Click to edit Master title style
WHA’s Learning Series:
QI 100 for Health Care Clinicians
Unit 3: Holding the Gains
Aligning Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to the
Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning Forces for Quality is a joint project by the
Wisconsin Collaborative for Healthcare
Quality, the Wisconsin Hospital Association, and other organizations.
Disclaimer information here…
Click
QI
100
toRules
edit Master
of Engagement
title style
Please read carefully:
1. This powerpoint must be in “Slide Show” mode in order for all links to be active
(see the Slide Show menu at the top of your screen).
2. You must complete this unit in one sitting. You will not be able to exit and re-enter
from where you left off.
3. This unit has three exercises and a five question quiz at the end. You must
complete the quiz to get credit for Unit 3. You will be asked to enter your name.
4. CEU’s will be awarded after you have taken all five units and completed the
Capstone Quiz – a link to this quiz is given in Unit 5.
5. The content provided in this unit is for educational purposes only and is not to be
interpreted as an endorsement by WHA or any of it’s member or partner
organizations.
6. This learning series is supported by the Aligning Forces for Quality grant. Aligning
Forces for Quality is supported by the Robert Wood Johnson Foundation, through a grant to
the Wisconsin Collaborative for Healthcare Quality. In Wisconsin, Aligning Forces for Quality
is a joint project by the Wisconsin Collaborative for Healthcare Quality, the Wisconsin
Hospital Association, and other organizations.
7. If you have questions or problems please e-mail: ssobczak@wha.org
Disclaimer information here…
2
Click
QI
Unit
to Progression
edit Master title style
Unit 1
• Why Quality Matters
Unit 2
• Participating in Improvement
Unit 3
• Holding the Gains
Unit 4
• Health Care Change Systems
Unit 5
• Capstone & Credit
Disclaimer information here…
3
Click to edit Master
Introduction
to Unittitle
3 style
You are about to participate in the QI 100 Unit 3
Holding the Gains
After completing this unit, you will be able to:
• Understand the dynamics of change.
• Learn why some change efforts don’t “stick”.
• Understand the components of work in health care impacted by
change.
• Understand the importance of trend in process measurement.
• Learn about control charts to track variation.
• Understand how to help others that may be struggling with change.
Disclaimer information here…
4
Click to edit
Getting
Credit
Master
for Unit
title3 style
• When you see a light bulb icon, you can access a brief
exercise to reinforce the concept. Simply click on the
light bulb.
• When you see a screen icon, you should access a quiz
to test your knowledge. Simply click on the question
mark.
• When you are done with an exercise simply close the
page by clicking the X or
at the top of the page.
• In order to officially participate in this unit, and receive
continuing education credit, you need to complete the
Unit 3 quiz.
Disclaimer information here…
5
Click to edit change
Continuous
Master in
title
health
stylecare
Have you noticed frequent change at your workplace?
New technology
Software Updates
Changing procedures
Changing requirements
“More with less”
Cost reductions
Zero adverse events
Reporting requirements
Disclaimer information here…
6
Clickimpact
The
to editof
Master
change
title
onstyle
work
Procedures
IT Systems
Processes
Reports &
Data
Budgets
Change
Job Roles
Documentation
Job
Descriptions
Patient
Experience
Disclaimer information here…
When considering a
change, it is a good idea to
systematically consider all
the components of work
that may be impacted by
the change.
Each of these must be
addressed to reduce the
potential for things to “go
back” to they way they used
to be once a change is
implemented.
7
Click people
Why
to edit Master
may resist
titlechange
style
These are some examples about how someone may,
unconsciously or consciously, react to a change. Have
you seen any of these in others?
1. The risk of change is seen as greater than the risk of not
changing.
2. People feel connected to other people who are identified
with the old way.
3. People have no role models for the new process.
4. People fear they lack the competence to change.
5. People feel overloaded and overwhelmed.
6. People really feel the change is a bad idea.
Disclaimer information
Disclaimer
informationhere…
here…
8
Your
– how totitle
react
to change?
Clickdecision
to edit Master
style
Identify your reaction to change. How you react is your decision.
Which decision-making style best describes you?
Analytical Style
Technical, logical, careful, methodical, needs
much data, likes order, enjoys problemsolving, enjoys structure, enjoys scientific
study, and enjoys working alone.
Behavioral Style
Supportive of others, empathetic, wants
affiliation, nurtures others, communicates
easily, uses instinct, avoids stress, avoids
conflict, relies on feelings instead of data, and
enjoys team/group efforts.
Disclaimer information
Disclaimer
informationhere…
here…
Conceptual Style
Creative and artistic, future oriented, likes to
brainstorm, wants independence, uses
judgment, optimistic, uses ideas vs. data,
looks at the big picture, rebellious and
opinionated, and committed to principles or
a vision.
Directive Style
Assertive, acts rapidly, takes charge,
persuasive and/or is manipulative, uses rules,
needs power/status, impatient, productive,
single-minded, and enjoys individual
achievements.
9
Click to strategies
Coping
edit Master
fortitle
change
style
Strategies to help you with change if your decision-making style is:
Analytical - You see change as a challenging
puzzle to be solved. You need plenty of time
to gather information, analyze data, and draw
conclusions. You will resist change if you are
not given enough time to think it through.
Conceptual - You are interested in how
change fits into the big picture. You want to
be involved in defining what needs to change
and why. You will resist change if you feel
excluded from participating in the change
process.
Behavioral - You want to know how everyone
feels about the changes ahead. You work best
when you know that the whole group is
supportive of each other and that everyone
champions the change process. If the change
adversely affects someone in the group, you
will perceive change as a crisis.
Directive - You want specifics on how the
change will affect you and what your own
role will be during the change process. If you
know the rules of the change process and the
desired outcome, you will act rapidly and
aggressively to achieve change goals. You
resist change if the rules or anticipated
results are not clearly defined.
Disclaimer information
Disclaimer
informationhere…
here…
10
Understanding
the dynamics
of change
Click to edit Master
title style
Exercise #1:
This is a True/False exercise to help you consider
the dynamics of change – more information
may be provided based upon your answer.
Just click on the light bulb 
When you are done, simply close out by clicking the X or
Disclaimer information here…
at the top.
11
Why
change
efforts
Clicksome
to edit
Master
titledon’t
style‘stick’
Did you know that in US businesses, some 70% of change efforts
don’t result in lasting change, or fail altogether.
In Wisconsin, the WHA survey found that only 30% of QI Managers
could say their hospital’s change efforts were successful at least
80% of the time.
Reasons for this are varied, but significant keys to change that
‘sticks’ are communication about the change, early involvement
by those affected by the change, and measurement that shows
definite improvement.
Disclaimer information here…
12
Click to edit
Helping
change
Master
“stick”
title style
Studies have show that change efforts are likely to succeed when several factors
are in place. (These success factors are gleaned from a 3 year international
study of 500 organizations’ successful projects.)*
•
•
•
•
•
•
•
•
Leadership supports and encourages QI efforts.
Internal champions of improvement efforts are identified and involved.
Successful improvement efforts are widely recognized in the organization.
All employees are encouraged to be involved in improvement efforts.
Managers ensure that the work of improvement efforts is shared by many.
Widespread communication about improvement efforts occurs at least monthly.
There are specific strategies used to ensure that the change “sticks”.
Every project uses data so that actual improvement can be measured.
*see reference slide
Disclaimer information here…
13
Measurement
& Change
Management
Click to edit Master
title
style
In addition to having a solid plan, obtaining buy-in among
staff, and providing consistent communication about the
change, the importance of measurement is sometimes
forgotten.
Sometimes short term measures used to
implement a process don’t evolve into
measures that monitor a process over
the long term.
This is one reason a change may not stick.
Disclaimer information here…
14
Click to edit Master
Understanding
Trendtitle style
One key to ensuring long lasting change is to incorporate
ongoing measurement into the process to track data
trends
Measuring processes over a period of time provides a
good indication that the change made results in
improvement, and that the improvement will last.
Disclaimer information here…
15
Click to
What
trending
edit Master
tells us
title style
Trend cannot be determined
because at least 3 points in
succession are needed to
determine a trend.
An Increasing
Trend
A Decreasing
Trend
When a data series trends in the
wrong direction, it may be time for
another cycle of improvement.
Disclaimer information here…
16
Click toChange
When
edit Master
Comes
title
Around
style
As we have seen, there are very good data driven
methods for determining when a change is needed,
and how to monitor a change over time.
Great reasons to change don’t necessarily make the
actual change easier on a personal level.
Disclaimer information here…
17
Helping
Struggling
with
Change
Click toThose
edit Master
title
style
Here is a strategy to consider when you encounter a negative or strong reaction:
Pause: A quick “off the cuff” response can have unintended effects, such as keeping
others from expressing their feelings
Listen: The next step is to listen carefully not only to what they are saying but also to
how they are saying it. Listen for any hidden messages. You can also ask good
questions to ensure you really understand their point of view.
Empathize: Make your initial response one that empathizes with their position. First
show that you understand (even though you may not agree) and respect their right
to voice an honest opinion.
Think: Before you respond, think carefully about what you are going to say and how you
are going to say it. This is a moment of choice on your part to respond positively or
negatively.
Respond: Respond in a way that offers the other person a dignified way out. Seek a winwin. Reframe their position to allow them to see and consider a bigger picture.
Disclaimer information here…
18
Click to edit
Different
thinking
Master
about
title style
change
A frame, or 'frame of reference' is our set of unquestioned beliefs,
and values that we use when inferring meaning. If any part of
that frame is changed (hence 'reframing'), then the meaning
that is inferred may change.
Here are some examples of reframing:
• A problem as an opportunity
• A weakness as a strength
• An impossibility as a potential possibility
• Oppression ('against me') as neutral (‘wait & see')
• Abruptness as a lack of caring or understanding
Disclaimer information
Disclaimer
informationhere…
here…
19
Click to editchange
Re-framing
Master title style
Exercise #2
Match the feeling about change with a
statement re-frames that feeling into
something more positive.
Just click on the light bulb 
When you are done, simply close out by clicking the X or
Disclaimer information here…
at the top.
20
Click 3toSummary
Unit
edit Master
Quiz
title style
Congratulations!
You have completed Unit 3: Holding the Gains
You can now test what you have learned by taking a short
assessment:
Just click on the screen icon 
**You must take the assessment to get full credit for Unit 3
When you are done, simply close out by clicking the X or
Disclaimer information here…
at the top.
21
Click Resources
Unit
to edit Master title style
•
•
•
•
•
•
•
•
Quality Improvement Implementation and Hospital Performance on Quality Indicators. Bryan J Weiner, et
al. Health Services Research 2006 41:2, 307.
Ten reasons people resist change. Copyright (c) 2003 A. J. Schuler, Psy. D.
. A. J. Schuler is an expert in leadership and organizational change. To find out more about his programs
and services, visit www.SchulerSolutions.com
Develop a coping strategy based on who you are. http://ezinearticles.com/?Coping-with-Change:Develop-Your-Personal-Strategy&id=51313
New Ways of Working in Hospitals. American Hospital Association publication 2008. Price Waterhouse
Cooper study reference:http://www.aha.org/aha/issues/Workforce/nww/nww-resources-toc2.pdf
http://www.cdc.gov/nchs/data/misc/healthcare.pdf for Trend Chart Examples
Qual Saf Health Care 2007;16:387-399 doi:10.1136/qshc.2006.022194
Phillips, B. (1999). Reformulating Dispute Narratives Through Active Listening, Mediation Quarterly,17(2),
161-180
http://changingminds.org/techniques/general/reframing.htm
Disclaimer information here…
22