Mention the word ‘change’ to staff and the response rarely includes instant fist-pumps and high-fives.
There are degrees of resistance to change—it can be slightly daunting for some and outright confronting for others. So how can we best manage it within the healthcare sector to ensure a positive outcome for all stakeholders?
Broad communication is important
Bree Nation is an industry coach at Safer Care Victoria. Bree was a Nurse Director who developed a skill and passion for improvement science. She suggests that the challenge is to lift ourselves out of the busyness of the day and share the problems and the learnings, the failures, as well as the successes within our own health services and with other health services. This helps us to expedite our own organisational learning and improvement.
“Providing opportunities for peers to talk is really important,” she says. “It allows for problems to be shared, an understanding of what’s been tried, what’s working and where partnerships are meaningful.”
Bree’s tip is to ensure the right people analyse processes from end to end, in order to collectively understand and agree where the problem lies. Involving frontline staff removes barriers and allows them to be involved in finding a positive solution. “This method allows involved parties to see that the process is the problem, not the people,” she says.
Fellow consultant Simon Craig is a systems improvement specialist and an industry coach. Simon has a background in engineering before becoming an expert in improvement methodologies.
He sees a need for improvement sustainability in the health sector due to the rapid medical and technological advancements that create constantly changing work dynamics. “We need to know how to react to problems, because what worked yesterday may not work today,” he says.
Three key ingredients
Simon believes the three key ingredients to sustainability are direction, capability and control.
“Firstly an organisation needs direction and clarity from management in terms of what’s important. What do our patients need? What do we need to focus on? What do we need to achieve?” says Simon.
“The second thing is that when problems occur, we need to be capable of effectively addressing them.
“We need capability of the organisation and individuals—but not as doctors or nurses or managers—as problem solvers.
“They’ve got to be capable of seeing a problem and in a structured, methodical way, fixing that problem. We teach our doctors to be great doctors and our nurses to be great nurses, and there’s an assumption that they should be able to identify and fix a problem. Without the appropriate training and tools, this is often not the case.
“They need to be brought on a journey. They need training, tools, frameworks, literature, resources, and to be provided with expert support.”
Control is the third component in sustainability. Simon believes that, without it, the improvement could fail when the project team leaves.
“Without control we can’t see how our process is performing. We don’t see our problems so we can’t fix them,” he says. “We don’t want to micro-manage, but we do need to understand things at a detailed enough level so that we can catch problems before it’s too late.”
“Sustainability is not about sustaining a specific change, it’s about being able to react to future problems and that will sustain the change.”
The control component is also strongly reflected in the Juran Trilogy outlined by the Institute for Healthcare Improvement. Improvement advisor David Williams says that pace is needed in the control phase—following on from the planning and improvement phases—to continually implement small improvements so that performance doesn’t drop.
Both Bree and Simon’s recommendations are also encapsulated in the Harvard Business Review’s article—‘Four Steps to Sustaining Improvement in Healthcare’. Both authors—Mate and Rakover—mention aligning organisational goals and involving frontline and clinical staff in implementing improvements. They suggest starting with a pilot unit as a small-scale test environment.
The collaborative approach to improvement partnerships is also supported by Better Care Victoria in their Improvement Partnership documentation and the Collaborative Improvement Journey roadmap diagram.
Caution around scalability
On scalability, Simon warns against assuming one can pick up another unit’s improvement and apply it to their own without understanding the journey.
“Scaling improvements within and across Health Services is a great way of accelerating the improvement cycle, but it is not a case of simply copying what others’ are doing.
“They need to understand the context around their own problems and look for people who have had the same problems in the past,” he says. “Then they can take on the concept, understanding not only the solution but the journey.
“They need to understand why the improvement was implemented and ask ‘Does this apply to us?’—and they may need to adjust, to suit their own environment.”
Change management is complex, but with these expert tips up your sleeve, your improvements can succeed and your stakeholders may not feel like fish out of water.