Moving from testing to implementation (creating permanence) 8 May 2013

1. Moving from testing to implementation(creating permanence)8 May 2013 Peter Leong 1

2. Questions • How do we go about testing? • When do we decide we are ready to implement? • What must we do to make the change a success? 2 2

3. An example of a change gone wayward 3 3

4. Testing a software 4 4

5. Murphy’s Law Whatever can go wrong, will go wrong ….. http://geert-hofstede.com/new-zealand.html

6. PDSA Cycle 6 6

7. From idea to changeFrom Qualitative to Quantitative Evidence http://geert-hofstede.com/new-zealand.html

8. Phase 1 – work of improvement http://geert-hofstede.com/new-zealand.html

9. Phase 2 – Testing under multiple conditions 9 9

10. Break out exercise …. Work at your table – 10 minutes Using the software testing as an example, what sort of tests would you do for your PDSA cycles to provide you with the confidence necessary for implementation? When you are ready, share the THREE essential ones. 11 11

11. An exercise …. • On a piece of paper, write your name in full. • Assume, for some reason, that you are unable to use your normal writing hand. Now, using your other hand, write your name in full again. 12 12

12. Testing and Implementing • Testing • Change is not permanent • Failure is OK and we learn • Fewer people are impacted • Implementing • Failure not really a good thing • System integration needed • More people impacted • Increased resistance • More time needed to bed it 13 13

13. Machiavelli “There is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle than to initiate a new order of things. For the reformer has enemies in all those who profit by the old order and only lukewarm defenders in all those who would profit by the new …” 14 14

14. History of the Metric System for the USA 15 15

15. Key principles to bear in mind when doing change • It is a series of cycle • Provide support – data feedback, coaching, leadership • The psychology of change 16 16

16. 3 approaches • Just do it … • Parallel …. • Sequential … 17 17

17. Make it stick - the permanence of change • Standardisation • Establishment of specific policies and practices • Definitions/ Business rules • Standard operating procedures • Documentation • Job description, role • Data collection • Training • Current and Future Staff • Measurement • Outcome/ Process/ Balancing measures • Resourcing • What to change • How to communicate • How to update current documents and practice 18 18

18. Standardisation and Documentation • Standardization • Map out the flow of the new process • Standardize crucial steps in the new process • Develop measures and feedback on crucial steps • Clarify individual responsibility/authority • Define some “rules” to guide the practice • Documentation • One source of truth • Many changes only as good as their documentation • Used for ongoing education and training • First and only stop for training • Ownership of document regarding maintenance 19 19

19. Measurement • Visible measurement of key outcome measure(s) • Viewed over time • Measurement of crucial support processes (early warning system) 20 20

20. Training and Resourcing • Training • One time or complex/formal • Use documents (One source of truth) • Answer the ‘why’ question • Calibration of learning • Getting Implementation Resources (time, $, etc.) • Testing often not resource intensive- implementation may be • Need to plan for resource request and allocation • Including ongoing ownership • Communication, training and knowledge transfer • Ongoing updating flow sheets, policies, measures, etc. 21 21

21. Training 22 22

22. Change Checklist Template 23 23

23. Reaction to change • Resist - to strive against or oppose • Indifferent – feeling or showing little or no interest • Ready • Compliance – publicly acting in accordance with social pressure while privately disagreeing • Conformance – a change in behaviour or belief because of group pressure • Commitment – an internalised belief in the course of action 24 24

24. Sustaining a change that has been implemented We need to create structures that make it easy for people to do the right thing (i.e. use the new system) and hard to the do the wrong thing (i.e. go back to the old system). Some inhibitors to sustaining a change are: • We met our goals • We assumed the improvement would hold • Other priorities took all resources away • Not on senior management’s radar screen • Did not learn how to maintain the gains • Infrastructure not in place 26 26

25. Getting commitment to change • Create the will: • Create dissatisfaction with current state • Communicate direction relentlessly • Express excessive faith in success • Embrace the mess • Provide information on why change is being made • Empathize -don’t expect to eliminate it • Reiterate how change supports aim of organization • Put it in historical perspective • Link to needs of patient/family/community • Reframe ‘change’ as opportunity • Provide hotline for questions/comments 27 27

26. Getting commitment to change - continued • Provide specific info on how the change will affect people • Share results from testing • Be prepared for questions • Study rational objections and be prepared to address them • Include members of team who tested in presentations • Get consensus on resources and other support for implementation • Define plan with milestones/dates • Ask leaders and key people to publicly support • Express confidence in those asked to carry out the change • Publicize the change • Use symbolism, stores, pictures • Summarize key points and agreements as made • Show appreciation for those developing and testing change • Take advantage of significant events (crisis, inspection, complaint) and tie to implementation 28 28

27. Break out exercise Return to the change you developed using the implementation checklist • What are some barriers that see working against the sustainability of this change? • What can your team create an atmosphere of commitment to the change? • Who (name up to 3 people) would it be very important to recruit when trying to make this change the norm? • How can data be used regularly with staff at the frontline to encourage ongoing commitment ? 29 29

28. Change is about engaging our minds and EMOTIONS Change our words, change our world 30 30

29. The End …. Thank You …. 31 31