Facilitating Change and the Concept of Spread

1. Facilitating Change and the Concept of Spread Content adapted for CMRI Collaboratives from materials developed by the Institute for Healthcare Improvement

2. The Role of the Collaborative Team • Make improvements in management of Surgical Site Infections in your facility • Spread the improvements to others

3. “Real improvement comes from changing systems, not changing within systems.”– Berwick

4. Spreading the Improvements to Others Target Population in your Aim Statement Population for Spread • Other clinicians- Other units - Other clinics - Other hospitals

5. Spread Questions • Spread What? • Spread to Whom and Where? • When to Spread? • How to Spread?

6. Spread What? • Test of change • Successful change strategy, ready for implementation

7. Spread to Whom and/or Where? • Other clinicians, i.e., surgical staff • Other types of surgery • Other departments of surgery • Other hospitals

8. When to Spread • Spread change from pilot populations to the target population as successful intervention strategies are defined • Spread improvement to additional populations after success in the target population is demonstrated

9. How to Spread:Make the Case for Change • How to sway and motivate? • Show evidence supporting the changes (literature, experience) • Describe the benefits • Let your data (annotated run charts)“tell the story”

10. Organizational Approach: Facilitating Change • Improving the management of the surgical patients is a strategic initiative within the organization • Improvement team demonstrates success with the proposed changes • Executives (senior leaders) are supporting the changes and planning the spread

11. What You Can Do to Help with Adoption of Change • Help to make the case for change • Make the “new way” easier • Consider spheres of influence • Develop your network–agents of change • champions • messengers

12. Develop the Messengers • Remember to consider spheres of influence • Utilize your senior leader • Choose the right messengers • Opinion leaders • Connectors • Educate the messengers (to deliver the message)

13. Adopter Categorization (speed of adoption) Innovators Early Adopters Early Majority Late Majority Traditionalists 34% 2.5% 16% 13.5% 34% Cultural change Source:Everett Rogers, 1995 System-wide supports

14. Active Resistance • Critical, demeaning comments • Finding fault • Selective use of facts • Active sabotage • Intimidation • Distorting facts • Spreading rumors

15. Passive Resistance • Verbal agreement, “yes-ing” and nodding • Playing dumb • Withholding critical information • Actions don’t support words • Standing by and watching failure • Portraying the “victim”

16. Peg Game Exercise

17. The Peg Exercise • Consists of an exercise board of a “representative” equilateral triangle with 15 circles within the exercise field • Each circle is consecutively numbered from one (1) to 15 • Marker (M&Ms) are placed on all but one position • The goal is to jump a single, adjacent M&M along the path lines indicated and to remove the jumped M&M (please do not eat them until the end) • The exercise is over when no more M&Ms can be jumped • The desired finishing point is only one M&M remaining on the exercise board • Please work quietly • Each participant should note how many M&Ms you had left on the exercise board at the end

18. The Peg Exercise

19. Act Plan Study Do Model for Improvement What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement?

20. To Be Considered a PDSA Cycle: • The test or observation was planned(including a plan for collecting data). • The plan was attempted (do the plan). • Time was set aside to analyze the data and studythe results. • Action was rationally based on what was learned. Improvement Guide pp.60-61

21. PDSA for the “PEG Exercise”

22. The Peg Exercise

23. “Change is disturbing when it is done to us. Change is exhilarating when it is done by us.”– Rosebeth Kantor

24. “The definition of ‘insanity’ is continuing to do the same thing overand over again and expecting adifferent result.”– Albert Einstein

25. Q & A

26. Please complete your evaluation.