Overcoming Resistance to Change Kelly  McCutcheon  Adams,  MSW,  LICSW  Director,  Institute  for  Healthcare  Improvement  

November 12, 2014

Thank you to the Leading Quality Improvement Faculty at IHI

! Jill Duncan ! Robert Lloyd ! Carol Haraden ! David Munch ! Jesse McCall

High-Impact Leadership Behaviors

Person-­‐centeredness   Be  consistently  person-­‐centered  in  word  and  deed.      

Front  Line  Engagement   Be  a  regular,  authen7c  presence  at  the  front  line  and  a  visible  champion  of  improvement.  

Relentless  Focus   Remain  focused  on  the  vision  and  strategy.    

Transparency   Require  transparency  about  results,  progress,  aims,  and  defects.      

Boundarilessness   Encourage  and  prac7ce  systems  thinking  and  collabora7on  across  boundaries.    

Swensen S, Pugh M, McMullan C, Kabcenell A. High-Impact Leadership: Improve Care, Improve the Health of Populations, and Reduce Costs. IHI White Paper.

Cambridge, Massachusetts: Institute for Healthcare Improvement; 2013. (Available at ihi.org)

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Danish Moments ! Even if you do not consider yourself to be in a formal

leadership role, how do these behaviors apply to you? ! When are you called upon to be a leader?

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What  are  we  trying  to  accomplish?  

How  will  we  know  that  a  change  is  an  improvement?  

What  changes  can  we  make  that  will  result  in  improvement?  

                       The  Model  for  Improvement  

Act   Plan  

Study   Do  Source:  

Langley,  et  al.  The  Improvement  Guide,  1996.  

The  three  quesKons  provide  the  

strategy  

The  PDSA  cycle  provides  the  tacKcal  approach  to  tesKng  ideas  

   

“Everyone in healthcare really has two jobs when they come to work every day:

to do their work and to improve it.”

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Dr.  Paul  Batalden  Senior  Fellow,  IHI  

Overcoming Resistance to Change

! Meet people where they are!

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Rogers’ Adopter Categories

Rogers, E. M. (2003). Diffusion of innovations. New York, Free Press.

‘Traditionalists’

Early Adopters

Early Majority

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Late Majority 11

Laggards/Traditionalists 12

Matching Activities to Key Adopter Categories Early adopters ! Search for successful sites (“Found Pilots”) ! Create pull through communication ! Change agents need a plan for sites that come forward ! Focus on influencers as messengers ! Invest resources initially with the early adopters ! Make the work of early adopters observable

Early majority ! Allow for peer-to-peer contact with early adopters ! Communicate local successes

Late majority ! Peer pressure is necessary ! Communicate adoption of the changes is inevitable

Danish Moment ! Using Rogers’ Adopter Categories, what is an area of

your life where you are an early adopter and what is an area of your life where you are a laggard/traditionalist?

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