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Change That Lasts

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Here's how to keep process improvements from becoming the "initiative of the week."

Process improvement initiatives have been known to garner less-than-enthusiastic employee support—healthcare workers often view them as one more thing they are responsible for in an already stressful environment. Since becoming the head of business transformation at Boston's Beth Israel Deaconess Medical Center four years ago, Alice Lee has learned her share of lessons when it comes to driving change. Chief among those lessons, Lee says, is that having a sustainable strategy involves more than just telling employees to "keep this up."

How can healthcare organizations foster long-term support of improvement programs? Here are four lessons to keep your initiatives on track.

Avoid "fly-by improvements." This means executives can't task an employee with fixing something and then never to be heard from again, Lee says. Leaders' involvement shouldn't end with a simple appearance on "the shop floor," she adds.

Senior leaders have four key roles in sustaining change, says Pete Knox, executive vice president of Bellin Health, an integrated delivery system in Green Bay, WI:

  • Act as an administrative champion. Executives should be removing barriers and helping facilitate the work.
  • Be a team member. Senior leaders—including the CEO—need to work alongside physicians and other employees on process improvement teams.
  • Develop infrastructure. Executives should be constantly evaluating and building better measurement systems, creating more knowledge about process improvement initi tives, and communicating the strategic plan.
  • Manage organizational energy. Senior leadership must allocate limited resources effectively. For example, Bellin Health hired seven additional FTEs in its IT department two years ago after experiencing repeated bottlenecks with its IT resources. "We felt there could be a huge return on that investment," Knox says.

Have a defined sustainment strategy. For example, organizations can use audit sheets, checklists, formal communication, or rotate tasks so everyone understands an initiative's importance. "It doesn't matter which one you pick, but you need to plan for the sustainability component," says Lee. "For every one week of improvement work, you need to do eight to 10 times that to sustain it."

Start with a crowd pleaser. When Lee was tasked with improving a medical-surgical unit where stressed hospital employees were working long hours, she noticed how much time nurses, physicians, therapists, and other workers wasted looking for something in the supply room only to come out empty handed. Lee and her team worked with staff on the floor and co-located items that went together, created a physician supply cart, and labeled everything with a picture, official name, and nicknames. To maintain the newly organized supply room, nurse managers have a very simple audit sheet. At a glance, they can write down items that are overstocked, empty, or low and communicate that to the stocker.

Create staff champions. Lee says nurses who were involved in the supply project now go to other units as teachers. They are recognized for their accomplishments and viewed as leaders, she says.

Carrie Vaughan

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