sustaining change how to make lasting changes in your primary care practice sue butts-dion...
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Sustaining ChangeHow to make lasting changes in your
primary care practice
Sue Butts-DionImprovement Advisor
Institute for Healthcare Improvement
This project was supported by grant number R18HS019508 from the Agency for Healthcare Research and Quality (AHRQ). The content is solely the responsibility of the authors and does not necessarily represent the official view of the AHRQ.
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Learning Objectives
By the end of this module you will be able to: Identify characteristics that make it easier
to sustain change and improvement Utilize a checklist of considerations when
working to sustain change Describe gaps in your practice as it relates
to sustaining change List something that you could test immediately
in your organization
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Your Improvements—Are They Sustainable?
SUSTAINABLE?
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Persistence
Sustaining change is as hard as making it
“Never, never, never give up.”
--Winston Churchill
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Practice Exercise
Think of a change that was sustained What characteristics were present? List them
Then Think of a change that was not sustained What characteristics were absent? List them
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Were these items on your list?
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Were these items on your list?
New way was better than old way
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Were these items on your list?
New way was better than old way Desire to want to change (urgency)
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Were these items on your list?
New way was better than old way Desire to want to change (urgency) Had a clear vision—we knew why we were doing it
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Were these items on your list?
New way was better than old way Desire to want to change (urgency) Had a clear vision—we knew why we were doing it Had a way to measure that we were holding our gains
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Were these items on your list?
New way was better than old way Desire to want to change (urgency) Had a clear vision—we knew why we were doing it Had a way to measure that we were holding our gains Someone took ownership
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Were these items on your list?
New way was better than old way Desire to want to change (urgency) Had a clear vision—we knew why we were doing it Had a way to measure that we were holding our gains Someone took ownership Had a coach
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Were these items on your list?
New way was better than old way Desire to want to change (urgency) Had a clear vision—we knew why we were doing it Had a way to measure that we were holding our gains Someone took ownership Had a coach Support for the change (people, resources, etc.)
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Were these items on your list?
New way was better than old way Desire to want to change (urgency) Had a clear vision—we knew why we were doing it Had a way to measure that we were holding our gains Someone took ownership Had a coach Support for the change (people, resources, etc.) Recognized and understood competing commitments
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Characteristics Present in Organizations Able to Sustain Change
Support from management Robust, transparent feedback systems Shared sense of the systems to be improved Culture of improvement; deeply engaged staff Formal capacity-building programs Built-in structures to “foolproof” change
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Helpful 7-Question Checklist
Do we have process owners (a “home”) and leadership support?
Do we have a consensus understanding of what’s being improved?
Do we have built-in structures to “foolproof” the change?
Do we have a way to measure that the change is still working?
Do we have transparent communication/feedback systems in place?
Do we celebrate (even the small things)?
Do we engage/involve patients, families, clients, and customers?
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Problem: 45,000 open orders in EMR
Solution: Staff closed all open lab orders!
How can Dr. Folch now sustain and
continuously improve this change?
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Example: Damian Folch, MD
Hear Dr. Folch describe his improvement journey
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Consideration: Do we have a process owners
and management support?
Examples: Practice Manager Office Manager Supervisor
Checklist: Question 1
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Checklist: Question 2
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Consideration: Does everyone have the same understanding of the
processes and systems we are trying to improve or have improved?
Examples: Communication Tool: Flow map
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Checklist: Question 3
Consideration: Have we built in structures to “foolproof” the change?
Examples: Checklists Standardized processes, protocols, guidelines Information technology (IT) Job/descriptions/policies Training
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Checklist: Question 4
Consideration: Do we have a way to measure that the change is still
working (or not)?
Examples: Measurements Charts, graphs
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Checklist: Question 5
Consideration: Do we have transparent communication and feedback
systems in place?
Examples: Communication plan “Six times, six different ways” Huddles (only 10-15 min.)
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Checklist: Question 6
Consideration: Do we celebrate—even the seemingly small wins?
Examples: Lunch time party Celebration Acknowledgements
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Checklist: Question 7
Consideration: Do we engage patient, families, customers, clients?
Examples: Inquiry (simple surveys) Focus groups Improvement meetings
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Importance of Sustainability StrategiesThroughout Phases of Work
Improvement
HOLD GAINS and SUSTAIN
Test Implement
I. During testing
II. During implementation
III. After implementation
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In Summary…
As they say:
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In Summary…
As they say:
Improvement work is never completed and takes planning and time.
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In Summary…
As they say:
Improvement work is never completed and takes planning and time. Systems degrade, situations change.
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In Summary…
As they say:
Improvement work is never completed and takes planning and time. Systems degrade, situations change. You must create a system of improvement to be on top of the situation.
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What Could You Do Today?
A place to start—In the past year: Note one improvement in your practice Decide if the improvement was sustained Determine why it was, or was not Check if a step in the checklist was missed
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Thank You!
Thank you
for your time
and attention today
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Want to learn more?
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Refer to the NSPG Beverly video
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References
Improvement leaders’ guide to sustainability and spread. NHS Modernisation Agency. Ipswich, England: Ancient House Printing Group; 2002. Available: www.modern.nhs.uk/improvementguides/sustainability/fw.html
Spread and sustainability of service improvement: Factors identified by staff leading modernisation programmes. London, England: NHS Modernisation Agency; February 2003. Research into Practice, Report No. 4: Overview of early research findings.
Teamworking for improvement: Planning for spread and sustainability. London, England: NHS Modernisation Agency; August 2003. Research into Practice, Report No. 5.
Øvretveit J, Bate P, Cleary P, et al. Quality Collaboratives: Lessons from research. Qual Saf Health Care. Dec 2002;11:345-351.
Juran J, Godfrey B. Juran’s Quality Handbook (5th Edition). New York: McGraw-Hill, 1998. (Chapter 4)
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The NHS Institute for Innovation and Improvement offers spread and sustainability resources, including a model to assess likelihood of holding gains. See their website for more information: http://www.institute.nhs.uk/sustainability_model/general/welcome_to_sustainability.htmlhttp://www.institute.nhs.uk/sustainability_model/introduction/find_out_more_about_the_model.html
References