spreading successful changes cdi prevention collaborative audio conference call september 21, 2011
TRANSCRIPT
Spreading Successful Changes
CDI Prevention Collaborative
Audio Conference Call
September 21, 2011www.macoalition.org
C. Difficile Prevention Collaborative Agenda
Introductions & Upcoming events
Spreading changes: Tales from the trenches
Spreading Change: principles and process
Susanne Salem-Schatz, Sc.D.
Collaborative Director
Deb Hylander, MSN, RN, CIC, COHN-S
Director of Infection Prevention
Southcoast Hospitals Group
Jane Taylor, D.Ed.
Improvement Advisor
St. Paul, Minnesota
Spreading Change
Adapted from IHI’s IMPACT Collaborative Spread Presentation
Jane Taylor, Ed.D.August 2011
Spread
• To other units in hospital• To other hospitals in system• To other hospitals in community for greater
good • To other cross continuum members
Spread: why & how do ideas spread• Roger’s Diffusion Characteristics:
– See it– Try it– Is it:
• Compatible?• Easy to use?• Better?
– What supported it? Hindered it?
The Total Health Care System
Cycles for testing and
implementation
What is Spread?
P
D
A
SP
D
A
S
P
D
A
S
P
D
A
S
P
D
A
S
Set-upSuccess-ful Sites Socia
l Syste
m
Social
System
Better Ideas
Communication Strategies
Knowledge Management
Measurement and Feedback
Leadership
A Framework for Spread
Spread
Leadership:
It takes a village to prevent HAIAnd LeadershipExperience with ChangesWilling receiversAccountability
Better ideas:What are your best ideas,
ready for spread?What has already spread?
Choosing “Better Ideas”
Attributes Affecting Rate of Adoption
• Relative advantage (evidence from testing)• Compatibility with current system (structure,
values, practices)• Simplicity of the change and transition• Testability of the change• Ability to observe the change and its impact
Spread ExerciseChoose one specific change (not just a vague concept) from your improvement
work. Evaluate this change on the five attributes. Rate the change from a “spread
target” point of view (not your point of view!). Use a 1- 5 scale:1 - change is very weak relative to this attribute 3 - change is okay relative to this attribute5 - change is very strong relative to this attribute
• Relative advantage• Compatibility with current system • Simplicity• Testability of the change• Ability to observe the change and its impact
Total the evaluations for each of the attributes
What does the score mean?• How easy will it be to spread the change:
25 = it will spread like wild fire5 = no chance of spreading in present form
• Which attributes would you work on to increase the chance of spread? How?
Now to theory
Set-up
Questions to ConsiderTarget population:• What changes do you plan to spread and to whom?
Adopter audience:• Who makes the adoption decisions for the
improvements you plan to spread?• Will adoption be voluntary for units, staff, providers?
Questions
Do you need to tailor your message to specific adopter groups: patients, families, clinicians, providers, community, cross continuum partners, others? Does health literacy play a role or influence your communication strategy?
Key partners:•Do you have sufficient physician involvement?•Have you identified partners and/or thought leaders in the target areas?•Family and patients on team?
Social System
Late Majority
Early Majority
Early Adopters
Innovators
Types of Adopters
2% 13% 35% 35% 15%
Traditionalists
The “Tipping Point” “The name given to that one dramatic moment in an epidemic when everything can change all at once.”
- M. Gladwell
“The part of the diffusion curve from about 10 percent to 20 percent adoption is the heart of the diffusion process. After that point, it is often impossible to stop the further diffusion of a new idea, even if one wished to do so.”
- E. Rogers
Tipping
point
Key Messengers
• Decision makers• Thought leaders• Innovators / early adopters• Communities of practice / work groups
Adapted from Ashkenas, 1995
SHAREINFORMATION
SHAPE BEHAVIOUR
GeneralPublicationsflyersnewslettersvideosarticlesposters
PersonalTouchletterscardspostcards
InteractiveActivitiestelephoneemailvisitsseminarslearning setsmodeling
Face-to-faceone-to-onementoringsecondingshadowing
Ways to Communicate
(C) 2001, Sarah W. Fraser
PublicEventsRoad showsFairsConferencesExhibitionsMass meetings
Measurement and Feedback
Measurement and FeedbackData collection• Outcome and/or process measures• Progress of spread of specific ideasReporting• Evidence of progress / success• Two-way communication with senior leaders,
families, staff, community:– Progress reports to senior leaders & others– Senior leaders seek, hear and use feedback
Outcome Measurement over Time
Tracking Spread Progress
Tracking Spread Progress
Tracking Spread Progress
Knowledge Management
Managing Knowledge to Enable Spread
• Make the case for the new system– The reasons people would want to make the changes
• Describe the new system – “What is being spread”– The concepts and ideas that form the content of the new system
• Transition materials– Specific methods, tools, examples, and documents to assist people
in adopting the content
• Technical Support – Where people can go with questions regarding the changes
Leadership Requirements for Spread
• Topic is a key strategic initiative• Goals and incentives aligned• Executive sponsor assigned• Day-to-day managers or designated
responsibility identified
Topic is a Key Strategic Initiative• Topic is included in strategic aims and plans of
practice or health center• Leader(s) frequently reinforce the need to close the
gap• Senior executive(s):
– Provide progress reports to the Board or Community– Calendar regular attention to the spread work
Goals and Incentives are Aligned• Assure appropriate resources are assigned and
engaged• Recommend alignment of incentives sufficient
to motivate leaders and new adopters
Day to Day Responsibility Identified
• Manager, staff, physicians may lie outside the original collaborative team
• Assign great performers• Make it an important part of their regular
jobs, not added work
Summing it Up: Managing Spread
• Create plan– Completeness vs. coverage -all changes vs key changes
• Set schedule• Anticipate needed support services
– IT– Case management/community liaison– Technical expertise
• Eliminate barriers– Accessible knowledge
• Measurement and feedback
Spread Strategy Matrix
May June July Aug Sept
Jones ABCD+
Gutierrez A B C D
Wong A B C D
Krey C A B D
West Clinic AB
A= Isolation technique B=Hand cleaning C= xzy. D=abc
Set-up• Target population • Adopter audience• Key partners
A Framework for Spread
Social System• Adopter types• Key messengers
Communication Strategies
Knowledge Management
Measurement and Feedback
Leadership• Topic is a key strategic initiative
• Goals and incentives aligned• Executive sponsor assigned
• Day-to-day managers identified
Better Ideas
• Successful tests• Positive attributes
References
Attewell, P. Technology Diffusion and Organizational Learning, Organizational Science, February, 1992
Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, N.J.: Prentice Hall, Inc. 1986.
Brown J., Duguid P. The Social Life of Information. Boston: Harvard Business School Press, 2000.
Cool et al. Diffusion of Information Within Organizations: Electronic Switching in the Bell System, 1971 –1982, Organization Science, Vol.8, No. 5, September - October 1997.
Dixon, N. Common Knowledge. Boston: Harvard Business School Press, 2000.Fraser S. Spreading good practice; how to prepare the ground, Health Management, June
2000.Gladwell, M. The Tipping Point. Boston: Little, Brown and Company, 2000.Kreitner, R. and Kinicki, A. Organizational Behavior (2nd ed.) Homewood, Il:Irwin ,1978.
Upcoming Opportunities
Partnership CDI Prevention Collaborative for Acute Care Hospitals and Long Term Care Facilities
November 15th Learning Session: Westborough
Final reports and follow up calls.