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Adding Effective Change Management to your Quality & Patient Safety Toolbox

Patient Safety Quality Monthly, June 12, 2009

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"We thought the move of the pediatric service to the new location was going to be great—unfortunately, we didn't consider all the aspects and we were overcome with unintended consequences."

The old adage "Out of the frying pan and into the fire" is really discussing change management and our ability to make changes and only experience the good rather than the bad, unintended consequences. We can't leave this to chance if we want our changes in process, equipment, location, methods, etc., to go well. If we do not effectively make changes, there is the possibility of a large impact on patient safety and quality.

The science of making sure a change goes well is called change management, not to be confused with managing change, which is usually used to describe the methods of getting people to emotionally accept and support change. When we use the term "change management," we are talking about a structured approach to make sure that all possible implications are considered when we make a change.

As with cause analysis, change analysis needs to use a graded approach. Some changes need to be very carefully managed—such as moving an ICU to a new location with a full patient population. Other changes can be done within the normal business methods. It all depends on the risk and complexity of the change. Highly complex changes with a high potential risk need to be carefully managed.

Following are some key parts of change management:

Step 1: Make sure you know about changes. Set up a formal process to make sure major changes do not get made without the ability to manage them. People have to tell you about change.

Step 2: Determine what level of change management you need to apply. Evaluate the risk and complexity of the change.

Step 3: Use the appropriate Change Management Tools. Some typical change management tools might include:

High-risk/high-complexity changes:

• FMEA of new process, equipment, service, etc.
• Checklist of key potential effects
• Management risk review meetings

Low-risk/high-complexity changes:

• FMEA
• Checklist of potential impacts

High-risk/low-complexity changes:

• Checklist of potential effects
• Management risk review meetings

Low-risk/low-complexity changes:

• Normal business practices

Step 4: Plan for and manage off ramps. Make sure you know how you will respond if you find that there is a major problem halfway through a change. Some changes are irreversible; make sure you know what you will do.

Don't leave change management to chance! If we can be of assistance to you in developing a realistic and workable change management process for your facility, please contact us at 888/749-3054 ext. 3506 or email mnicosia@greeley.com.

Ken Rohde 6-10-09

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