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Workforce of the Future

How to Sustain Change: Advice From an Innovation Expert

Failing to plan is a plan to fail

Unit-based teams across Kaiser Permanente conduct thousands of performance improvement projects a year, achieving measurable benefits for KP members and patients. But how can teams make sure their changes stick?

Lynne Maher is the director for innovation for the Ko Awatea Centre for Health System Innovation and Improvement in New Zealand, an associate professor of nursing at the University of Auckland and a faculty member of KP’s Improvement Institute. She recently answered four questions to help teams sustain success.

Q: How can teams keep a successful change going and avoid having the results be a flash in the pan?

A: Sustaining positive outcomes is the result of effective preparation and implementation of the project itself. Starting to think about it only after you have completed a project is too late. It will not just happen by itself; you have to plan for it.  

The sustainability model we teach at the Improvement Institute has 10 factors, including team training and involvement, leadership, organizational culture and tracking progress. Teams need to pay attention to these at the beginning and throughout the project. KP’s improvement advisors know this model and can help teams address them.

Q: What do you do if your results slip over time or the team falls back on old behaviors?

A: You need to understand why the results are slipping or why people are reverting to the old ways of doing things—and then address those underlying causes. In my experience, there are a few common pitfalls. For instance:

  • The team has attempted a change but is not really engaged or has not understood why things needed to change.
  • People are not fully trained or prepared to work in the new way, so they slip back to the status quo, which is more comfortable.
  • Team members don’t actually know how they are doing in terms of sustaining the new way of working, because there are no ongoing measures they can track.

Q: At what point, if ever, can teams stop tracking the results of a particular process improvement?

A: Measures are really important, both during the project and afterwards. However, teams should not think they have to continue all the measures they have been collecting during the project. They should consider which one or two measures will let them know how they’re doing and can be easily collected. Ideally, these ongoing measures are part of the organization’s standard data collection.

Checklist - ColorGet Them Talking

The health care landscape is ever-changing, and it helps to stay abreast of what is new.

If you know your team needs to roll with the tide, use this Checklist for Sustaining Results before starting a test of change.

Q: What is the role of team leaders or managers in maintaining momentum and engagement in the change process?

A: Team leaders and managers have a huge role in maintaining staff engagement and momentum. Sponsors, for example, are often most visible at the beginning and the formal end of a project. They have many competing demands, but they need to plan ways to maintain their team’s performance improvement work. This could be through periodic supportive reviews to identify roadblocks. Or sharing thank you messages from patients who are benefiting from the new way of doing things. Or having an annual prize for the best sustained improvement.

Sustaining performance over time is important, not only because these improvements will have brought benefit to patients, staff and the organization, but also because they represent a significant investment in time, resources, and intellectual and emotional energy. For nothing to come of that investment is a massive waste. Team leaders need to prevent that waste from happening.

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