By Julie Kliger, BSN, MPA
Editors 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 todays 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 dont 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 someones 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, lets 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. Josephs 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.
Engaging Others to Believe in and Support Your Vision
Your team can create the most incredible vision with the right steps to implement it, but it must be effectively communicated throughout the organization in order to see change. You want everyone to understand the vision, buy in to and help develop the strategy and tactics and, as a result, alter behaviors to effect the desired improvements.
To accomplish that, first, think about the main message that will communicate your vision and what supporting points you will use as evidence to back-up your rationale. For example, if your main message is Reduce CRBSIs, develop some short supporting points to answer the most common questions: Why? (Infections are big and dangerous). What? (Central line best practices). How? (Understand what nurses need to get it done). Why should I care? (Save lives and money).
To effectively communicate your message, it is important to know your audiences. Communicating your vision to a CEO or CNO will require you to highlight what achieving the vision will mean for the organization overall, how it aligns with organizations goals, and what, if anything, it will mean to the hospitals bottom line both short-term and long-term. For this audience, you must be compelling and make your case succinctly.
Communicating to staff may require slightly different messages because what motivates an IV team may not be the same as what motivates a bedside nurse. Tailor your messages to communicate how the change will be relevant to colleagues and how it will impact them and alter what they do every day. Let them know the personal benefits of adopting the change and the risks to them of maintaining the status quo. Most importantly, add the human touch. Tell them why they should care and what this means for their patients.
Finally, determine what you need to do to communicate your message. Every institution has preferred methods of communication; use them early and often. Delivering your message at one staff meeting will not bring about change. But delivering your message at weekly staff meetings for three months, reinforcing it through memos, signs at nursing stations, posters and t-shirts will consistently reinforce the message, thus making people more open to it. And bring in others to help you, especially someone trusted by staff and looked to as a leader. If people hear the same story over and over again from different people, they are apt to join your efforts and begin to understand what needs to be done.
At some point in the change process, you will undoubtedly encounter detractors -- those who are resistant to the change you are suggesting. It is important to include these individuals in your efforts because they may think of things that havent occurred to you. You may not change their minds, but demonstrating a willingness to listen and taking their feedback into account may prevent them from becoming permanent roadblocks.
Measuring, Celebrating and Applying Success - Knowing When Change is Really an Improvement
Measurement is a crucial activity in process improvement. Without adequate and appropriate measurement, it is difficult to assess whether progress is being made or if adjustments need to occur in plans and actions. At the beginning of the project, gather data to set your baseline, which could include a chart review or looking at hospital infection data. Then set pre-determined points throughout the defined time period for which you will collect data using the same methods. Data collection doesnt end once the goal has been met; keep tracking metrics in order to maintain success. Finally, continually revisit the strategy and tactics put in place to make sure they are still working, and make corrections as needed.
Revisiting the example of St. Joseph Mercy, the hospital realized success after adopting some new products, including a new chlorhexidine gluconate transparent IV securement dressing. CRBSI rates in the ICU dropped to zero and have remained at zero for 15 months, however the team still reports CRBSI rates monthly at the facilitys Critical Care Meeting and to the administrative team and corporate offices to show that the goal is being maintained.
When a vision like that is achieved, celebrate and show appreciation to staff. However, do not celebrate too early or too often, since it could dilute the importance of the celebration. Another key component of celebrating is sharing success with others. St. Joseph Mercy celebrated by purchasing polo shirts for the critical care team and they used their success to trial new dressing protocols at other facilities within its healthcare system.
As Ghandi once said, "We must become the change we want to see." While change is challenging, any healthcare professional can take up the mantle through a well-defined vision, measurable strategies and tactics and consistent communication, and become the change agent they knew they could be.
Julie Kliger holds a master's degree in public administration from Harvard University Kennedy School of Government, where she focused on patient safety and error reduction policies, and a bachelor of science in nursing degree from Columbia University. In addition to working with organizations on practice redesign, medical error reduction and systems improvement, Kliger is a frequent speaker at national conferences, including Joint Commission and National Quality Forum. Kliger is an independent consultant with her company, The Altos Group. To learn more about leadership development, rapid cycle improvement and organization coaching, visit www.thealtosgroup.com