Wrightington, Wigan and Leigh
Foundation Trust
The only Constant is Change…but How?
Dr Chandrashekar Shetty
Consultant Chemical Pathologist, WWL NHS FT, Wigan
Background
As an effective leader one has to have a certain vision and to bring this to fruition there is a need to bring about changes in existing practices or enhance them in any way.
During this course, I had opportunities to bring about change, big or small, a few times. Some changes are ongoing but during these processes I am constantly discovering
elements of myself, my colleagues and something about the whole dynamics of change. I have tried to highlight my experiences with Change in the 3 examples given below.
Change 1
Change 2
Change 3
Aim
Aim
Aim
To stop using GGT enzyme estimation as part of the
Liver test profile in all routine samples from both
GPs and from within the hospital. However the test
would be available at all times as a separate
request if needed.
To bring about a change in the Troponin testing
protocol, brought about because of a new test
introduced by the manufacturing company.
To bring about a merger of Pathology services
across three Trusts in the North West sector of
Greater Manchester region
The old test would be phased out and no kits would
be available.
Methods
Methods
Evidence base for this change researched and
confirmed validity for the change
Cross-checked with peer and specialist user
groups like the Gastroenterologists and regional
hospitals
Stakeholders : GPs, practice nurses, Hospital
doctors, laboratory staff, laboratory managers, IT
staff
Analysed the impact on clinical services if the test
is withdrawn through a departmental audit including
cost savings if any made.
Departmental discussion re: impact on
stakeholders
An email prepared with complete explanation of
the proposed change and the procedures that
would be put into place to auto request the test if
clinically warranted.
Methods
•Stakeholders identified to be mainly laboratory
staff, Cardiologists and AE staff.
•Evidence base strong and uncontested for the
proposed change
•Proposal put forward to Cardiologists and
discussion re: clinical benefits of the change started.
•Issues re: financing the new protocol (more
expensive) discussed
•Further involvement of Finance managers.
•Business case drawn up for the proposed change
and impact on the dept/hospital finances elucidated
Trust directive given out to consider the possibility
of streamlining Pathology services across the three
trusts with the aim of reducing costs and enhancing
quality.
Various subsections of the department started
meeting with each other
Focus group discussions started and results to be
analysed
Conflicts of interests to be dealt with.
Evidence base for the change to be clearly
presented
Project leads appointed and overall Project
manager appointed midcourse.
Updates
Revision of plans for project given out to
subgroups
•Business case to be presented finally in a couple of
weeks.
Updates
•Change to be rolled out probably in 6 weeks
Email/letter posted to all the stake holders (GPs,
practice nurses, Hospital doctors and managers)
Upside
Proposed change to be enforced after a lead out
time of 3 months.
•More inclusive approach with the stakeholders
involved in actually bringing about the change.
Upside
•Anticipated to cause less resentment when the
change is finally rolled out.
Ongoing meetings and proposals
No clear end in sight
Changing end goals
Revised plans
Upside
Change resulted in significant savings for the
department in terms of reagent cost.
Downside
Clinically more appropriate use of the test was
noticed
•Lengthy delays as a result of getting all
stakeholders to agree to a timeframe.
After initial teething issues current practice is
unaffected and
•Disagreements re: costs involved and taking
responsibilities.
Ownership of the resulting change could be
satisfying
Downside
•Seemingly unending chains of correspondence to
get things moving
Downside
Few complaint letters were received mainly from
GPs stating their concerns. These were attended to
with a satisfactory response through letter and
telephone conversations.
•Project started with no clear structure to begin with
as regards to allocating responsibilities
More involvement of stakeholder groups through
discussion and QA sessions.
More democratic process
Lengthy delays
Uncertainty re: direction of proposed change
Stakeholder discontentment huge mainly because
of uncertainties and suspected redundancies
Some time spent in dealing with these complaints.
Lack of overall vision
Learning points
•Dictatorial type of change as in Change 1, works more quickly and effectively but could bring about discontentment esp. if change is not fully justified and evidence-based.
•Involving more parties in the process of change leads to delay and frustrations if no common goal is clearly elucidated at the start.
• Big changes as in Change 3 should be initially conceptualised and managed with a proper project structure and team and any further changes to the direction of the change
could be slowly introduced
CHANGE IS INEVITABLE BUT NOBODY LIKES IT!