The more things change, the more they stay the same: How do you prevent this from happening?

Communicating for effective change: Questions and Resources

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Change, change management, process improvement and integration are all words that we hear repeatedly! And yet while we use these words, communicating change is not done with effectiveness or efficiency. One reason is because of ineffective communication of the details.

Just imagine having a family dinner and when the meal is over there is usually some expectation about whether each family member clears his or her own plate or if a few people are designated for cleanup. Even if it takes some “encouragement” for the kids, there may still be an understood expectation. When the expectations are not shared, plates are left and the cleanup is less than efficient. It’s usually ok if this happens a few times, but if every day, plates are left behind for someone else and that is not everyone’s expectation, the individual who steps in to do other people’s work, may become resentful over time. 

Think of hospitals or clinics as our clinical “home” environment.  We want our leaders, managers and staff to feel they are part of a family where all want to step up to help. However, if change occurs (whether from a new work flow, or changed expectations of accountability) and the “family” is not fully made aware of the change, many will keep doing what they have always done, and the few who are aware of the change will notice the gaps, and may even step up to bridge them.  However, over time these people will become overwhelmed, and even discouraged that everyone does not have the same shared understanding of the change and the new process.

So how do we make sure everyone is aware of why change is needed? How do we be sure the communication about change is integrated throughout the clinical home?  We need to start to ask (and answer) these questions locally. Questions such as: How is information shared? Verbally, electronically? And to whom? Is everyone aware of the need for change?  For example, as physicians, we write orders. But do we take the time to share the reason for the orders with the nurses and support team? The more information the support team has, the better they can understand and implement treatment orders, and monitor the patient.  

When there is a need for supplemental information such as during an adverse event investigation or even to carry out daily operations, key questions to ask include: how is the information stored and collected? Is the information in separate systems or can the data be pulled into a central repository?  Who has access to these systems? And what information can be shared? 

As healthcare providers, we wake up each day, hoping to do our best. But if the rules and roles change and expectations are not made clear along with the reasons for change, (and equally as important, an effective infrastructure is not in place to facilitate implementation of the change), we are set up to fail. No one wants to go to work knowing the system is setting them up to fail.  In healthcare, we should continue to identify both automated and non-automated tools, that will help us integrate clinical processes and data management, to improve communications and provider satisfaction with the delivery of care.  Here is an example where a process improvement change would have improved the delivery of care but the lack of communication stifled the benefit. There was a changed process for Emergency Department providers and hospital staff to access patient clinic records, but this was not effectively communicated by management. This change in process resulted in rework and missing current clinical information for clinic patients being treated in the ED. Ironically the infrastructure was in place as the IT department integrated the systems so the clinic EMR records were made readily available. But due to lack of communication about the easy access to up to date clinic records, several patients either underwent repeat diagnostic testing, or were worked up for conditions unrelated to the primary chief complaint.

Here are some useful resources:

Herman B. Shifting Cultures: A Change Management Guide for Hospital Leaders. Leadership and Management. Becker’s Hospital Review, 2011 November 22

National Learning Consortium. Health Information Technology Research Center. Change Management in EHR Implementation. 2013 April 30

Institute for Healthcare Improvement. Communication Strategies for Spreading Changes.