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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.