Facilitating Change and the Concept of Spread

Content adapted for CMRI Collaboratives from materials developed by the Institute for Healthcare Improvement

The Role of the Collaborative Team

Make improvements in management of Surgical Site Infections in your facility

Spread the improvements to others

“Real improvement comes from changing systems, not changing

within systems.”

– Berwick

Spreading the Improvements to Others

Population for Spread

Target Population in your Aim Statement

- Other clinicians- Other units - Other clinics - Other hospitals

Spread Questions

Spread What?

Spread to Whom and Where?

When to Spread?

How to Spread?

Spread What?

Test of change

Successful change strategy, ready for implementation

Spread to Whom and/or Where? Other clinicians, i.e., surgical staff Other types of surgery Other departments of surgery Other hospitals

When to Spread

Spread change from pilot populations to the target population as successful intervention strategies are defined

Spread improvement to additional populations after success in the target population is demonstrated

How to Spread:Make the Case for Change

How to sway and motivate?

Show evidence supporting the changes (literature, experience)

Describe the benefits

Let your data (annotated run charts)“tell the story”

Organizational Approach: Facilitating Change Improving the management of the

surgical patients is a strategic initiative within the organization

Improvement team demonstrates success with the proposed changes

Executives (senior leaders) are supporting the changes and planning the spread

What You Can Do to Help with Adoption of Change

Help to make the case for change Make the “new way” easier Consider spheres of influence Develop your network–agents of

change champions messengers

Develop the Messengers

Remember to consider spheres of influence

Utilize your senior leader Choose the right messengers

Opinion leaders Connectors

Educate the messengers (to deliver the message)

Adopter Categorization (speed of adoption)

Early Adopte

rs

Early Majority

Late Majority

TraditionalistsInnovators

2.5% 13.5% 34% 34% 16%

Cultural changeSystem-wide

supports

Source:Everett Rogers, 1995

Active Resistance

Critical, demeaning comments Finding fault Selective use of facts Active sabotage Intimidation Distorting facts Spreading rumors

Passive Resistance

Verbal agreement, “yes-ing” and nodding

Playing dumb Withholding critical information Actions don’t support words Standing by and watching failure Portraying the “victim”

Peg Game Exercise

The Peg Exercise Consists of an exercise board of a “representative”

equilateral triangle with 15 circles within the exercise field Each circle is consecutively numbered from one (1) to 15 Marker (M&Ms) are placed on all but one position The goal is to jump a single, adjacent M&M along the path

lines indicated and to remove the jumped M&M (please do not eat them until the end)

The exercise is over when no more M&Ms can be jumped The desired finishing point is only one M&M remaining on

the exercise board

Please work quietly Each participant should note how many M&Ms you had left

on the exercise board at the end

The Peg Exercise

PlanAct

DoStudy

O b ject ive - test another approach to rem oving pe gs P redict ions - will we leave fewer pegs? P lan - who , wha t, record m oves

C arry ou t the p lan . R ecord m oves. N o te p rob lem s o r changes to p lan .

C om pare da ta to p red ic tions S um m arize w hat w as

lea rned . U pda te the team ’s

theory (approach).

D oes our approach leave 1 peg?

W hat new ideasshou ld w e test on thenext cyc le?

What are we trying toaccomplish?

How will we know that achange is an improvement?

What change can we make thatwill result in improvement?

Model for Improvement

Act Plan

Study Do

To Be Considered a PDSA Cycle:

The test or observation was planned (including a plan for collecting data).

The plan was attempted (do the plan). Time was set aside to analyze the data

and study the results. Action was rationally based on what

was learned.

Improvement Guide pp.60-61

PlanAct

DoStudy

Objective - test another approach to removing pegs Predictions - will we leave fewer pegs? Plan - who, what, record moves

Carry out the plan. Record moves. Note problems or changes to plan.

Compare data to predictions Summarize what was

learned. Update the team’s

theory (approach).

Does our approach leave 1 peg?

What new ideasshould we test on thenext cycle?

PDSA for the “PEG Exercise”

The Peg Exercise

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1

3

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“Change is disturbing when it is done to us. Change is exhilarating when it is done by us.”

– Rosebeth Kantor

“The definition of ‘insanity’ is continuing to do the same thing overand over again and expecting adifferent result.”

– Albert Einstein

Q & A

Please complete your evaluation.