1. Select a high functioning department. When developing an implementation strategy, selecting a unit that has history of high performance, leadership, energy, enthusiasm and ability to champion innovative ideas enhances likelihood of achieving and sustaining change. The team will likely be engaged, motivated, and empowered.
2. Engage front-line staff. Involve staff who will be directly affected by the change process, providing them with an opportunity to build ownership and support for the outcome. Strategically select individuals based on their level of experience, readiness to learn, ability to lead or mentor, and openness to change.
Hint: According to the Institute for Healthcare Improvement, experts in Lean management believe that sustainability of new, improved processes depends on participant’s belief in the process. Staff who are highly engaged demonstrate motivation and buy-in, converting skeptics into believers and champions of new ideas.
3. Establish a multidisciplinary team. A team consisting of clinical and non-clinical staff, experts from other disciplines, individuals involved in similar change initiatives and patient participants enhances collaboration, shared learning, broader understanding and facility-wide commitment. Keep in mind that groups of 7-9 participants provide optimal opportunity for active dialogue and meaningful input; the multi-faceted strategy may potentially involve large number of stakeholders. Not all stakeholders need to be engaged at the same time or in the same manner and can for example, be involved in planning educational material, communication, or consultation.
4. Determine leadership. An executive sponsor, team leader and facilitator are essential to keep the team focused, remove roadblocks, and ensure team progress. The sponsor is responsible for removing obstacles or roadblocks while providing global focus, organizational support and encouraging risk taking and creativity. The team leader and facilitator work as a team sharing the responsibility of keeping the team focused, energized, engaged and productive.
Hint: Experts in Lean management believe the success of the working group is dependent on the staff’s action-oriented participation as well as a receptive organizational culture that embraces active participation at the grass roots level and orchestrates effective executive support with ability to relinquish control.
5. Prepare the participants. Team members should be provided adequate information regarding the group’s focus, intent, anticipated outcomes, duration of involvement as well as the rationale for being selected to participate and expectations for active involvement. Participants will benefit from educational material and related journal articles and these should be available prior to the working group sessions. Providing participants with specific details related to meeting dates and monetary compensation for involvement will enhance their motivation and commitment.
6. Select coaches for implementation. Once the working group has designed the bedside reporting process, staff will be needed to coach and facilitate roll-out of education to front-line staff regarding the process change. Staff should be strategically selected to ensure a mentoring and supportive learning environment is maintained. A coaching plan should include training and support sessions for coaches along with an educational package for staff. A predetermined coaching roster, assigning specific dates and staff, is helpful to ensure there is contact with all staff on the various shifts. A coaching package is available in the resource section of this blog.
Hint: develop a coaching strategy
for casual, relief, and float staff.
The medical unit had a history of high performance and overall creative, engaged and responsive team members. The team was dedicated to maintaining high quality of patient care and patient satisfaction scores substantiated this quality. The current method of taped shift handover had been well established for many years and generally accepted as adequate. Recent events led to some staff identifying concerns with the taped report and began advocating for alternate methods for shift handover, such as bedside reporting. Other staff was ambivalent, uncertain, disinterested or opposed.
Based on leadership abilities, experience, motivation and readiness to learn, a team of individuals was selected to participate on a working group to develop a bedside reporting process specific for their unit. Time was spent with each individual to explain goal and purpose of the group, rationale, expectations, duration of involvement, and to allow opportunity for open discussion of ideas and concerns. Each participant was given an educational package, including related articles, scheduling details and a letter of appreciation. A manager, executive sponsor and team leader were selected to facilitate group work and provide appropriate leadership support.
