Spreading Successful Changes CDI Prevention Collaborative Audio Conference Call September 21, 2011

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.