Building a Culture of Change

Tami Michele, D. O. FACOOGAnn Forster Page, MS, APRN, CNM

Principles of Implementing Change

How do we respond to change?

Our limbic brain responds very quickly

Multi-site Systems Change Example

• Hospital Association OB Keystone Project• Plan to implement change• Team had clear rationale and evidence for

practice change. Core team was formed.

Recruitment, Find Champions• Most opposed providers and nurses• Older leaders• Younger leaders• Kick-off meeting to create a sense of focus and teamwork, include team

building activities• Partner with senior executive leaders• Gathering Data for Quality Improvement• Opportunity to be a leader in practice for other hospitals to follow• Use existing quality improvement committees

Existing QI Committees• Projects are easily acceptable when placed in the context of “quality

improvement”

• Reducing interventions → Reduced patient risk → Reduced provider risk

• When patients feel they are receiving individualized care, and part of shared decision making, their perception of quality care goes up, and hospital scores increase.

Individual Work Styles of OB Unit• Example: DiSC

• Understanding personal characteristics can help overcome barriers

• 4 basic individual work styles– Dominance (direct, results-oriented, strong-willed, forceful)– Influence (outgoing, enthusiastic, high-spirited, lively)– Steadiness (even-tempered, accommodating, patient, humble, tactful)– Conscientiousness (analytical, reserved, precise, private, systematic)

Individual Motivators and Fears• Dominance:

– Likes Competition, Winning, Action, Results– Fears Loss of Control, Vulnerability

• Influence:– Likes Recognition, Enthusiasm, Collaboration– Fears Rejection, Disapproval

• Steadiness:– Likes Stability, Cooperation, opportunities to help– Fears Change, Loss of Harmony, Offending others

• Conscientiousness:– Likes using Expertise and Knowledge, Quality– Fears Criticism, being Wrong, Disorganization

Evidence• Providers and nurses are more willing to change current practice when

shown evidence and when they are emotionally engaged in the importance of the practice change

• Use hospital success stories

• Provide packet of information on project with supportive articles

• Journal Club to review & discuss

Barriers• Find common ground

• Define the areas of concern

• Plan regular meetings, inform & update at every opportunity

• If the system is overwhelmed by too many changes, present the project in stages, go for the low hanging fruit.

• Reduces resistance

• Easier to get Buy-In

Unless you perceive there is a really good reason to change, you won't. Change goes against what is familiar, stable and routine