Building a Culture of Change
Tami Michele, D. O. FACOOG
Ann Forster Page, MS, APRN, CNM
Principles of Implementing Change
How do we respond to change?
Our limbic brain responds very
quickly
Multi-site Systems Change Example
• Hospital Association OB Keystone Project
• Plan to implement change
• Team had clear rationale and evidence for
practice change. Core team was formed.
Recruitment, Find Champions
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Most opposed providers and nurses
Older leaders
Younger leaders
Kick-off meeting to create a sense of focus and teamwork, include
team building activities
Partner with senior executive leaders
Gathering Data for Quality Improvement
Opportunity to be a leader in practice for other hospitals to follow
Use existing quality improvement committees
Existing QI Committees
• Projects are easily acceptable when placed in the context of
“quality improvement”
• Reducing interventions → Reduced patient risk → Reduced
provider risk
• When patients feel they are receiving individualized care,
and part of shared decision making, their perception of
quality care goes up, and hospital scores increase.
Individual Work Styles of OB Unit
• Example: DiSC
• Understanding personal characteristics can help overcome barriers
• 4 basic individual work styles
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Dominance (direct, results-oriented, strong-willed, forceful)
Influence (outgoing, enthusiastic, high-spirited, lively)
Steadiness (even-tempered, accommodating, patient, humble, tactful)
Conscientiousness (analytical, reserved, precise, private, systematic)
Individual Motivators and Fears
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Dominance:
– Likes Competition, Winning, Action, Results
– Fears Loss of Control, Vulnerability
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Influence:
– Likes Recognition, Enthusiasm, Collaboration
– Fears Rejection, Disapproval
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Steadiness:
– Likes Stability, Cooperation, opportunities to help
– Fears Change, Loss of Harmony, Offending others
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Conscientiousness:
– Likes using Expertise and Knowledge, Quality
– Fears Criticism, being Wrong, Disorganization
Evidence
• Providers and nurses are more willing to change current practice
when shown evidence and when they are emotionally engaged in
the importance of the practice change
• Use hospital success stories
• Provide packet of information on project with supportive articles
• Journal Club to review & discuss
Barriers
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Find common ground
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Define the areas of concern
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Plan regular meetings, inform & update at every opportunity
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If the system is overwhelmed by too many changes, present the project in stages,
go for the low hanging fruit.
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Reduces resistance
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Easier to get Buy-In
Unless you perceive there is a really good
reason to change, you won't. Change goes
against what is familiar, stable and routine