Recently I have been asked to help provide advice on implementation for a few patient safety projects which made me revisit my previous research in 2008. Its always interesting to review the knowledge you had at the time and compare with the knowledge you now have. Mixing the two here are six tips for implementation that might help:
1. Demonstrate that the change is better than status quo
This remains highly relevant. If all is ok then why change? We can be a bit like that with even our personal stuff. If the fridge freezer works why change, even though I know there are some amazing super new fridge freezers on the market! So the change has to either replace something that isn’t working or have clear and tangible benefits on the existing way of doing things.
2. Try and make the change as easy as possible to do
This is a bit of a conundrum. I think it does need to be easy but at the same time, doing something difficult well is incredibly rewarding. I think the main thing is not to over complicate it. So don’t produce the 100 page manual that is a nightmare to understand or follow or create something that requires on-going and intense hours of training. The behavioural insights world has a lot to offer in this respect. http://www.behaviouralinsights.co.uk
3. Adapt the change to local conditions – use the 80/20 rule
I have slightly changed my thinking on this. I used to think that organisations or people need to completely adapt something to make it theirs and to own it. This way they would be invested in it and want it to work more. However, too much adapting means that simple interventions across the country or similar documentation for things like prescribing are all a bit different as you go round the country. This is sort of ok if no one moves but with a workforce that is highly transitory then this becomes an issue. The key is to standardise what you can, stay true to the core of what ever it is you are adopting and then only adapt say 20% of it to fit with your environment. And maybe think again when you want to change the name of something – I came across a team who had decided to call huddles ‘cuddles’ – confused the hell out of everyone who worked there!
4. See who you can get on board to help ‘champion’
If you respect and like someone you pay attention to what they say and what they do. This is a human trait. So if someone you like and respect at work thinks the ‘change’ would be a good thing to try and the added bonus is that they have actually done it themselves then you are more likely to do the same. This is what people refer to as peer to peer influence or the use of opinion leaders or role models.
5. Carefully use intrinsic and extrinsic motivators
Intrinsic motivation is defined as performing an action or behaviour because you enjoy the activity itself. It is an internal form of motivation. People strive towards a goal for personal satisfaction or accomplishment. The inspiration for acting on intrinsic motivation can be found in the action. Whereas acting on extrinsic motivation is done for the sake of some external outcome or pressure, itself. Extrinsic motivation can be another person, or some outside demand, obligation, or even reward that requires the achievement of a particular goal. Think carefully about these when you are developing your implementation plans.
6. Major on reward and recognition
Linked to intrinsic and extrinsic motivators is that of reward and recognition. If people are recognised for their actions, thanked and valued for their contribution to safer care they will feel great. Others will see that they feel great and want to feel that way too. This can mean anything from shining a light on someone’s achievement to sharing their work in a journal or a blog, to giving people awards. But a ‘thank you’ goes a very long way.
Before I go… just a few things that get in the way of success:
- Relying on training as the way to get people to change
- Simply sending out stuff – dissemination of alerts or guidance with no support expecting people to notice
- Punishment for poor compliance
- Devising the wrong solution that doesn’t actually address the particular problem that needs addressing
- The sheer number of ‘top down’ articles, policy documents, guidance, interventions published daily – coming from all different directions including within your own organisation– trying to figure out which are the ones to pay attention to and which are the ones to ignore
As I have said before …. if we do ‘one thing’ it is for the ‘problem of implementation’ to be owned by the guidance developers, solution designers and researchers. The people tasked with developing something for others to use or to action. This means when planning it all out, spend as much time on implementation as innovation and improvement.
All of this could increase the chances of sustained change.
Patient Safety Now 