It’s a common occurrence: A change management project kicks off with high expectations and much anticipated success, but loses steam long before it can reach its conclusion. Project leaders are diverted. Stakeholders divide. Education falls by the wayside. The project finally limps through on its last legs, having become a minor achievement rather than the glorious solution it was intended to be. Sound familiar? Businesses everywhere face this issue, as do hospitals.
However, hospitals are in the business of healing, where a successful change management process is even more critical. Lives are at stake, especially in the NICU. What important steps are necessary to begin a path to change management success, and more importantly, manage risk? Although exceedingly condensed, the following five steps and suggested activities can help direct healthcare teams to their desired change management outcome from inception to adoption.
Step 1 | Culture and History: What Makes Your Healthcare Organization Unique
A commitment to a thorough change management process is vital when a neonatal intensive care unit participates in a large-scale protocol change. Hospitals will find that their current change management process hinges on a few cornerstones, but none so influential as the culture and history of their own organization. While many change management practices can be outlined from a reliable reference resource, clinicians should customize these practices with organizational character building. Ignoring these unique factors could undermine the project.
In “Change Management Approach to Achieve Healthcare IT Adoption,” author Ricky Arredondo says “Successful cultural change requires methods, techniques, strategy and implementation tactics be tailored to the particular history, culture and personalities of healthcare’s organization.”1 He defines it further with, “Prior to defining a Change Management strategy, understand the organization’s culture in terms of readiness and capability for change.”1
- Evaluate your hospital’s culture: Is it open to change? Is it ready for change?
- Consider your hospital’s history: How has change historically been received? Which efforts were successful? How did the organization respond to the success or failure?
Step 2 | Evaluate the Proposed Change: How Valuable is the Expected Impact?
Is the proposed change required? If not, is it a change which will positively impact patients, clinicians, or the hospital? Will it reduce cost, improve patient experience, or improve patient outcomes? A close examination is necessary to provide full transparency to value analysis teams and other stakeholders as to the reason for the change. Thorough preparation in this area can save a lot of time and will identify if the change is viable and/or valuable.
To provide a framework example for this step, consider the new ENFit enteral connectors now available on many enteral feeding devices. Reasons for the proposed change could take into account the ISO/AAMI recommendations, the Joint Commission stance on enteral connectors, and the ultimate impact to patient experience and outcomes. Include the positive results related to each reason for the change. In this way, a hospital unit can build a robust change management request.
- Identify the top three reasons (or more) for the proposed change
- Clearly outline the anticipated positive results related to each reason
- List any potential difficulties
Going back to the ENFit enteral connector example, the activity would begin something like this:
ISO and AAMI recommend transitioning to ENFit enteral connectors
- Positive impacts: Compliant with international small-bore connector safety recommendations / prevent dangerous misconnections / improve patient safety
- Difficulties: Adoption of new process, training time investment
Be sure to keep records of all research and substantiation to support reasons for adoption of the new product or process. It will be useful later for stakeholders and committees. Actively shape your vision as you compile this information into a persuasive, fact-based change management document.
Step 3 | Identify Tasks and Team: Assign Roles
Identifying leadership and stakeholders involved with the change management process enables a NICU to assign responsibility for project tasks moving forward. If a leadership plan is not established from the beginning, it risks floundering later when critical input or approvals are missed.
Now is the time to identify necessary tasks to obtain the change management approval. Include every possible step in a list. This in-depth breakdown will be a compass directing the team to next steps.
After the tasks list is complete, assign those tasks to the team members involved. Management tools such as a responsibility assignment matrix can help with this. One such tool is the RACI Method, a common Six Sigma task versus role diagram.2
RACI is an acronym:
Responsible: Responsible for completing the activity
Accountable: Accountable for the activity being completed
Consulted: Consulted for information and knowledge
Informed: Informed when steps are made
The RACI Method helps organizations to identify roles and responsibilities, which is especially crucial in a change management process. To enact this tool, create a new spreadsheet for your specific change management need. List the team members involved in the project across the top.
List the specific tasks and activities down the left side of the spreadsheet. Your chart should look something like this, although it will likely include more staff and activities as needed:
After you have completed those steps, begin assigning RACI to team members based on activities. Who will be responsible, accountable, consulted or informed for each? After completion, your chart may look similar to this:
Remember that change management will be unique to your team and your facility. Enter as many activities as needed, along with as many team members are required to complete them all. Accept that this charting process is fluid and may change during planning – it is perfectly fine to adapt as necessary all the way to the finish line.
Using a tool like RACI can help planning for team members involved, while visibly assigning roles and responsibilities. Be sure to share the RACI spreadsheet with each team member. It is a clear and direct way to keep everyone focused.
Don’t forget to include tasks relating to product or process partners. Assign a team member to handle the data gathering from these resources. They will need to acquire the following information: Will the product partner be available for the amount of time necessary to train effectively? What supporting materials can they bring to the table? Are there sufficient representatives to meet the needs of staff? Can they meet the needs of your patients? What will the long-term relationship look like?
Step 4 | Tactical Implementation: Create Actionable Steps
After all the planning, detail gathering and group presentations, change approval has hopefully been obtained. Now the project can move into the change adoption phase. It is a crucial time for attention to detail, not only for product adoption, but also the overall mindset of your department and team.
Be conscious of the team’s anxiety about change, which can be an insidious demotivator. Know that team members may feel overwhelmed by the project scale now that it is official, and at this point fear of failure is a real concern in their minds. Often this is a silent problem in change management that does not have a voice.
Be proactive and spell out actionable steps (tactical implementation) to offer a clear order to the adoption process. On a psychological scale, these mapped steps allow the team to mentally segment and compartmentalize a large product or process adoption into manageable, bite-size pieces. This alleviates stress and keeps the team focused, while allowing team leaders control over pace.
Create your tactical implementation chart (RACI can help here too):
- Place all activities in the order needed to occur for optimal success.
- Include columns for resources and support needed for each activity.
- Assign team members to activities.
- Touch base with the team often to verify activities are on track and in order.
- Document your observations as progression is made. If the change management project is something that will eventually impact other departments, your plan and comments here can become a valuable guidance document for them.
Step 5 | Implementing the Change: Communication and Education
Effective communication at this point is imperative. Hospitals, just like large businesses, must work with an infrastructure of multiple departments, stakeholders and individuals who will all process the change in their own way. To make this change management adoption a success, all of the impacted parties must participate in communications. Be prepared for challenges here, as the proposed change will impact habits and behaviors others have cultivated over time. This may hinder successful communication.
In her Inc. blog article, “10 Tips for Communicating Change,” Sarah Fenson hones in on a few communication aspects that can benefit this last stage adoption process:3
- Share information with employees as soon as possible
- Quantity is fine, but quality and consistency are crucial
- Use varied communication pathways and vehicles (redundancy and repetition are helpful)
- Don’t confuse process (visioning, chartering change teams, planning) with communication
Hand in hand with communication comes education. Make sure education staff is fully aware of new product or process details in order to successfully educate team members. Give them access to whatever information they may need to facilitate a smooth transition. The greatest risk resides in the change management process right here. A new healthcare practice or protocol can be compromised and the patient along with it without deliberate and successful education.
Prepare yourself for the communication and education challenge:
- Appoint a communication team from your department. This team will then be responsible for communications to other departments, such as purchasing or pharmacy, as well as product resources and more.
- Follow the communication aspects listed above. Be sure the communication team follows them also.
- Align the education and communication team. They will overlap and must remain consistent with messaging as they work with different people in the organization.
Change management is a daunting task all its own, made even larger by the risk involved when healthcare patients may be directly impacted. Despite this, a change for the better to improve the hospital and patient health is well worth it. Thorough planning, a united team and clear communication can help to ensure the entire experience is a win for everyone.
1. Arredondo, R. (2015, May). Change Management Approach to Achieve Healthcare IT Adoption (blog post). Retrieved from www.sierra-cedar.com
2. Viswanathan, V. (2015, April) Understanding Responsibility Assignment Matrix (RACI Matrix). Retrieved from www.project-management.com
3. Fenson, S. (2000, June). 10 Tips for Communicating Change. Inc. Retrieved from www.inc.com