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Copy of How to Change Education
Transcript of Copy of How to Change Education
Spread is a Better Idea Communicated in an intentional way to a Targeted Audience $upported by Structure & Leadership over Time with continued Learning for Success
Sustaining & Spreading
What does it take?
I'm Lost in the Weeds!
A Better Idea...
$upported by Structure
Spread is ...
How do we know when we are
ready to spread?
When we have:
Senior Leader Responsible
Agreed Upon Plan
Changes "rolled out" before their time waste resources, lack "sticking power", take more time with lots of rework and fail to reach maximum benefit
What do you mean by
Objective evidence that the "Better Idea" is working
What Do You Mean by "Organizational Will" ?
"Every day I come to work I feel like I'm sitting at the bottom of a waterfall. The stuff keeps coming and coming."
Should It Matter To Me That the Improvement Project is a Key Organizational Priority?
The Currency of Leadership is Attention
A Senior Leader is Responsible for Spread
Improvement plans are integrated in the overall strategic plan of the organization
There is an Agreed Upon Spread Plan
The work of Spread is to Build Will; Develop the Idea & Execute En Mass
Competing priorities & system complexity weaken the 'signal' to frontline and dilutes available resources
Different Audiences = Targeted Approaches
Customize the message and the method to the social systems targeted
Adaptable so it's Adoptable
What are the core "non negotiable parts" of the behavior? How you do them is up to you.
Package the Ideas/Behavior
How can we make it easy for the next area to understand what to do?
"Inputs" create "Outcomes"
(We think. Usually.)
Spend: Time, money, educate, show data, input technology...
Get: Buy IN
What Motivates Us?
Are Bribes Bad?
Checklists; process maps; tools; "go to" person; One pagers
Great leaders motivate staff mostly by way of their intrinsic drive for:
1. Autonomy – the desire to direct our own lives.
2. Mastery — the urge to get better and better at something that matters.
3. Purpose — the yearning to do what we do in the service of something larger than ourselves.
Do X, get Y as a reward!
Do A, get B as punishment.
Moving Adopters from Decision to Action
Supporting and Mentoring Adopters
Learn to tell the "Elevator Story" - Result, Who did what and why it is cool.
How Will They Know? Who Will Tell Them?
Train the messengers
Peer to Peer
Pose it and Pause
So What DOES it Take to Shape Behavior?
What is the Best Way to Tell the Message?
Communication is relational
Use both Formal & Informal channels
Multiple Methods for Maximum Uptake
Balance the benefits and barriers for each method
Promise, Tool & Bargain
The 'lived' Promise is more powerful than the verbal promise
The Tool must enable the promise
The Bargain is our group expectations
Spread happens best in an environment of permissive curiosity.
The Spread Unit Isn't a Place
It's a Social System
Address the Elephant in the room.
It Takes a TEAM!
Dedicated staff & resources for a period of time make the difference
Rebuilding starts with one willing person of influence
Of all the Improvement work, Leaders need to "own" spread
Channel Attention & Participation
Make the decision to channel attention to project reviews
Learn how to do a good project review
Data for learning is like opening a conversation... it tells an honest story and invites a constructive response.
System Drivers... Good or Evil?
The benefits of system drivers for system- wide improvement refocus on the patient ...
The drawbacks to system drivers are the competing focus, unrealistic timelines in a constrained complex system.
Limited Resources? STAGE IT!
Available TIME and PEOPLE are our greatest constraint.
Design a reporting process and assign regular accountability to spread activities
Measurement.. Keep Your Eye on the Goal!
Measurement is your lens to understanding how the spread process is working.
It is the cue which signals course adjustments.
Don't measure if you don't intend to act!
What Do We Measure?
Feedback is KEY to Learning
Adjusting tools, providing additional instruction, moving to another organization, mentoring.
Your People and Data Agree
Ask anyone at the local area
about the process & they will be able to tell you the steps and "this is the way we do it"
Four-Six levers of influence encompassing personal, social and structural motivation and skill
The Power of 1
Specific Behavior Vital to achieving the pilot site results - "What do you want me to do?"
What IS the Better Idea?
Reinertsonl Pugh & Nolan (2003) wrote an outline of a senior executive project review - checklist of specific activity
A staged spread approach to regional organizations allows the time needed for new areas to adapt the ideas, accelerates the
can shorten adoption
time on the back end.
For the BIG picture on Spread.. Ask...
Have all who need to know... heard?
Are all the core pieces being done every time?
Are the outcomes better in the new place?
How many more organizations need to adopt the behavior?
For the LOCAL picture on Spread
What is working, why?
How can we support you better?
What isn't working? What do you suggest?
No investment (or reform, or book, or website...) on its own can magically make Spreading Improvement work. Sorry!
Spread is easy to mess up.
It's hard to stay the course...
...& it's the nature of human work
to be complex and wiggly.
Is What Counts
Spend 20% of your time on the Spread Plan & 80% on getting out there to
learn what is working
change what is not!
Change Happens in Relationship
ay attention to the
arts of spreading innovation!
So... What Can I do?
Many people have opinions about that.
Sustaining & Spreading improvement is
a LOT of work!
Why should we make the investment?
How can it work better?
In response, the NHS did extensive research into what factors and activities support sustaining change
Summarize the core principles and ideas.
Here's what we know.
...in a structured, orderly way
...AND with depth
PriceWaterhouseCoopers surveyed 200 leading companies (Global)
total of 10,640 projects per year
Only 2.5% (254) delivered the desired business benefits
source Boosting Business Performance through programs and projects
33% of NHS projects revert within 1 year
The approach to change is a factor
Allowing time for developing a solid change, shortened implementation time
NHS studied the projects implemented over a 10 year period comparing successful projects with less successful projects
Greater benefits were realized with a well thought out and tested solution
The way we approach change and involve people determines our success in sustaining Lynne Mayer NHS
Your recent Engagement Survey supports the NHS experience with approx 1/3 supporting an innovation culture, 1/3 being neutral and 1/3 not engaged.
"The all -too-common consequences of
poor employee engagement
during the change progress, the reduced magnitude of the benefits achieved, drawn out time scales for their achievement and the
failure to sustain
them beyond the immediate implementation phase - should be compelling enough to encourage the adoption of a bold new approach"
Corven Consulting, 2005 to NHS
Approach to Change
"Roll out" is really "ROLL OVER"
Adoption must allow for Adaptation
We have been talking about what it takes to sustain
improvement work at a project level.
What about Spread?
How do we know we are ready to spread the innovation?
Constancy of Purpose
'Holding the gains and evolving as required NOT going back to the old way'
There is considerable evidence of high failure rate in projects sustaining their efforts (as much as 70%)
Daft and Nice, 2000
Within Fortune 100 companies success rates of projects reported to be between 20% & 50%
Sustaining at www.institute.nhs.uk
The NHS Sustainability Model consists of ten factors relating to process, staff and organisational issues that play a very important role in sustaining change in healthcare.
Leadership attention to the Improvement translates to staff prioritizing this into their work
If a project produces real results—i.e. sustained improvement of a breadth and depth that makes both patients and caregivers notice—it sends a signal that will be heard throughout the organization that quality improvement is not just a sidebar activity.
If, on the other hand, projects produce superficial results, or tepid results are over-praised, or those working in projects cannot connect them to overall organizational strategies, this also sends a signal—one that will hinder, rather than accelerate the transformation.
For these reasons, projects are key leverage points—high visibility moments—in the long-term transformation process.
Executive Review of Improvement Projects, Reinertsen, Pugh & Nolan, IHI Tool
Tanis Rollefstad, RN, BN, MACT Candidate
Safety & Improvement Advisor
Canadian Patient Safety Institute
Safer Healthcare Now!
How we engage people determines success in sustaining & spreading innovation
Most often the better idea is the "WHAT" not the "HOW"
Attributes of the Idea
(it is better than alternative)
(you can test it first)
(you can see it)
Compatibility with current values
(it’s simple to understand and do)
How far back in the process does the testing go? IE: Do we want the next unit retesting the idea?
testing for customization is about the HOW, as far as possible, keep the core elements of the WHAT standard. The main issue is making sure that the what is truly relevant in their context.
People will attempt to change behavior if
1. they believe it will be worth it ( motivation)
2 they can do what is required (Ability)
Q: How do I know where to spread first?
Go where there is interest, look at the motivation, history and leadership goals
Q: What do you do with those who jump the gun and start before we have done the “steps”
Consult, provide a platform for discussion and sharing, learn from them, share your learning, discuss the CORE elements (the what). Allow customization of the how.
Interior Health BC Pressure Ulcers Project
Core elements remain
The way we approach change & how we involve people are powerful antecedents of sustaining and adpoting new change.
Interior Health Pressure Ulcer Project
The Promise is the "why would I bother?"
The Tool is "how will you make it easy for me?"
The Bargain sets the rules of the road and is a function of the group not a single edict
"People pay attention to individuals who are viewed as knowledgeable about the issue & who are trustworthy"
"they know alot and have others' best interest in mind"
Spread team where local, middle & senior leaders are active members
Not just in the planning but in the executing too!
RQHR; Assiniboine Health Authority MB; Capital Health , NS; PEI Health Authority
Creative solutions for small regions
limited return to work positions
Avoid the Lone Ranger scenario!
Accelerating the Spread of Good Practice
Sarah Fraser, 2002
Short lead time
Don't know if it has been recieved or understood
Higher response rate
Need to know names
Good learning process
Time away from work
Inaccessible for some
Higher production costs
Sense of ownership&
Inaccessible to some
Long lead time
Limited is scope
James Reinertsen, MD
Leaders must make quality a core strategy of the organization. That's probably the most important barrier that must be addressed — a mindset change from "quality is the job of the quality department" to "quality is a core operational responsibility for every executive, every person."
Whose Job is It?
Dr. Bill Rupp, CEO of Luther Midelfort-Mayo
"I couldn't be personally responsible for directing specific projects... but I could make sure the teams working on these projects knew I was interested and expecting results."
Met monthly with project leaders
Scheduled "drop-in" for a few min
Problems? Is it Will, Ideas or Execution?
Author of 10 Powerful Ideas for Improving Patient Care
"When the music changes, so does the Dance!"
Adjust the spread plan based on feedback from the field and data on spread progress and measures.
Ask the locals and share that feedback with the spread team.
Take action to adjust your course.