developing concepts of change & change packages
DESCRIPTION
Developing Concepts of Change & Change Packages. What about Change Concepts?. What are they? How can we use them to generate new change ideas when we encounter failure with our current ideas?. Theory of Change. Change Concepts. Specific Change Ideas. Ideas: 1 2 3 4 5 6 7 8 9 . - PowerPoint PPT PresentationTRANSCRIPT
Developing Concepts of Change
&
Change Packages
What about Change Concepts?
• What are they?
• How can we use them to generate new change ideas when we encounter failure with our current ideas?
Theory of ChangeChange
ConceptsSpecific Change
Ideas
Concept 1
Concept 2
Concept 4
Concept 3
Concept 5
Concept 6
Ideas:123456789........N
How we use change concepts?Incomplete list of change concepts
27. Give people access to information
Counsel patients on want to expect on Admission
Provide electronic patient progress board in surgical waiting area
Display patient safety data publically for patients, families and co-workers to see
Langley, et al.
Develop a radio program Integrate topic
in a local soap opera
Comprehensive list of concepts related to improving quality
Langley et al, The Improvement Guide
Break out
• Select 2 change ideas that are a apart of your current theory
• Review the list of Change Concepts to find which concept(s) relates to each idea
• Spend 2 min silently at your table brainstorming other ideas that could flow from that concept
• Share those in a round robin at your table – remember crazy ideas are encouraged later we can analyze them for feasibility
Comprehensive list of concepts related to improving quality
Langley et al, The Improvement Guide
Finally
• Select 1 idea you might like to develop into a change idea for testing using the Model for Improvement next week when you are back in the day to day of improvement
Developing Change Packages
What is a Change Package?
• A change package is simply a collection of change ideas that are known to produce the desired result on a process or system
Aim or Outcome
1⁰ driver 1
1⁰ driver 2
2⁰ driver 3
2⁰ driver 2
2⁰ driver 1
2⁰ driver 4
2⁰ driver 5
Concept 1
Concept 2
Concept 4
Concept 3
Concept 5
Concept 6
Ideas:123456789.........N
Theory informs testing and in turn testing refines theory
Repeated Use of the PDSA Cycle
Hunches Theories
Ideas
Changes That Result in
Improvement
A P
S D
APS
D
A P
S D
D SP A
DATA
Very Small Scale Test
Follow-up Tests
Wide-Scale Tests of Change
Implementation of Change
Improvement Guide, Chapter 7, p. 146
A P
S D
AP
SD
A P
S D
D S
P ADATA
A P
S D
AP
SD
A P
S D
D S
P ADATA
A P
S D
AP
SD
A P
S D
D S
P ADATA
A P
S D
AP
SD
A P
S D
D S
P ADATA
Changes That Result in Improvement
Hunches Theories Ideas
When to implement?
Current Situation Resistant Indifferent Ready
Low Confidence that change idea will lead to Improvement
Cost of failure large
Very Small Scale Test
Very Small Scale Test
Very Small Scale Test
Cost of failure small
Very Small Scale Test
Very Small Scale Test
Small Scale Test
High Confidence that change idea will lead to Improvement
Cost of failure large
Very Small Scale Test
Small Scale Test
Large Scale Test
Cost of failure small
Small Scale Test
Large Scale Test Implement
Staff Readiness to Make Change
Improvement Guide Pg 146
Break out
• Reviewing your Driver diagrams and PDSA trees
• Can you Identify which change ideas are ready for implementation and potential inclusion in a change package
Necessary components
• For any idea included in a change package you will need:– A description of what the change idea is (in what
way will the status quo look different after the change is made permanent, i.e. new process map, appended tool, etc.)
– A description of how to institute the change in a reliable way so that the change applies to all people working in the system and happens reliably for all patients moving through the system
What does it take to achieve sustained change?
• Standardization
• Documentation
• Training
• Measurement
• Resourcing
• Removing the old process/system
Improvement Guide Ch 8
Break out
• For the ideas you believe are ready to become the new status quo:
• Identify related processes that will need to change in order to accomplish permanence (i.e. budget, data collection/analysis, maintenance, professional development, resource allocation, etc.)
• Also note, who owns these related processes– How active have they been thus far in the improvement journey? – How will you engage them successfully going forward?
What theory do you have to make associated changes?
• What ideas does the team have about how to change associated processes and structures in order to create permanence?
• These, once tested successfully, will also need to be included in a comprehensive change package
Break out
• Finally, with your team, discuss how much time you think you will need to:
– Engage associated process owners
– Introduce through testing associated changes in non-clinical processes
• Summarize what your next steps are to begin this process for relevant/ready change ideas in your project