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Engaging, Spreading, and
Sustaining Change
Janet Stifter, PhD, RN, CPHQDirector, Center for Care Innovation
and TransformationAONE
Chicago, IL
NY Partnership for PatientsDecember 7 and 8, 2017
Table Exercise #1
• Think of a time when a proposed change was implemented, but the change did not stick.
• Why do you think the change did not stick?
Objectives
• To identify considerations and strategies for empowering, spreading and sustaining change by front line staff.
Today’s Presentation
• Part I. Change Adoption• Part II. Generational Differences• Part III. Teamwork and Patient Outcomes• Part IV. Suggested Strategies from the Front Line
Changes in Healthcare Today
• Volume to value driven economics
• Models of accountable care (Quadruple Aim)
• Meaningful Use• Pay for Performance• Technology of health• Interdisciplinary team
decisions/actions
• Patient safety indicators• Hospital acquired
conditions• Transparency in public
reporting (Health Grades, Hospital Compare, U.S. News and World Report, CMS 5-Star Ratings)
• Patient Satisfaction and Engagement
John Kotter’s Change Management Model
With Change - First Deal with the Feelings
• Complacency, anger, false pride, pessimism, arrogance, cynicism, panic, exhaustion, insecurity, anxiety, etc.
• Need to turn these negative feelings into positive proactive feelings such as faith, trust, optimism, urgency, reality-based pride, passion, excitement, hope, and enthusiasm.
Kotter’s See-Feel-Change Approach
• Employees who are motivated feel it in their hearts and not necessarily in their heads – the heart is what motivates them into action
• Kotter recommends a ‘see-feel-change’ approach, a compelling vision that helps the employee to envision the problem and to then identify a solution
• Behavior fueled by emotion lasts longer than that fueled just by analysis
William Bridges Transition Curve
Change Theory – William Bridges
• Transitions that come with change are the most painful
• Transitions mean letting go of the world as staff know it and the security, self-identity, and self-efficacy that comes with it
• Transitions – Start with endings, move through the neutral zone (the unfamiliar space – letting go to learning how), and end with new beginnings (Bridges, W. (1991). Managing Transitions:
Making the Most of Change. Philadelphia, PA: Perseus Book Group)
William Bridges Transition Curve
Why do Organizational Changes Fail?
• Complacency• Failure to create a sufficiently powerful guiding
coalition and change team• Not truly integrating the vision• Allowing for barriers• Not celebrating “short term wins”• Declaring victory too soon• Neglecting to anchor changes firmly in the culture
Errors Common to Organizational Change
• Culture change comes after behavior changenot the other way around.
• Employees will not persist in using the new changes or systems until there is a strong culture in place that reinforces now this is the way we do things around here.
Gaining Staff Engagement
“The new critical mass is only 20% of your intended audience so don’t wait for 100% buy-in before you make
your move.”
Tim Porter O’GradyAONE Transforming Care Conference
11/2/2015
Rogers Diffusion of Innovation
• Diffusion is the process in which an innovation (innovative change) is communicated through certain channels over time among members of a social system. The message being communicated is related to new ideas.
• Innovations are an idea, practice, or object that is perceived as new by an individual or another unit of adoption.
• Recognize that not everyone changes at the same pace or within an established timeframe.
Rogers, E. M. (2003). Diffusion of Innovations. 5th Edition. New York, N.Y: Free Press
Rogers Adopter Categories
Adopter (Staff) Response to Change
Adopter Categories:1. innovators (2.5% of the staff) – Gatekeepers
2. early adopters (13.5% of the staff) – Opinion Leaders
3. early majority (34% of the staff) – Deliberators
4. late majority (34% of the staff) – Skeptics
5. laggards (16% of the staff) – Traditionalists
Engagement Interventions by Adopter Category
• Innovators – willing to take risks and to try an innovation. Action: Don’t need to do anything for this population other than support their initiative.
• Early Adopters – opinion leaders who embrace change and don’t need to be convinced. Action:Give them the “how to” manuals and information sheets and turn them loose!
Engagement Interventions by Adopter Category
• Early Majority – they adopt change but need to see evidence that the change will work before adopting. Action: Share success stories and evidence of the change’s effectiveness in other organizations.
• Majority – skeptical of change and only adopt after the majority have. Action: Provide the facts on how many others have tried it and adopted it successfully.
• Laggards – traditional and conservative. Hardest to get on board. Action: Share stats and exert peer pressure from other adopter groups.
Table Exercise #2
• Think about your own hospital and your past experiences with change. Can you think of anyone who fits in the following categories?• Innovators?• Early adopters?• Early majority?• Late majority?• Laggards?
• How do you now plan to intervene and engage each type around your change?
Generational Intelligence
• By 2020 there will be 5 generations working together –Awareness is Key!
• Our newest generation has grown up in an environment relying on technology
• Two growing trends:• increased need to engage the entire workforce • increased use of new technologies to
communicate
Generational Differences
Generational Differences – Learning, Communication, Interacting
(https://www.slalom.com/thinking/adapting-to-the-multigenerational-workforce)
Generation Traditionalists Boomers Generation X MillennialsBirth Years 1925 – 1945 1946 - 1964 1965 - 1980 1981 – 1999Outlook Loyal Optimistic Skeptical CollaborativeWork is An obligation An exciting adventure A difficult challenge A means to an end;
fulfillmentChange is A revolution Managed Expected FluidTraining The hard way Too much and I’ll leave Required to keep me Continuous and
expectedLearning Style Classroom Facilitated Independent Collaborative and
networkedCommunications Top-down Guarded Hub and spoke Direct and openProblem Solving Hierarchical Horizontal Independent CollaborativeDecision Making Seeks approval Team informed Team included Team decidedLeadership Style Command and control Get out of the way Coach PartnerFeedback No news is good news Once per year Periodic On demand
The Baby Boomers (1945-1964)
• Recognize, respect, and show interest in their past experiences, work efforts and accomplishments.
• Employ face to face communication. Praise in public, discipline in private.
• Pair with younger generations on projects and consider how each could mentor from their positions of strength.
Generation X (1965-1979)
• Casual and comfortable relationships with those in positions of authority and will respect that position if competence in the role is evident.
• Be straight-forward, use a results-based approach to problems and show respect for their time.
• Present how situations will most benefit them.
The Millennials (1980-1994)
• Expectation is to advance based on their achievements and they often have a plan for their professional growth early on in their career.
• The best approach is positive and collaborative with respect for their achievements.
• They appreciate technologically impressive presentations and the ability to use technology for their work, project assignments and communication.
Generation Z or “the linksters” (1995-present)
• Called “linksters” because no other generation has been so linked to each other and to the world of technology
• Managing Generation Z:• They need a routine they can master• Fun and engagement to hold their attention• Frequent rewards • Immediate correction when needed
Benefits to Understanding the Generational Differences
• More effective communication and less misunderstandings
• Increased recruitment and employee retention• More effective motivational methods• Better formed expectations• Increased productivity and team work
Teamwork Climate and Patient Outcomes
The teamwork climate domain is an effective predictor of various adverse events and patient satisfaction at the
unit levelData from >40 hospitals
Source: Dr. Michael Leonard, Bryan Sexton.
Teamwork Climate Across Michigan ICUs
Attribution Bryan Sexton
A TEAM CULTURE IS RELATED TO . . .
. . . AND INCLUDES EMPLOYEE OUTCOMES
Nuggets From Staff on How to Engage, Spread and Sustain Change
• Everyone must be on board – not unique to the quality team or formal leadership.
• Change ideas must be staff driven – staff have to talk it up, take the lead and identify ways to change.
• Keep projects within scope of control and don’t overestimate the importance of quick wins.
• Hold each other accountable – not top down, but bottom up and from one peer to another.
Nuggets from Staff on How to Engage, Spread and Sustain Change
• Educate and communicate• 1 on 1 invite • Brand it – give it a face• Celebrate wins • Link to staff goals• Make it part of every
meeting (agenda item)• Put into performance
evaluations
• Part of orientation to unit• Part of new hire interviews• Keep it visible• Use communication board
and round to it daily• Develop connectedness
Q&A sessionsWebsite Facebook pageNewsletters
Hardwiring After Implementation
• Communication• Rewards and recognition, publicize benefits, etc.
• Infrastructure Change• Policies, hiring, orientation, job description• Assign ownership for maintenance of the new process
• Design an effective control system• Use internal quality resources to integrate new change• Plan to standardize the new change• Integrate with other initiatives (shared governance,
Lean, TeamSTEPPS)
In Summary - 8 Crucial Strategies for Change
(1) Develop a vision for change
(2) Focus on the change process
(3) Analyze which individuals in the organization must respond to the proposed change and what barriers exist
(4) Build partnerships between physicians and the administration
(5) Create a culture of continuous commitment to change
(6) Ensure that change is supported by leadership and includes everyone
(7) Ensure that change is well communicated
(8) Build in accountability for change Joint Commission Journal of Quality Improvement. 2000. Jul;26(7):388-99. Effecting and leading change in health care organizations. J. Edwin Wood Clinic, Pennsylvania Hospital, Philadelphia, USA
Change has a considerable psychological impact on the human mind.
To the fearful it is threatening because it means that things may get worse.
To the hopeful it is encouraging because things may get better.
To the confident it is inspiring because the challenge exists to make things better.
- King Whitney Jr
