Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month

1. Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month Questions ? Contact: Skip Valusek PhD, CPHQ MHQP Education Chair skipvalusek@comcast.net January 22nd 2009 Dealing With Change Nancy Jaeckels ICSI Skip Valusek HealthEast CPHQ Exam Prep Course March 14 0800 - 1700 March 15 0900 – 1300 Minneapolis VA Medical Center 10 CPHQ CEU’s • Concepts about Change • Models of Change • Facilitating Change Slides are posted at: http://www.healthforceminnesota.org/pages/Programs/courses.html

2. Register your Attendance Hopefully you provided your name & organization when you signed in. • If so: Just say Hi in the Chat Pod and we’ll capture your name and organization in the log. • If not: identify yourself and organization in the Chat Pod to the left of your screen. If there are more than one attending on your sign-in, tell us how many by saying “Hi (tell us the number of attendees) “

3. Poll: Who is Attending this Session ? • Rural / Out state ? • Metropolitan area ? • Organization that has (or serves) both ?

4. Healthcare system Hospital Clinic or Clinic System Long term care Health plan Homecare / Hospice A Quality Support Organization Other ? (Identify other in Chat Pod) Poll: Who is attending: Organization Type ?

5. Poll: What do you hope to gain by participating? • I am a CPHQ and want to obtain CEU’s for recertification. (Note: this is not guaranteed at this time. We are still working on this) • I am a healthcare quality professional and am interested in additional education. • I am a healthcare professional interested in developing quality skills as a core competency. • I am a healthcare professional interested in learning more about healthcare quality.

6. Agenda • Concepts about Change • Models of Change • Facilitating Change

7. Change • The only constant is change • (except from a vending machine) “It is not the strongest of the species that survive, nor the most intelligent, but the ones most responsive to change.” Charles Darwin • Life is change . . . . • Growth is optional • It is not necessary to change. • Survival is not mandatory. • Deming 159

8. Introduction to Change • Change is not only inevitable but also an essential ingredient for growth • Each level of change requires different strategies • Type of change • People involved • Magnitude of behavior to be modified • Ability to manage change in a planned productive manner is a key skill • Organization’s ability to handle frequent change is dependent upon individuals/leaders 159

9. Introduction to Change • Healthcare is a complex system which demands change quickly • Competition is intensified among organizations due to limited resources • Organizations question not whether to make changes but how much and how often • Two factors are critical in assessing change in organizations • Limits of human performance in being able to respond to change • Actual capacity of the systems to handle change 159

10. Introduction to Change • Resiliency of individuals is critical element in an organization’s ability to make changes quickly & rebound from one change to the next • Individual resiliency will have an effect on an organization’s ability to change, but leaders establish the culture of change, role model flexibility, & the behaviors needed to adapt to change • Resilience: process of adapting well in the face of adversity, trauma, tragedy, threats, significant sources of stress 159

11. Introduction to Change • First order change • Small, relatively easy steps & minimal effort • Second order change • Complex & requires significant change in behavior • Change intrinsically linked with how people view work processes • Change of significant magnitude often entails loss of emotional comfort & may cause distress • Change generally focused on moving people from existing state through transition state to future state 160

12. Introduction to Change • If participants view change as positive, more likely to value results • “All changes do not necessarily lead to improvement but all improvement requires change.” IHI • People may make changes that have no impact on improving services or product, but will disrupt routines • No single model or tool will fit every situation 160

13. Sample Models of Change • Lewin • Kotter • Prochaska • Rogers’ Diffusion

14. Lewin’s Change Model • Motivation and readiness for change must occur before the change can actually take place. • The impetus to change is based on a force field of driving and restraining forces. • In order for change to occur, the force field needs to be altered so that driving forces are stronger than restraining forces. • The force field and impetus to change could be impacted more by removing restraining forces than adding more driving force 161-163

15. Force Field Analysis Example: Proposed change is to allow families 24 hour visiting hours for patients in the ICU 162

16. Kotter’s Heart of Change Model • Change is based on ensuring that people fully accept and incorporate the change into their belief system • Get to the “heart” or emotional/feeling aspects associated with change 170

17. Kotter’s Heart of Change Model • Step 1. Increase Urgency • Step 2. Build the Guiding Team • Step 3. Get the Vision Right • Step 4. Communicate for Buy-In • Step 5. Empower Action • Step 6. Create Short-Term Wins • Step 7. Don't Let Up • Step 8. Make Change Stick 170-171

18. Prochaska’s Transtheoretical Change Model • Stages of change explain the individual’s readiness to change behavior, rather than a process change. • Useful for working with individual staff, patients, and providers to change behaviors • Useful for changing personal behaviors • Can also be used with individuals and the use of technology or specific behavior changes 171-172

19. Rogers’ Diffusion of Innovations • Adapted by Berwick (IHI) for healthcare • Influence in three major areas • Perceptions of the innovation • Characteristics of individuals who may or not adopt the change • Managerial & contextual factors involving communication, incentive, leadership, & management • Develop plans to adopt concepts ensuring greater likelihood of acceptance of innovations

20. Change Management • Assessing Readiness for Change • First step is critical • Point of change is to make an improvement • Applies to large-scale projects and PDSA Cycles of Change 172-173

22. Is your organization ready to change? No Yes Yes Implement Canyou make itready? change successfully No STOP Try later

23. PDSA Cycles of Change • Plan for multiple cycles of improvement • Scale scope & size of test • Choose people who want to work • Capitalize on existing resources • Select easy, visible wins • Don’t delay for technology • Collect useful, meaningful measures • Test change under different conditions • Be prepared to stop if no improvement 174

24. Change Concepts • Eliminate waste • Improve work flow • Optimize inventory • Change the work environment • Enhance producer/customer interface • Manage time • Manage variation • Design error-proof systems • Focus on product or service 174-175

25. Factors that Support Successful Change • Leadership systems designed for results • Design organizational culture • Clear understanding mission & vision • “Urgency” - rapid response • Desired results defined, measured, aligned • Decisions based on sound data • Customer focus • Measurement at all levels 175-176

26. Factors that Support Successful Change(continued) • Innovation valued • Partnerships created • Continuous improvement • Organizational learning • Human resources support culture • Employees involved • Focus on improving employee knowledge • Social responsibility • Systems perspective 175-176

27. Factors that Reduce Resistance to Change • Not willing to make the change • Setting goals, measuring performance, providing coaching & feedback, rewarding & recognizing positive efforts • Not able to perform change • Educating & training staff • Do not have knowledge • Communicating, positive outlook, clear focus, flexible, structured approach, planning & coordinating change, proactive approach 176-177

28. A Factor that Supports BothSuccessful Change and Reduces Resistance to Change Prevent Change Fatigue

29. * Cognitive factors that contribute to error : ·   Stress & fatigue; ·   Lack of familiarity with the task; ·   Trying something new under pressure; ·   Information overload; ·   Workload & multi-tasking; ·   Doing more with less resources; ·   Favoring production over safety; ·   Task saturation; and ·   Task prioritization. Human Factors & Patient Safety * Simpson & Knox: “Adverse Perinatal Outcomes: Recognizing, understanding and preventing common accidents.” AWHONN Lifelines, Jun-Jul 2003

30. From This Impact Of Change To This Week Week The Change Calendar Manage the scope and velocity of change affecting those providing patient care. Contact skipvalusek@comcast.net if interested in more details.

31. Change Calendar Snapshot

32. Summary: Facilitating Major Change • Establish a sense of urgency • Create guiding coalition with Champions • Develop vision and strategy • Communicate change vision • Empower broad based action • Generate short term wins • Consolidate gains • Anchor new approaches in the culture • Prevent change fatigue 128-130

33. Facilitating Major Change: Empowerment • Deming: Improvements in quality are more likely to be realized when workers are empowered • Empowerment enables people to • Take ownership of jobs • Make decisions concerning their area • Take responsibility for decisions • Add value to jobs • Empowerment does not mean people can • Do whatever they want • Reassign work they don’t want to do • Disregard existing policies/practices • Avoid accountability 101 44

34. Facilitating Major Change:Build & Sustain Resilience • Make connections • Avoid seeing crises as insurmountable problems • Accept that change is part of living • Move toward goals • Take decisive actions • Look for opportunities for self discovery • Nurture a positive self view • Keep things in perspective • Maintain a helpful outlook • Coordinate/Manage the timing of changes • Take care of self 159

35. Questions ?

36. Welcome to the MHQP & HealthForce MN Quality Brownbag Room Monthly Noon Brownbag Fourth Thursday Every Month CPHQ Exam Prep Course March 14 0800 - 1700 March 15 0900 – 1300 Minneapolis VA Medical Center 10 CPHQ CEU’s Questions ? Contact: Skip Valusek PhD, CPHQ MHQP Education Chair skipvalusek@comcast.net Feb 26 2009 About the CPHQ Slides are posted at: http://www.healthforceminnesota.org/pages/Programs/courses.html