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

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

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

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  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 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:

  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

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

  22. 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

  23. 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

  24. 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

  25. 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

  26. 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

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

  28. * 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

  29. 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 if interested in more details.

  30. Change Calendar Snapshot

  31. 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

  32. 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

  33. 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

  34. Questions ?

  35. 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 Feb 26 2009 About the CPHQ Slides are posted at: