Making quality improvement changes in the healthcare field are difficult. Making the changes stick is even harder! Consider, if you would, some change at your site that made a vast improvement in quality. Time was saved, patient care improved, and the bottom line improved. Now, look back, is that change still in place? Sadly, after some time has passed, many positive changes disappear. Why? We slip back into old habits. They are hard to shake. What personal habits have you tried to change? Was it hard? Habits in an organization are just as hard to change, if not harder, since more people are involved. Another reason your site changes didn't stick may be that personnel changed. One organization I know of had several changes in top leadership. Each new leader wanted to make his/her imprint on the organization; so, they instituted changes which saved money immediately but which overturned best operating procedures which had been successful and which had been developed with a lot of effort by staff. There are many other reasons quality changes don't stick.
How are you going to fight this, then? I don't have a cure all, but let me suggest a technique used in many organizations—a written Standard Operating Procedure. If you look up Standard Operating Procedure in a search engine on the internet you will get many hits. It is especially common in government sites and the military. What is it? It is a manual or text describing how things are done.
As a quality engineer I've worked on successful projects that saved significant amounts of money for organizations. The changes were made permanent by writing them down in a manual for the department in which they were used. That way, if changes in personnel occurred, the standard operating procedure stayed in place. Too, the written manual was used to disseminate the changes throughout the organization. The change leaders incorporated the changes in the organization manual for standard operating procedures and then made sure that the techniques were followed by all involved. Manufactures who are ISO certified use this technique commonly.
Once you have written the quality changes into your manual and spread the word, is that enough? No. I believe that you should occasionally take an audit of the procedure. By that, I mean that once in a while, you as a change leader should go out to wherever the change is incorporated and observe if it is still being followed. If not, corrections should be made to make sure the changes are followed again. In other words, make sure the changes are practiced until they become the habit.
Beyond incorporating the changes in your manual and making sure they are followed over time, try to make the top leadership aware of the operating manual and respect it. If you can demonstrate that the ideas are money savers for the organization or that they meet some other important goal of the organization you will probably be successful. If current leaders buy into the manual as a body, then a new leader who wants to incorporate unproven changes will probably meet resistance by others who buy into the manual. In other words, a good standard operating procedures manual is self-perpetuating in spite of the changes that occur in the organization.
Does this mean that no changes should ever be made in the manual? No. If new personnel come on board with new ideas then they should be given the chance to prove their ideas. If the new ideas are indeed better for the organization then the manual can certainly be amended.
Summarily, to incorporate changes in your organization and make sure they stick in spite of changes in the work environment, create a standard operating procedure manual or manuals (you may have different ones for each department, as long as they are compatible with other manuals in the organization) which are respected by the top leadership and which are continually referenced by those involved. If you don't have such a manual on site, don't try to create a mammoth volume that incorporates all present practices. Rather, start small with a manual that incorporates new changes and use it until you feel comfortable with it. Then, go back and add other best operating procedures.
Donald Bryant helps healthcare providers meet their challenges. If you liked this article and want more free tips, visit http://www.bryantsstatisticalconsulting.com for a free article to help you start making improvements at your site immediately.
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