Questions

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Welcome to the MHQP HealthForce MN Quality
Brownbag Room Monthly Noon Brownbag Fourth
Thursday Every Month
August 27th Change The Change
Calendar Skip Valusek PhD, CPHQ HealthEast Direc
tor Clinical Analytics
Questions? Contact Skip Valusek MHQP
Education Chair skipvalusek_at_comcast.net
Slides are posted at http//www.healthforceminn
esota.org/pages/Programs/courses.html
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Register your Attendance

• Hopefully you provided your name organization
  when you signed in.
• If so
• Just say Hi in the Chat Pod and well
  capture your name and organization in the log.
• If not
• identify yourself and organization in
  the Chat Pod to the
• left of your screen.
• If there are more than one attending on your
  sign-in, tell us how many by saying Hi (tell us
  the number of attendees)

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Poll Who is Attending this Session ?

• Rural / Outstate ?
• Metropolitan area ?
• Organization that has (or serves) both ?

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Poll Who is attending Organization Type ?

• Healthcare system
• Hospital
• Clinic or Clinic System
• Long term care
• Healthplan
• Homecare / Hospice
• A Quality Support Organization
• Other ? (Identify other in Chat Pod)

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Poll How many total participating in your room ?

• 1
• 2
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• 4
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• 7
• gt7

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Poll What do you hope to gain by participating?

• I am a healthcare quality professional and am
  interested in additional education.
• I am a healthcare professional interested in
  developing quality skills as a core competency.
• I am a healthcare professional interested in
  learning more about healthcare quality.

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(No Transcript)
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Patient Safety Amidst an Avalanche of Change
NNSDO Leadership Concurrent Session IV July
2008

• Beth LaVelle, PhD, RN, CEN
• Skip Valusek, PhD, CPHQ

HealthEast Care System, St. Paul, MN
No relevant relationships to disclose
Please turn your cell phones pagers to vibrate
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Objectives
At the end of this workshop, the learner will be
able to

• Recognize change fatigue in their environments
• Describe the potential impact of change fatigue
  on patient safety
• Develop a strategy for limiting negative effects
  of change by discussing or championing a Change
  Calendar in their facility

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To ensure we are all on the same wavelength

• The only constant is change
• (except from a vending machine)

• Life is change . . . .
• Growth is optional

• It is not necessary to change.
• Survival is not
  mandatory.
• 
  Deming

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From a Nursing Perspective Has Changed
CHANGE

• constant
• rapid pace
• huge cognitive

• small steps
• slow pace
• natural breaks

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• Constantly
• evolving

• Conflicting directions of change

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Psychological stress

• Relationship between person the environment
  that is appraised as taxing or exceeding
  resources endangering well-being
• Change
• Significance
• Frequency
• Volume

stakes
?
power to control outcome
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Overload/Turbulence ? change fatigue
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Change fatigue

• Burnout
• staff
• preceptors
• managers
• leaders

• Emotional exhaustion
• Depersonalization
• ? Personal accomplishments
• Absenteeism
• Think about looking for different job

• Organizational studies dont underestimate the
  impact of organizational changes
• direct impact on work environment
• contribute to higher rates of dissatisfaction,
  burnout, absenteeism

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system problem
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? Avoiding change fatigue

• Take charge
• We DO have choices
• Balance our day-to-day work must get done
• Balance standardization individualization
• William Ury The Power of a Positive No
• Need slack time
• Know We are not in this alone
• Use Crew Resource Management techniques

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Time
WHEN?
WHO
WHERE
WHAT?
Changes
WHY?
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? Change calendar
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Survey Form
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How often do you encounter multiple, simultaneous
changes at work ?
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Human Factors Patient Safety
Cognitive factors that contribute to error

• Stress fatigue
• Lack of familiarity with the task
• Trying something new under pressure
• Information overload
• Workload multi-tasking
• Doing more with less resources
• Favoring production over safety
• Task saturation
• Task prioritization

Simpson KnoxAdverse Perinatal Outcomes
Recognizing, understanding preventing common
accidents. AWHONN Lifelines, Jun-Jul 2003
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How do you think these changes affect patient
safety? Comments?
Survey

• I think the multiple, frequent changes
  affect patient safety in subtle ways. A great
  deal of time and mental energy is spent fumbling
  through new processes or new equipment and this
  takes time and mental focus away from our
  patients. When a nurse can work with familiar
  systems, documents and equipment she/he can
  confidently care for patients. The constant
  change in our work environment also creates a
  persistent undercurrent of stress and overload -
  and a feeling of futility (like getting slammed
  by wave after wave when you're just trying to
  swim !) I cannot believe this undercurrent of
  stress and overload does not have a negative
  impact on patient safety and it certainly impacts
  our ability to satisfy our patients beyond their
  safety needs.

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The Change Calendar
Impact Of Change
Manage the scope velocity of change affecting
those providing patient care
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Change Calendar as a tool to reduce risk
Objectives

• Forecast pro-actively schedule changes that
  affect caregivers
• Assess the impact of each change
• Purposefully plan how to meet educational needs
• Justify requests to either
• Increase preceptor educator staffing OR
• Delay implementations to prevent change fatigue
  to ensure adequate training/education

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The Process
Change Calendar as a tool to reduce risk

• Identify an Executive Sponsor (COO?)
• Identify Categories/Contributors/Input Champions
• Choose a Database Engine (e.g. MS Project?)
• Choose an Implementation approach
• Top Down Requires a really engaged Sponsor
• Bottom Up Will lose the forest for the trees
• Middle Out Engages those who manage the
  projects

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If top down doesnt work, try middle out.

• Pick one or two Model Units
• Unit Director
• Clinical Manager
• Clinical Nurse Specialist
• Lead Preceptor

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What are the categories of change?

• Education evaluation of competency
• Policies / Procedures / Guidelines / Order Sets
• Compliance
• Information technology
• Equipment Materials
• Facilities
• Research
• Operational

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How do we assess the impact of change?

• Use the 3 Cs of nursing education to assess
• cognitive impact on a unit/department on any
• given week
• Communication (awareness 10)
• Comprehension (understanding 25-50)
• Competency (new skills cognition 50-100)

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Who maintains the Calendar?

• A committee?
• A department?

Which department ? (this is an interactive part
of the presentation)
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How do you measure Change Calendar success
. . . or do you ??

• The KISS principle is essential!
• Is it on the Change Calendar ?
• Calendar is being used proactively to schedule
  an implementation or pilot.
• Impact on staff (also a research opportunity)

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Status of Change Calendar in Evolution

• Launched at 1 of 3 system sites
• Initially labeled Pilot
• Better labeled Proof of Concept
• Helpful creating awareness of major competing
  projects ensuring they are not simultaneous.
• Has not reached state where major efforts on any
  given unit on any given week are visible
• Still missing flow of nursing education/competency
  training information
• Another site has named Executive Sponsor and
  operational champion
• Restructured Calendar format to emphasize units
  departments

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Struggles you may encounter
AWARENESS

• Engagement Requires individualized pre-reviews
• Some project owners dont welcome
  transparency/visibility of their projects
• Often missing changes that are internal to a unit

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Individualized Pre-Reviews
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Struggles you may encounter (contd)

• Determining Which projects make it onto calendar?
• Room Service nutrition
• Replacing lab microbiology system
• new room/unit/department numbering
• (all IT systems, signage)
• Electronic nursing documentation (EHR)
• Mobile portal for MDs

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Struggles you may encounter (contd)

• Determining how long projects stay on the
  calendar?
• How do we predict time required to reach steady
  state, especially considering part-time nurses?
• Is it a phased rollout ?
• Mine is always the highest priority mindset

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A Snapshot from St Josephs Change Calendar
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? Assess your present situation
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? Assess your present situation
new CNO much, much more.
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Patient Safety Amidst An Avalanche of Change
Objectives

• 1. To recognize change fatigue in your
  environment
• 2. To understand the potential impact of change
  fatigue on patient safety.
• 3. To be able to develop a strategy for limiting
  the negative effects of change by discussing or
  championing a Change Calendar in your facility.

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References suggested readings

• Beaudan E. Making change last How to get beyond
  change fatigue. Ivey Business Journal 2006.
  Jan-Feb, 1-7.
• Felgen J. I2E2 Leading Lasting change. Creative
  Health Care Management 2007.
• Kerfoot K. Beyond busyness Creating slack in the
  organization. Dermatology Nursing 2007. 19(10),
  107-109.
• Lundin S, Christensen J, Paul H. Fish Series
  Fish! (2000) Hyperion Fish Sticks! (2003)
  Hyperion
• Patrick K. Burnout in nursing. Australian Journal
  of Advanced Nursing 2007. 24(3) 43-48.
• Maslach C Jackson, SE (multiple). Three Maslach
  Burnout Inventories (MBI) human services,
  educators, general survey. www.cpp/detail
• Sexton JB, Helmreich RL, et al. The safety
  attitudes questionnaire psychometric properties,
  benchmarking data, and emerging research. BMC
  Health Services Research 2006. 6(44).
  www.biomedcentral.com/1472-6963-6-44.

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References suggested readings, cont.

• Shanley C. Management of change for nurses
  lessons from the discipline of organizational
  studies. Journal of Nursing Management 2007.
  538-546.
• Spear SJ. Fixing care from the inside, today.
  Harvard Business Review 2005.83(9)89-91.
• Tracy MF (2007). Powered by insight. Presented at
  the American Association of Critical-Care Nurses.
  National Teaching Institute Critical Care
  Exposition, Atlanta GA.
• Ury W 1991 Getting to Yes Negotiating
  Agreement Without Giving In, 2nd Edition with
  Roger Fisher Bruce Patton. Penquin Book. 2007
  The Power Of A Positive No How To Say No And
  Still Get To Yes. Bantam Dell.
• Valusek JR. The change calendar A tool to
  prevent change fatigue.The Joint Commission
  Journal on Quality and Patient Safety 2007.
  33(6), 355-360.
• Watkins JM Mohr B. Appreciative Inquiry
  Change At The Speed Of Imagination.
  Jossey-Bass/Pfeiffer 2001.
• Wojner A. Outcomes Management Applications to
  Clinical Practice. Mosby 2001

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References suggested readings, cont.

• Cohen MH. What you accept is what you teach.
  Setting standards for employee accountability.
  Creative Healthcare Management, 2007.
• Simpson Knox. Adverse Perinatal Outcomes
  Recognizing, understanding preventing common
  accidents. AWHONN Lifelines, Jun-Jul 2003

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Contacts

• Beth LaVelle, PhD, RN, CEN
• St. Josephs Hospital, St. Paul, MN
• belavelle_at_healtheast.org
• 651-232- 4751 CDT
• Skip Valusek, PhD, CPHQ
• srvalusek_at_healtheast.org
• 651-232-3728 CDT

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Welcome to the MHQP HealthForce MN Quality
Brownbag Room Monthly Noon Brownbag Fourth
Thursday Every Month
September 24th Access Patient Flow Panel
Questions? Contact Skip Valusek MHQP
Education Chair skipvalusek_at_comcast.net
Slides are posted at http//www.healthforceminn
esota.org/pages/Programs/courses.html