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Becoming a Change Agent: Practical Steps for Transforming a Vision Into Reality

Article

By Julie Kliger, BSN, MPA

Editor’s note: In June, 3M hosted a two-day seminar at its St. Paul, Minn., headquarters for 55 healthcare professionals from across the country, including nurses, infection preventionists, physicians and specialists in vascular access. The company brought in leading experts in change management to educate and inform these professionals on how to adopt and implement change within their own organizations. The following article is the first of a two-part series on some of the information shared attendees that may help healthcare providers who deliver patient care everyday become change agents in their own institutions.

In today’s environment, the delivery of healthcare is constantly evolving, requiring practitioners to be nimble and quickly adapt to new guidelines, protocols and technology. Healthcare professionals are adept at looking at the situation in front of them and making a needed adjustment to improve patient outcomes in the moment, while simultaneously thinking to themselves, "There has to be a better way." Countless healthcare professionals have the leadership skills, energy and desire to create the better way, but don’t always have the tools to navigate the sometimes treacherous process of creating and implementing their ideas in complex organizations.

Implementing long-term change is neither swift nor easy. It requires patience, persistence and, sometimes, a little creativity. For change to be sustained over time, a system-wide approach is necessary, which requires examining and understanding both the broader system, as well as the individual components that are involved in a problem and developing a multi-pronged approach to solving them.

With healthcare-acquired infections (HAIs) a keen area of focus for hospitals across the country, there is a great desire among practitioners and institutions to implement a more effective paradigm for patient care to manage and prevent HAI risks. To create real and lasting change, these organizations require a leader – or change agent – who can take a critical step back and see what needs to be done not just for one patient, but for all patients. This change agent is a person who sees the future of what "can be;" someone who is both fueled by passion and inspires passion in others. Most importantly, the change agent is able to create a vision and develop a framework for carrying out that vision.

There is a growing body of work and proven methodologies on how to help these change agents make change happen -- how to collect data, how to craft a clear, measurable vision statement, how to create effective strategies and most importantly, how to communicate to not only staff but also hospital management. The following are a few methods for how to break through obstacles to change and develop your plan of attack:

Writing and Articulating Your End Goal

Whether you are trying to make a large or small improvement, a vision statement is a critical first step in creating positive change in your organization. A vision statement, as with all change work, is strongest and has the best chance of achieving success if it is developed in collaboration with colleagues in the organization.

A vision for change is a sensible and appealing goal for a future state. It should be big and motivating to those who care about the organization. It should win their hearts and minds, raise the bar and be specific with a focus on the ideal situation in the future. A sample vision statement might be "We will not cause infections in people who have catheters in 2010," or, "Be the best place to work, the best place to practice medicine and the best place to receive care." A vision statement should be brief and direct so it captures someone’s attention when speaking about it, even on a short elevator ride.

Creating an Effective Strategy and Tactics to Meet Your Goals

Once the vision is established, the next steps help achieve your vision through day-to-day action. First, develop your strategy, which is the overall plan to achieve your vision and then your tactics, which are short-term, adaptive moves designed to achieve strategies.

When developing your strategy, it is important to recognize that it will vary in scale and time, and may take days or even years, depending on your overall goal, yet your tactics should be something that could be implemented on a day-to-day basis. Strategy is determined based on multiple factors, including the scope/environment/alignment with mission and goals. The tactics used might include trials of new products, changes in protocols and, when appropriate, new educational measures. Sometimes, organizations rely too heavily on education as an "easy fix" to larger, organizational issues. Education is a critical, though "low-voltage" tactic and should not be overlooked, but it should be one tactic among many that help drive organizational change.

To demonstrate how this all comes together, let’s build off of the vision statement: We will not cause infections in people who have catheters in 2010. One strategy might be: Focus on lines placed within the first eight hours. A tactic to achieve that strategy might be Ensure proper products, approach and documentation are in place. Another strategy for that same vision might be: Ensure all personnel are trained in proper line placement. A tactic for this strategy might be: Hold educational in-services first with nurses, then physicians.

Using a real-life scenario, St. Joseph’s Mercy Health Center in Hot Springs, Ark., successfully created and implemented a strategy and tactics to fulfill their vision of reducing catheter-related bloodstream infections (CRBSIs). Their vision was to: Aim for Zero CRBSI in 2009. Their strategy was: Achieve zero CRBSIs in the intensive care unit (ICU). One tactic used to achieve that strategy included a three-month trial of silver alginate IV patches and chlorhexidine gluconate transparent IV securement dressings.

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