43. Create a sense of urgency Build an effective team
The heart of change 1
Create a sense of urgency 2
Build an effective team 3
Establish the right strategy 4
Communicate, communicate, communicate! 5
Remove obstacles 6
Create short term wins 7
Don’t let up 8
Make change stick

44. Transactional change
A form of process modification intended to facilitate the attainment of strategic objectives by shifting functions, overall duties and specific assignments within a project or organization.
Transformational change
A paradigm shift in the culture of an organization resulting in a change within the underlying strategy that the organization has used in the past.

45. Burke Litwin model
Long term impact
Short term impact

46. Facilitator notes:
Acknowledgements The creation of this training material was commissioned in 2011 by ECDC to Health Protection of Scotland, National Services Scotland, University of Chester and University of Dundee with the direct involvement of Eastaway A, C Wiuff, A Seaton, J Reilly, M Rivett. This lecture was authored in 2017 by Michael Borg, Mater Dei Hospital, Msida, Malta. The revision and update of this training material was commissioned in 2017 by ECDC to Transmissible (Netherlands) with the direct involvement of Rita Szabo, Remco Schrijver and Arnold Bosman

47. This work is licensed under the Creative Commons (http://creativecommons.org)
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Author: Prof. Michael Borg, Mater Dei Hospital, Msida, Malta, 2017 (commissioned by ECDC)
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