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A Change-management Playbook Helped QI Projects Survive Their Most Fragile Phase: Adoption

Ryan Vincenzo, CRNA, MSN, EdD

  • Team Level
  • Department Level
  • Organization Level
  • <1 month
  • Cost: <$1k

Overview

What was the reason for the change?

Lack of adoption of Quality Improvement (QI) projects by direct patient care providers in the direct patient care setting.

What were we trying to accomplish?

Improve the adoption of QI projects by direct patient care providers by:

  1. Enhancing communication,
  2. Fostering teamwork, and
  3. Facilitating consultation.

How will we know that a change is an improvement?

Improve adoption of QI projects while minimizing disruption to workflow.

Implementation

How long did it take to get up and running?

The process can be completed in less than a month unless you want to collect data about individuals attitudes towards change, conduct interviews, select participants, and hold project information sessions.

How was readiness assessed & required resources identified?

Readiness was assessed using the Attitudes Towards Change Survey (ATCS) (Ozkalay & Karaca, 2021; Seren & Baykal, 2007). Five process and outcome-guided semi-structured questions were asked to five designated participants. The department manager held change communication huddles with two voluntary direct patient care providers. Communication facilitators then passed the change information to two communication receivers.

What were the missteps and lessons learned along the way?

Missteps included not anticipating that managers’ busy schedules would hinder the communication process and the need for a designated point person for change communication. There was a lack of clarity and structure in the communication process, and staff or managers often lacked a proper understanding of change management strategies. We did not anticipate the complexity of the department environment, where staff viewed preoperative, perioperative, and postoperative phases as distinct teams. Staff sometimes saw change as a punishment rather than an opportunity for education. Ignoring patient care providers’ communication preferences led to resistance, and there was unanticipated resistance to site verification due to frustration with current paperwork practices.

Solution Design

What changes can we make that will result in an improvement?

  1. Enhancing communication
  2. Fostering teamwork
  3. Facilitating direct patient care providers consultation regarding change and work environment

What was your implementation strategy and critical steps?

Communication facilitators relay change information to receivers. The process involves facilitators passing vital change information from managers to direct patient care providers in this sequence:

  1. Here is the change,
  2. This is why we are changing,
  3. Do you have any questions about the change?

To increase the desire for change, I would add a 4th question:

  1. Do you have any suggestions?

Critical steps include appointing a change facilitator for each department who understands the environmental workflow and shifting from top-down to closed-loop communication within the organization.

Adoption & Sustainability

How did you communicate the tactic to those affected by it?

Facilitators improved change acceptance through direct communication, promoting teamwork, diverse solutions, and positive attitudes. Empowering staff with active involvement fostered a desire for change. A designated communication facilitator allowed managers to focus on daily operations, enhancing communication and QI success. Using the ADKAR model, facilitators presented changes, explained reasons, and encouraged questions, ensuring successful change management and provider awareness without disrupting workflow. The project enhanced QI adoption. For example, its implementation inspired providers to make additional changes in the EMR charting system to improve department workflow .Click or tap here to enter text.

How did you design for sustainability of the change?

I followed simple rules from the literature and participants’ answers from the interview process. The key aspects for providers regarding change were workflow, respect, value, awareness, communication, knowledge, involvement, and inclusion.”Click or tap here to enter text.

Evidence & References

Other References

Keywords:
  • change management
  • communication