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Departments & Programs,UW Health,Ambulatory Education,Educational Opportunities,Grand Rounds,Nursing Grand Round Presentation Video Archive 2012,Leading and Managing in a Clinical Practice Discipline 2012,Resources

Sustainability: Making Change Stick

Sustainability: Making Change Stick - Departments & Programs, UW Health, Ambulatory Education, Educational Opportunities, Grand Rounds, Nursing Grand Round Presentation Video Archive 2012, Leading and Managing in a Clinical Practice Discipline 2012, Resources


Sustainability: Making Change
Stick
Sue Rees, DNP, RN, CPHQ,
CENP
Vice President, Development,
Nursing & Patient Care Services

Objectives
• Review the UW Health change model
(Kotter)
• Reflect upon changes that have/have not
been sustained
• Identify aspects of leadership that promote
changes being sustained
• Identify the role of accountability
• Discuss models for making changes stick

Some quotes about change
• What use could the company make of an electric toy?"...Western Union
(telegraph company), when it turned down rights to the telephone in 1878
• "Everything that can be invented has been invented."...Charles H. Duell,
Director of US Patent Office 1899
• "Who the hell wants to hear actors talk?"... Harry M. Warner, Warner Bros
Pictures, 1927
• "Heavier than air flying machines are impossible." ...Lord Kelvin, President,
Royal Society, 1895
• "Video won't be able to hold on to any market it captures after the first six
months. People will soon get tired of staring at a plywood box every night."
Daryl F. Zanuck, 20th Century Fox, commenting on television in 1946
• "Sensible and responsible women do not want to vote."...Grover Cleveland,
1905
• "Babe Ruth made a big mistake when he gave up pitching."...Tris Speaker,
1921
• "The horse is here today, but the automobile is only a novelty - a
fad."...President of Michigan Savings Bank advising against investing in the
Ford Motor Company

Change is the name of the game
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Leader Be Nimble

Change is good
• “If you don't change, you can become
extinct”.
• “The world hates change yet it is the only
thing that has brought progress”. -Charles
Kettering
• “You cannot expect to achieve new goals
or move beyond your present
circumstances unless you change”. -Les
Brown

Change is good
• “Cause change and lead; accept change
and survive; resist change and die”. -Ray
Norda
• “After you’ve done a thing the same way
for two years, look it over carefully. After
five years, look at it with suspicion. And
after ten years, throw it away and start all
over”. -Alfred Edward Perlman

Getting from here to there

The Yellow Brick Road for UW Health

IOM Levels of Change
Berwick.  A User’s Manual for the IOM’s Quality Chasm Report.  Health Affairs 2002.  

UW Health Change Model-Kotter

UW Health Change Model-Kotter

Create a sense of urgency
• For change to happen, it helps
if the whole organization really
wants it.
• Develop a sense of urgency
around the need for change.
This may help you spark the
initial motivation to get things
moving.

Create a guiding coalition
• Convince people that change is
necessary. This often takes strong
leadership and visible support from key
people within your organization. Managing
change isn't enough - you have to lead it.

Develop a vision and strategy
• A clear vision can help
all understand why
you're asking them to
do something.
• When people see what
you're trying to achieve,
then the directives
they're given tend to
make more sense.

Communicate the change vision
• Communicate it frequently and powerfully,
and embed it within everything that you
do. When you keep it fresh on everyone's
minds, they'll remember it and respond to
it.

Empower broad based action
• Put in place the
structure for change,
and continually check
for barriers to it.
• Removing obstacles can
empower the people
you need to execute
your vision, and it can
help the change move
forward.

Generate short term wins
• Nothing motivates more than success.
Give a taste of victory early in the change
process. Within a short time frame you'll
want to have results that your staff can
see.
• Without this, critics and negative thinkers
might hurt your progress.
• Create short-term targets - not just one
long-term goal.

Consolidate gains and produce more
change
• Many change projects fail because victory
is declared too early. Real change runs
deep. Quick wins are only the
beginning of what needs to be done to
achieve long-term change.

Anchor new approaches in the culture
• Finally, to make any change stick, it
should become part of the core of your
organization. Your corporate culture often
determines what gets done, so the values
behind your vision must show in
day-to-day work.

The Kotter Model
• Do you know about the Kotter Model?
• Have you used the Kotter Model?
• Have you consistently followed all 8 steps
when implementing change?

But wait……there’s more!

See-Feel-Change vs. Analysis-Think-
Change
• People change what they do less because
they are given analysis that shifts their
thinking then because they are shown a
truth that influences their feelings.

See-Feel-Change vs. Analysis-Think-
Change
• The flow of see-feel-change is more
powerful than that of analysis-think-change.
• These distinctions between seeing and
analyzing, between feeling and thinking, are
critical because we use the latter more
frequently, competently, and comfortably
than the former.

See-Feel-Change vs. Analysis-Think-
Change
Analysis has at least 3 major limitations:
• You don’t need it to find the big truths.
• It works best when parameters are known,
assumptions are minimal, and the future is
not fuzzy. They have limitations in a
turbulent world.
• Good analysis rarely motivates people in a
big way. It changes thought, but doesn’t
send anyone out running to act differently.

See-Feel-Change vs. Analysis-Think-Change
See‐Feel‐Change Analysis‐Think‐Change
Help people see
Compelling, eye‐catching, dramatic situation are created 

to help others visualize problems, solutions, or progress 

in solving complacency, strategy, empowerment.
Give people analysis
Information is gathered and analyzed, reports are 

written, and presentations are made about problems, 

solutions, or progress in solving urgency, teamwork, 

communication, momentum slippage or other key 

problems.
Seeing something new hits the emotions
The visualizations provide useful ideas that hit people at 

a deeper level than surface thinking.  They evoke a 

visceral response that reduces emotions that block 

change and enhances emotions that support change.
Data and analysis influence how we think
The information and analysis change people’s thinking.  

Ideas consistent with the needed change are dropped or 

modified.
Emotionally charged ideas change behavior or reinforce 

changed behavior
New thoughts change behavior or reinforce changed 

behavior

Why do transformation efforts fail?
• “In around 80% of the cases, failure can
be tracked to the early stages;
transformation programs are most likely to
go wrong as a result of the way they are
initially conceptualized and planned.”
– Bevans, NHS Institute of Innovation and Improvement

UW Health Change Model

See-Feel-Change

See-Feel-Change

See-Feel-Change

See-Feel-Change Strategies
• Site visits
• Videos
• Patient stories
• Observations on other units
• Hearing from other staff
• Demonstration

Hand Hygiene Initiative

What See-Feel-Change is not
• A flyer
• An email
• A graph

Intentional Rounding
• Shared the data
• Left it up to each unit to individualize
• Left it up to each unit to implement
• Did not come back to it on a regular basis
• Looked at only the outcome (falls) to see if
it was successful

See-Feel-Change
• Match the magnitude of the change with
the degree of See-Feel-Change that is
required
• You may need to use multiple methods of
See-Feel-Change to reach everyone

Emotions during transition
Reale, Making Change Stick

The 4 ‘A’ Framework

Awareness
An organization must have awareness of the
performance gaps through direct
measurement

Accountability
Leadership must be accountable to improve
performance

Ability
Staff must have the ability to employ new
practices (have capacity, resources, and
competency)

Action
Action must be taken over time that is
measurable by process measures and
outcome measures that are clearly tied to
closing the performance gap.

4 ‘A’ Framework

The intersection of FOCUS-PDCA and
Kotter

Tying it all together
• Utilize Kotter’s 8 step framework for large
scale change
• Remember See-Feel-Change is more
powerful than Analysis-Think-Change
• As a leader, be aware and accountable;
assure staff have the ability; assure action
over time

And most importantly….
• Don’t let up—Hang in there!!

Resources
• Kotter, J.P. (2002). The Heart of Change.
Boston, MA: Harvard Business Review.
• Kotter, J.P. (2007). Leading Change: Why
transformation efforts fail. Harvard
Business Review.
• Kotter Change Model Flip Guide
• Project Template

References
• Berwick, D. (2002). A User’s Manual for the
IOM’s Quality Chasm Report. Health Affairs.
• Kotter, J.P. (2002). The Heart of Change.
Boston, MA: Harvard Business Review.
• Kotter, J.P. (2007). Leading Change: Why
transformation efforts fail. Harvard Business
Review.
• National Quality Forum, 4 A framework.
• Reale, R. (2005). Making Change Stick.
Signature Book Printing.

Questions