1. Facilitating Change and the Concept of Spread Content adapted for CMRI Collaboratives from materials developed by the Institute for Healthcare Improvement

2. The Role of the Collaborative Team  Make improvements in management of Surgical Site Infections in your facility  Spread the improvements to others

3. “Real improvement comes from changing systems, not changing within systems.” – Berwick

4. Spreading the Improvements to Others Population for Spread Target Population in your Aim Statement - Other clinicians - Other units - Other clinics - Other hospitals

5. Spread Questions  Spread What?  Spread to Whom and Where?  When to Spread?  How to Spread?

6. Spread What?  Test of change  Successful change strategy, ready for implementation

7. Spread to Whom and/or Where?  Other clinicians, i.e., surgical staff  Other types of surgery  Other departments of surgery  Other hospitals

8. When to Spread  Spread change from pilot populations to the target population as successful intervention strategies are defined  Spread improvement to additional populations after success in the target population is demonstrated

9. How to Spread: Make the Case for Change  How to sway and motivate?  Show evidence supporting the changes (literature, experience)  Describe the benefits  Let your data (annotated run charts) “tell the story”

10. Organizational Approach: Facilitating Change  Improving the management of the surgical patients is a strategic initiative within the organization  Improvement team demonstrates success with the proposed changes  Executives (senior leaders) are supporting the changes and planning the spread

11. What You Can Do to Help with Adoption of Change  Help to make the case for change  Make the “new way” easier  Consider spheres of influence  Develop your network–agents of change  champions  messengers

12. Develop the Messengers  Remember to consider spheres of influence  Utilize your senior leader  Choose the right messengers  Opinion leaders  Connectors  Educate the messengers (to deliver the message)

13. Adopter Categorization (speed of adoption) Early Adopter s Early Majority Late Majority Traditionalists Innovators 2.5% 13.5% 34% 16% Cultural change System-wide supports Source: Everett Rogers, 1995

14. Active Resistance  Critical, demeaning comments  Finding fault  Selective use of facts  Active sabotage  Intimidation  Distorting facts  Spreading rumors

15. Passive Resistance  Verbal agreement, “yes-ing” and nodding  Playing dumb  Withholding critical information  Actions don’t support words  Standing by and watching failure  Portraying the “victim”

16. Peg Game Exercise

17. The Peg Exercise  Consists of an exercise board of a “representative” equilateral triangle with 15 circles within the exercise field  Each circle is consecutively numbered from one (1) to 15  Marker (M&Ms) are placed on all but one position  The goal is to jump a single, adjacent M&M along the path lines indicated and to remove the jumped M&M (please do not eat them until the end)  The exercise is over when no more M&Ms can be jumped  The desired finishing point is only one M&M remaining on the exercise board  Please work quietly  Each participant should note how many M&Ms you had left on the exercise board at the end

18. The Peg Exercise

19. What are we trying to accomplish? How will we know that a change is an improvement? What change can we make that will result in improvement? Model for Improvement ActPlan StudyDo

20. To Be Considered a PDSA Cycle:  The test or observation was planned (including a plan for collecting data).  The plan was attempted ( do the plan).  Time was set aside to analyze the data and study the results.  Act ion was rationally based on what was learned. Improvement Guide pp.60-61

21. PDSA for the “PEG Exercise”

22. The Peg Exercise

23. “Change is disturbing when it is done to us. Change is exhilarating when it is done by us.” – Rosebeth Kantor

24. “The definition of ‘insanity’ is continuing to do the same thing over and over again and expecting a different result.” – Albert Einstein

25. Q & A

26. Please complete your evaluation.