Successful change management

When we fix the wrong thing for the wrong reason the same problems continue to surface. It’s costly and demoralising.
Brené Brown 2018

Change management is the complex process of turning policy or theory or interventions into practice.  It is the multiple steps required to take a good idea and turn it into action.  If the good idea is picked up or adopted by individuals and then used on a day-to-day basis it is said to be embedded.  If the good idea is then shared across other individuals, it is described as spread.  If the good idea sticks and people continue to be different as a result it is said to be sustained. 

Change management draws mainly from the disciplines of evidence-based medicine and implementation science, together with the diffusion of innovations, organisational development and behavioural change theories.  It is easy to have a change idea or design a device or write a guideline that should work if implemented.  The hard part is to take the idea, device or guidance and make it work well every time. 

Components of change management are raising awareness, gaining understanding, building engagement and then the process of dissemination, adoption, embedding, spread and sustainability.  It takes a long time, sometimes years to turn original research findings into practice and there is a significant sustainability failure rate of organisational change.  Therefore, we need to take our time to get it right and provide expertise and effort to achieve success.

Change management requires thoughtful action, and there is no easy way of doing it.  At every stage of the process people can and do get it wrong.  It needs dedicated resources, funding and time and a shift away from the short-term approach to a long-term view of change.  It is a unreal to think that an idea can be implemented through to sustained change in a short few months.  This is in part because change requires a culture shift; a culture whereby the embedded idea it still used even when people move on.  Making small incremental changes can make things easier, better, more effective and safer. The challenge is to convince people to change on a daily basis especially if they don’t see a significant and large change.  Visible outcomes are always great motivators whether you want to lose weight or reduce the number of falls or pressure ulcers.  Seeing the graph go down or the weight go off are a great way in which to convince people to continue. 

Change management, implementation science and safety-II have one key thing in common.  Those designing the interventions or guidance that they want to implement must be aware of the impact that they are making.  They must seek to understand work-as-done and get beneath the surface of what is going on every day.  Help people to notice the things they need.  Instead of prescribing steps people should be able to adapt and own the intervention or solution, fit the intervention within their team, unit or system.  Local contexts differ and as a result people need to vary their actions from place to place. 

Diffusion of innovations is the theory by Everett Rogers, on how, why and what rate new ideas are spread. Rogers proposes that there are five categories of adopters.

Key ingredients for implementation success

• Make it as easy and as intuitive as possible
• Demonstrate visibly with numbers, feelings, experiences that the change is better than status quo
• Deliver the message in person; using role models or opinion leaders to convince others of the need to change; people will implement changes that are liked by other people who do a similar job, and the people they respect
• Factor in the fact that people don’t have time
• Ensure the quality of the guidance associated with the idea or solution; do not produce a 100-page manual or rely on hours and hours of training
• Target the audience in design and help them own the change and choose things that they want to change because it improves their everyday and the activity of others
• Understand the receptive context; appreciate complexity of a problem or the context in which it is required
• Test it, adapt it, test it, adapt it and test it again to get everything to feel it fits – shift from the notion that something that works in another country, another organisation or even another team will automatically work for everyone
• Reward and recognise people for their actions, thank and value them for their contribution
• Invest resources dedicated to implementation including protected time for staff
• Leaders need to use a coaching style of leadership; if they simply try to solve the problems themselves then people will not own the outcome

Key lessons learnt from the EBC L&S approach to change management:

1. The importance of the ‘bottom-up’ QI approach involving multidisciplinary frontline staff from the beginning.
2. The Integration of the interventions with established unit norms and practices – ie local adaptation.
3. The importance of the core team leading the changes role modelling the desired communication structures and behaviours.
4. The high value of support and endorsement from senior leaders at unit and trust levels.
5. The importance of attending a range of departmental meetings and using multiple approaches to engage at different organisational levels.
6. Make it fun! Staff loved the cakes and T-shirts and overall the programme injected some much needed positivity.
7. Intrapartum band 7s are the most important staff group to engage – they are key to all of the interventions.

For more insights into what worked and didn’t work from one of our LDLs, see our Campaign Powerpoint (PPTX 359kb) and Programme Overview (PPTX 2.4mb).