roland valori consultant gastroenterologist november 2011 · roland valori consultant...
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The problem
• Even when there is clear, evidence-based guidance on how a
problem should be managed, there remains unacceptable variation
in care
• There may be resource or infrastructure constraints, but differences
in the rate and completeness of adoption account for most of the
observed variation
Adoption of change
Unconscious
Incompetence
Conscious
Incompetence
Unconscious
Competence
Conscious
Competence
‘Conscious Competence’ of accelerating
adoption of change
Recommended reading
• Effective Health Care; 1999:5(1)
• Berwick D, Disseminating Innovations in Health Care.
JAMA; 2003:1969-1975
• Grol R, Wensing M, Eccles M. Improving patient care. The
implementation of change in clinical practice. Elsevier.
Factors that influence the tipping point
• Perception of the guidance
• Characteristics of the adopters
• Contextual factors
Perception of the guidance
• Perceived benefit
• Compatibility with values, beliefs and needs
• Is it simple?
• Is it easy to test?
• Is it easy to observe others using it?
Laggards
Late majority
Early majority
Early adopters
Innovators
Uptake of
a change
in practice
Time
Characteristics of the adopters
100%
50%
0
Characteristics of the adopters
Laggards
Late majority
Early majority
Early adopters
Innovators
2.5% 13.5% 34% 34% 16%
mean -1SD -2SD +1SD
Time
Contextual factors
• Enabling organisations
• Prevailing culture
• State of readiness
• External levers
From prescription to description
• Identify your target audience
• Make the guidance easy to adopt
– written materials, web-based information, etc
• Invest in early adopters
• Make the early adopters ‘visible’
• Trust and enable re-invention
• Audit and feedback
Planning communications
• Describe the change:
– introducing guidance on ‘Optimal management of GI symptoms during
and after cancer treatments’
• Identify all the stakeholders
• Determine level of engagement or commitment required from each
– awareness, understanding, engagement, involvement and leading
• Define what communication techniques to use for who and when
Optimal management of GI symptoms during
and after cancer treatments
Stakeholder Awareness Understanding Engagement Involvement Leading
Oncologist +
Gastroenterologist +
Surgeon +
Macmillan nurse +
Pharmacist +
Ward manager +
Medical director +
GPs +
Hospice MD +
General manager +
Optimal management of GI symptoms during
and after cancer treatments
Level of engagement
Noticeboards
Interactive staff meetings
Letters Memos
Newsletters
Telephone
Clinical team meetings
Staff letters
Training needs analysis
Project team meetings
Technology
Face to Face Formats
Paper
Awareness Understanding Engagement Involvement Leading
Lev
el o
f en
gag
emen
t
Training
One to Ones
Website
Electronic dashboard
Patient feedback
Timing
support
Conscious competence of accelerating
change – where are you on this timeline?
unaware established practice
persuasion
UI
CI
UC
CC
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