Developing Concepts of Change

&

Change Packages

What about Change Concepts?

• What are they?

• How can we use them to generate new change ideas when we encounter failure with our current ideas?

Theory of ChangeChange

ConceptsSpecific Change

Ideas

Concept 1

Concept 2

Concept 4

Concept 3

Concept 5

Concept 6

Ideas:123456789........N

How we use change concepts?Incomplete list of change concepts

27. Give people access to information

Counsel patients on want to expect on Admission

Provide electronic patient progress board in surgical waiting area

Display patient safety data publically for patients, families and co-workers to see

Langley, et al.

Develop a radio program Integrate topic

in a local soap opera

Comprehensive list of concepts related to improving quality

Langley et al, The Improvement Guide

Break out

• Select 2 change ideas that are a apart of your current theory

• Review the list of Change Concepts to find which concept(s) relates to each idea

• Spend 2 min silently at your table brainstorming other ideas that could flow from that concept

• Share those in a round robin at your table – remember crazy ideas are encouraged later we can analyze them for feasibility

Comprehensive list of concepts related to improving quality

Langley et al, The Improvement Guide

Finally

• Select 1 idea you might like to develop into a change idea for testing using the Model for Improvement next week when you are back in the day to day of improvement

Developing Change Packages

What is a Change Package?

• A change package is simply a collection of change ideas that are known to produce the desired result on a process or system

Aim or Outcome

1⁰ driver 1

1⁰ driver 2

2⁰ driver 3

2⁰ driver 2

2⁰ driver 1

2⁰ driver 4

2⁰ driver 5

Concept 1

Concept 2

Concept 4

Concept 3

Concept 5

Concept 6

Ideas:123456789.........N

Theory informs testing and in turn testing refines theory

Repeated Use of the PDSA Cycle

Hunches Theories

Ideas

Changes That Result in

Improvement

A P

S D

APS

D

A P

S D

D SP A

DATA

Very Small Scale Test

Follow-up Tests

Wide-Scale Tests of Change

Implementation of Change

Improvement Guide, Chapter 7, p. 146

A P

S D

AP

SD

A P

S D

D S

P ADATA

A P

S D

AP

SD

A P

S D

D S

P ADATA

A P

S D

AP

SD

A P

S D

D S

P ADATA

A P

S D

AP

SD

A P

S D

D S

P ADATA

Changes That Result in Improvement

Hunches Theories Ideas

When to implement?

Current Situation Resistant Indifferent Ready

Low Confidence that change idea will lead to Improvement

Cost of failure large

Very Small Scale Test

Very Small Scale Test

Very Small Scale Test

Cost of failure small

Very Small Scale Test

Very Small Scale Test

Small Scale Test

High Confidence that change idea will lead to Improvement

Cost of failure large

Very Small Scale Test

Small Scale Test

Large Scale Test

Cost of failure small

Small Scale Test

Large Scale Test Implement

Staff Readiness to Make Change

Improvement Guide Pg 146

Break out

• Reviewing your Driver diagrams and PDSA trees

• Can you Identify which change ideas are ready for implementation and potential inclusion in a change package

Necessary components

• For any idea included in a change package you will need:– A description of what the change idea is (in what

way will the status quo look different after the change is made permanent, i.e. new process map, appended tool, etc.)

– A description of how to institute the change in a reliable way so that the change applies to all people working in the system and happens reliably for all patients moving through the system

What does it take to achieve sustained change?

• Standardization

• Documentation

• Training

• Measurement

• Resourcing

• Removing the old process/system

Improvement Guide Ch 8

Break out

• For the ideas you believe are ready to become the new status quo:

• Identify related processes that will need to change in order to accomplish permanence (i.e. budget, data collection/analysis, maintenance, professional development, resource allocation, etc.)

• Also note, who owns these related processes– How active have they been thus far in the improvement journey? – How will you engage them successfully going forward?

What theory do you have to make associated changes?

• What ideas does the team have about how to change associated processes and structures in order to create permanence?

• These, once tested successfully, will also need to be included in a comprehensive change package

Break out

• Finally, with your team, discuss how much time you think you will need to:

– Engage associated process owners

– Introduce through testing associated changes in non-clinical processes

• Summarize what your next steps are to begin this process for relevant/ready change ideas in your project