Change 101:  How To Achieve Change

According to Fast Company ("The Corporate Shrink"):  A culture can be changed.  Changing culture usually starts with leadership.

What Does It Take To Spread New Ideas?

According to the Institute for Healthcare Improvement's "Strategies for Spreading Improvements in Health Care Systems":

"Executive leaders have the ultimate responsibility for spread in the organization. During the initial phases of a spread effort, they ensure the topic is a key strategic initiative of the organization, align the goals and incentives of the organization with the topic, designate an executive sponsor for spread, and assign a day-to-day manager for spread. Once a spread strategy has been developed and is underway, leaders visibly support spread through written messages and presentations, review progress and address barriers, and make adjustments to the spread plan as needed."

The Malpractice Crisis:  What's Next?

Ronald P. Bangasser, M.D.

President-Elect

California Medical Association

The Breakfast Forum at UCLA

The Healthcare Collaborative at UCLA

March 6, 2003

Healthcare System Problems

• Doctors are seeing more patients/day and working more hours for less money
• Patient expectation has increased, as has patient disapppointment with outcomes

Current Results

• Increasing numbers of lawsuits filed
• Increased severity of judgments
• More lawsuits are settled to avoid risk with juries

What Happens?

• Those who can, quit early
• More doctors become angry and resentful
• Some physicians can no longer get coverage
• Delays in service increase due to fewer physicians practicing
• Patients complain and sue more

What Can We Do?  

Use physician education to help reduce patient complaints and reduce suits.

1-2-3 "How To" Strategy

1. Involve everyone.
   Everyone has thought.  Ask.

2. Demonstrate benefits.
   Clarify, clarify, clarify.

Talk to everyone involved in or affected by the proposed change.  

Clarify how the change will make each person's life better, easier, more interesting.

3. Implement slowly.
   Incremental change is good.

"How To" Resources

Critical Thinking:  allNurses.com Discussion

Journey Towards Safety:  A Cultural Revolution

"We found using "tests of change" provides some early successes that serve to motivate staff to push forward. Tests of change can best be described by trying a solution on a very small basis, i.e. one patient of one physician for one day. This allows the staff the opportunity to analyze the test, make adjustments and retest on a slightly larger scale."

Educational Techniques Used in Changing Provider Behavior

"Academic detailing"

Learning to Improve Complex Systems of Care

"Learning is most easily accomplished when lessons can be placed in a context and opportunities exist to apply the lessons learned."

Managing Change

"Major challenges to system success are often more behavioral than technical."

Directed Creativity

"Creative thinking for serious people."  --Paul Plesk and Associates.

80 Hour Work Week

A new challenge.

Crossing The Quality Chasm:  Appendix B 
Institute of Medicine (2001)

Think like a farmer.

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