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Making a change to clinical practice, Changes to information systems -…
Making a change to clinical practice
Improve healthcare quality by increasing the capacity of clinical practices to implement the best clinical evidence reducing healthcare inequalities, optimising clinical outcomes through an excellent experience
Drivers
Published Research
Process to search for and review new evidence
Implement quality improvement
Develop multi-disciplinary QI team
Intrinsic e.g. curiosity, meaning, autonomy or extrinsic e.g. financial, rewards, competition
Clinical care team developments
Establish teams with identified roles
Consider framework/approach best fit for local teams
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Stakeholder engagement
Identify which stakeholders may be impacted on by evidence
Consider how stakeholders may be impacted
Nurture leadership
Fosters a vision and culture within an organisation to adapt to new evidence
Tools and enablers allowing the system to work
Incentivise all staff to provide best possible care
Targets set by national policy e.g. quality outcome framework, waiting times target for OP appointment
Need to be aligned with strategic aims of service
Barriers
Characteristics of the individuals involved
Perceived increase in workload
Leadership instability/ cohesiveness - engagement and support of all involved
Perception of project not likely to be helpful
Lack in knowledge and skills of those involved
Lack in professional autonomy to make changes
Lack in confidence of making the changes
Lack in perceived ownership if changes implemented from top-down
Health professionals assumptions about perceived acceptability by patients
Characteristics of the initiative
Use of rigid tools can result in conflict and resistance
Use of carefully considered tool or framework - large scale change, established improvement method or behavioural approach
Consider local context
Magnitude and complexity of a project including competing demands
Not consistent with existing procedures
Lack of opportunity for small scale pilot
Lack of evidence-base to support an intervention - potential risk to patients or not seen to add value
Lack of clear information or guidelines on use
Organisational factors
Insufficient infra-structure
Hierarchical leadership structure
Poor championing by managers
High staff turnover
Lack of teamwork/collaboration or silo working
Lack of improvement culture/blame culture
Poor collaboration within or external to departments
Practical issues
Inflexibility - drivers need to be able to evolve and respond to local economic and operational background
Technical problems including access to IT - systems/ incompatibility/ training/ skills
Scare resources including lack of time within job plan or support staff/champions
Poor involvement in all stakeholders (including staff, leaders, champions or patients) including poor communication with relevant parties
Misunderstanding of changes proposed
Lack of incentives for staff
Contextual/ environmental factors
Patients not willing to participate/doubt whether professionals have skills/capacity
Project does not fit within existing rules or regulations
Priorities of commissioning organisations
Counter-incentives for competing targets
Financial burden of the change on systems
Enablers
Using a performance and project management approach
Shares accountability
Enhances scale and pace of change
Use of commitment goals (based on a shared sense of purpose) rather than compliance goals (minimum standard all must adhere to)
Organisation-wide involvement including leadership support/giving 'permission' to contribute to the project including the use of authority
Adequate training to prepare everyone with relevant knowledge and skills to work differently
Identification of champions and deputy to support staff and frequently monitor progress
Training/mentoring and support may be needed for some time for a change to be embedded in culture of organisation
Using evidence based methodology may support planned delivery of change using tried and tested methods
Use of appropriate outcome measures
Recognises change is happening and producing desired results
Needs to be relevant to the shared purpose to ensure most appropriate information collected
Enables celebration of successes
Mitigation of risk with prompt action if unforeseen consequences arise
Transparency of data ensures engagement of stakeholders
System Drivers/incentives e.g. standards to be achieved (local or national) to avoid penalties,personal incentives, culture, climate
Need to be aligned with quality improvement intent
Energy for change
= capacity/drive of team to make a difference necessary to achieve goals
Social energy - engagement/relationships and connections between people
Psychological energy - courage/resilience/safety
Physical energy
Intellectual energy - analysis/thinking/planning based on logical reasoning
Spiritual energy - common vision driven by shared values and purpose
Consistent effective leadership at all levels of an organisation
Consistency or low turnover of staff providing services
Changes to information systems
Incorporate data use with utilisation of appropriate personnel including admin support