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Spreading Successful Changes. CDI Prevention Collaborative Audio Conference Call September 21, 2011 www.macoalition.org. C. Difficile Prevention Collaborative Agenda. Susanne Salem-Schatz, Sc.D. Collaborative Director Deb Hylander, MSN, RN, CIC, COHN-S Director of Infection Prevention

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Spreading successful changes

Spreading Successful Changes

CDI Prevention Collaborative

Audio Conference Call

September 21, 2011

www.macoalition.org


C difficile prevention collaborative agenda
C. Difficile Prevention CollaborativeAgenda

Susanne Salem-Schatz, Sc.D.

Collaborative Director

Deb Hylander, MSN, RN, CIC, COHN-S

Director of Infection Prevention

Southcoast Hospitals Group

Jane Taylor, D.Ed.

Improvement Advisor

St. Paul, Minnesota

Introductions & Upcoming events

Spreading changes: Tales from the trenches

Spreading Change: principles and process


Spreading change

Spreading Change

Adapted from IHI’s IMPACT Collaborative Spread Presentation

Jane Taylor, Ed.D.

August 2011


Spread
Spread

  • To other units in hospital

  • To other hospitals in system

  • To other hospitals in community for greater good

  • To other cross continuum members


Spread why how do ideas spread
Spread: why & how do ideas spread

  • Roger’s Diffusion Characteristics:

    • See it

    • Try it

    • Is it:

      • Compatible?

      • Easy to use?

      • Better?

    • What supported it? Hindered it?


A

A

A

A

A

P

P

P

P

P

D

D

D

D

D

S

S

S

S

S

What is Spread?

Cycles for testing and implementation

The Total Health Care System


A framework for spread

Social System

Set-up

Better Ideas

A Framework for Spread

Leadership

Measurement and Feedback

Success-ful Sites

Knowledge Management

Communication Strategies


Spread1

Leadership:

It takes a village to prevent HAI

And

Leadership

Experience with Changes

Willing receivers

Accountability

Better ideas:

What are your best ideas, ready for spread?

What has already spread?

Spread


Choosing better ideas
Choosing “Better Ideas”


Attributes affecting rate of adoption
Attributes Affecting Rate of Adoption

  • Relative advantage (evidence from testing)

  • Compatibility with current system (structure, values, practices)

  • Simplicity of the change and transition

  • Testability of the change

  • Ability to observe the change and its impact


Spread exercise
Spread Exercise

Choose one specific change (not just a vague concept) from your improvement work.

Evaluate this change on the five attributes. Rate the change from a “spread target” point of view (not your point of view!). Use a 1- 5 scale:

1 - change is very weak relative to this attribute

3 - change is okay relative to this attribute

5 - change is very strong relative to this attribute

  • Relative advantage

  • Compatibility with current system

  • Simplicity

  • Testability of the change

  • Ability to observe the change and its impact

    Total the evaluations for each of the attributes


What does the score mean
What does the score mean?

  • How easy will it be to spread the change:

    25 = it will spread like wild fire

    5 = no chance of spreading in present form

  • Which attributes would you work on to increase the chance of spread? How?



Questions to consider
Questions to Consider

Target population:

  • What changes do you plan to spread and to whom?

    Adopter audience:

  • Who makes the adoption decisions for the improvements you plan to spread?

  • Will adoption be voluntary for units, staff, providers?


Questions
Questions

Do you need to tailor your message to specific adopter groups: patients, families, clinicians, providers, community, cross continuum partners, others?

Does health literacy play a role or influence your communication strategy?

Key partners:

  • Do you have sufficient physician involvement?

  • Have you identified partners and/or thought leaders in the target areas?

  • Family and patients on team?



Types of adopters
Types of Adopters

Traditionalists

Innovators

Early Majority

Late Majority

Early Adopters

2%

13%

15%

35%

35%


The tipping point
The “Tipping Point”

“The name given to that one dramatic moment in an epidemic when everything can change all at once.”

- M. Gladwell

“The part of the diffusion curve from about 10 percent to 20 percent adoption is the heart of the diffusion process. After that point, it is often impossible to stop the further diffusion of a new idea, even if one wished to do so.”

- E. Rogers

Tipping point


Key messengers
Key Messengers

  • Decision makers

  • Thought leaders

  • Innovators / early adopters

  • Communities of practice / work groups


Ways to Communicate

SHARE

INFORMATION

SHAPE

BEHAVIOUR

General

Publications

flyers

newsletters

videos

articles

posters

Personal

Touch

letters

cards

postcards

Interactive

Activities

telephone

email

visits

seminars

learning sets

modeling

Public

Events

Road shows

Fairs

Conferences

Exhibitions

Mass meetings

Face-to-face

one-to-one

mentoring

seconding

shadowing

(C) 2001, Sarah W. Fraser

Adapted from Ashkenas, 1995



Measurement and feedback
Measurement and Feedback

Data collection

  • Outcome and/or process measures

  • Progress of spread of specific ideas

    Reporting

  • Evidence of progress / success

  • Two-way communication with senior leaders, families, staff, community:

    • Progress reports to senior leaders & others

    • Senior leaders seek, hear and use feedback







Managing knowledge to enable spread
Managing Knowledge to Enable Spread

  • Make the case for the new system

    • The reasons people would want to make the changes

  • Describe the new system

    • “What is being spread”

    • The concepts and ideas that form the content of the new system

  • Transition materials

    • Specific methods, tools, examples, and documents to assist people in adopting the content

  • Technical Support

    • Where people can go with questions regarding the changes


Leadership requirements for spread
Leadership Requirements for Spread

  • Topic is a key strategic initiative

  • Goals and incentives aligned

  • Executive sponsor assigned

  • Day-to-day managers or designated responsibility identified


Topic is a key strategic initiative
Topic is a Key Strategic Initiative

  • Topic is included in strategic aims and plans of practice or health center

  • Leader(s) frequently reinforce the need to close the gap

  • Senior executive(s):

    • Provide progress reports to the Board or Community

    • Calendar regular attention to the spread work


Goals and incentives are aligned
Goals and Incentives are Aligned

  • Assure appropriate resources are assigned and engaged

  • Recommend alignment of incentives sufficient to motivate leaders and new adopters


Day to day responsibility identified
Day to Day Responsibility Identified

  • Manager, staff, physicians may lie outside the original collaborative team

  • Assign great performers

  • Make it an important part of their regular jobs, not added work


Summing it u p managing spread
Summing it Up: Managing Spread

  • Create plan

    • Completeness vs. coverage -all changes vs key changes

  • Set schedule

  • Anticipate needed support services

    • IT

    • Case management/community liaison

    • Technical expertise

  • Eliminate barriers

    • Accessible knowledge

  • Measurement and feedback


Spread strategy matrix
Spread Strategy Matrix

A= Isolation technique B=Hand cleaning C= xzy. D=abc


Measurement and Feedback

Knowledge Management

A Framework for Spread

  • Leadership

  • Topic is a key strategic initiative

  • Goals and incentives aligned

  • Executive sponsor assigned

  • Day-to-day managers identified

  • Social System

  • Adopter types

  • Key messengers

  • Set-up

  • Target population

  • Adopter audience

  • Key partners

  • Better Ideas

  • Successful tests

  • Positive attributes

Communication Strategies


References
References

Attewell, P. Technology Diffusion and Organizational Learning, Organizational Science, February, 1992

Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, N.J.: Prentice Hall, Inc. 1986.

Brown J., Duguid P. The Social Life of Information. Boston: Harvard Business School Press, 2000.

Cool et al. Diffusion of Information Within Organizations: Electronic Switching in the Bell System, 1971 –1982, Organization Science, Vol.8, No. 5, September - October 1997.

Dixon, N. Common Knowledge. Boston: Harvard Business School Press, 2000.

Fraser S. Spreading good practice; how to prepare the ground, Health Management, June 2000.

Gladwell, M. The Tipping Point. Boston: Little, Brown and Company, 2000.

Kreitner, R. and Kinicki, A. Organizational Behavior (2nd ed.) Homewood, Il:Irwin ,1978.


Upcoming opportunities
Upcoming Opportunities

  • Partnership CDI Prevention Collaborative for Acute Care Hospitals and Long Term Care Facilities

  • November 15th Learning Session: Westborough

  • Final reports and follow up calls.


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