Creating a Culture of Change: Implementing a Successful Healthcare Improvement Project

Previously, I covered 5 rules for planning a winning healthcare improvement project. Now that the planning is done, it is time to move into a long-anticipated implementation (aka “LET’S DO IT!”) phase.  Whether you are implementing improvements to an existing process or piloting a new product, process or service, you are asking people to CHANGE. The success of your project is tied to your ability to manage change.

There are many change management frameworks. Over the last 10 years, I led and advised hundreds of small and large-scale healthcare improvement projects, and I consistently used the Eight Step Process for the Successful Change by John Kotter. Kotter developed this framework to guide businesses in their large-scale transformation efforts. In this blog post, I will discuss how Kotter’s Eight Step Process is applicable to healthcare improvement projects, so you can successfully implement them.

Step #1: Create a sense of urgency.

The healthcare industry has the most intelligent and driven workers, both clinical and non-clinical, who dedicate their lives to helping others. You must clearly communicate to them WHY the change is urgently needed for the benefit of their patients, hospital or community, and appeal to their minds, hearts and competitive nature.

For example, if you are focusing your healthcare improvement project on decreasing hospital-associated infections (HAI) you may share your hospital’s HAI rates against national benchmarks, or their impact on hospital bottom line to appeal to minds. Data is great for understanding the problem and setting up goals, but frequently it is not enough to move people to action. You must appeal to their hearts by sharing stories of real patients whose lives were impacted by preventable HAI. Leverage clinicians’ competitive nature by using provider-specific HAI rates as compared to their peers to spark discussion.

If you skip the first step of creating a sense of urgency, your project is guaranteed to fail.

Step #2. Pull together the guiding team.

Previously, I discussed building the right team to lead the project. Your team should represent all major stakeholders and include senior executives as well as front-line staff. Look for people with the relevant knowledge and experience who are respected by their peers and can influence their opinion.

Step #3.  Develop the change vision and strategy.

You must be crystal clear on what you are trying to accomplish and how you plan to get there. Set up SMART (Specific, Measurable, Achievable, Relevant and Time-bound) goals for your project and clearly outline your solution. If your project involves front-line clinical staff, I strongly recommend estimating the impact of your project on their daily workload (e.g., additional time per patient). Front-line clinical staff functions in a fast-paced, high-stress, unpredictable environment and even a small change can feel overwhelming. If an estimated impact is significant, you need to discuss adding resources, negotiating trade-offs or offering incentives to proactively manage resistance to change.

Step #4. Communicate for understanding and buy in.

No project ever failed due to over-communication, but the opposite is true. Communicate often using all available channels – in-person meetings, intranet, emails and printed materials. Have a clear and consistent message and involve your entire team in spreading it to different levels of your organization. You need to make sure that as many people as possible embrace WHY improvements are necessary and understand HOW they will be accomplished. Be ready and available to answer question and address concerns.

Step #5. Empower others to act.

You should expect and plan for things to go wrong in the early implementation phase, as technology may fail, and people tend to get sidetracked. Proactively identify and address issues before they become barriers to successful implementation and empower your staff to come up with alternative solutions to put your project back on track.

Step # 6. Produce short-term wins.

Many new projects that met with initial excitement go off-track because attention fades or competing priorities take over. It may take 6 or more months to see the full impact of your project, but if you wait that long to evaluate and share results, you will lose a momentum. The best way to keep your project on the forefront is to show short-term wins. Do not leave those wins to chance – start your project with the most engaged hospital unit or a group of providers to increase your odds of early positive results and consider other ways to determine an impact in the interim.

For example, you may look for real stories of patients positively impacted by your solution. Those stories can be more meaningful to your staff than a “statistically significant improvement”.

Step #7. Don’t let up.

As your project moves forward, it is easy to relax if your project is showing early positive improvements, or to get discouraged if early results are below your expectations. My advice is not to let up or give up – continue to evaluate impact, remove barriers, refine your solution to get back on track if needed and constantly COMMUNICATE to share ongoing project results and lessons learned.

Step #8. Create a new culture.

Whether your project achieves the set goals or not, you will learn valuable lessons along the way. Openly share both positive and negative results and lessons learned with as many people as possible to foster open knowledge exchange that will augment organizational performance management expertise and inspire more successful healthcare improvements projects.

Successful healthcare improvements require a disciplined approach to developing, planning and implementing solutions that consider lessons learned from prior organizational successes and failures. By incorporating these steps into your project implementation, you will ensure a higher likelihood of success, and avoid the pitfalls that many organizations forget to plan for.

Want to discuss planning and implementing your next winning healthcare improvement project? Contact me if you have questions or want information about my services.

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