Spreading Successful Changes CDI Prevention Collaborative Audio Conference Call September 21,

C. Difficile Prevention Collaborative Agenda Introductions & Upcoming events Spreading changes: Tales from the trenches Spreading Change: principles and process Susanne Salem-Schatz, Sc.D. Collaborative Director Deb Hylander, MSN, RN, CIC, COHN-S Director of Infection Prevention Southcoast Hospitals Group Jane Taylor, D.Ed. Improvement Advisor St. Paul, Minnesota

Spreading Change Adapted from IHI’s IMPACT Collaborative Spread Presentation Jane Taylor, Ed.D. August 2011

Spread To other units in hospital To other hospitals in system To other hospitals in community for greater good To other cross continuum members

Spread: why & how do ideas spread Roger’s Diffusion Characteristics: – See it – Try it – Is it: Compatible? Easy to use? Better? – What supported it? Hindered it?

The Total Health Care System Cycles for testing and implementation What is Spread? P D A S P D A S P D A S P D A S P D A S

Set-up Success- ful Sites Socia l Syste m Better Ideas Communication Strategies Knowledge Management Measurement and Feedback Leadership A Framework for Spread

Spread Leadership: It takes a village to prevent HAI And Leadership Experience with Changes Willing receivers Accountability Better ideas : What are your best ideas, ready for spread? What has already spread?

Choosing “ Better Ideas ”

Attributes Affecting Rate of Adoption Relative advantage (evidence from testing) Compatibility with current system (structure, values, practices) Simplicity of the change and transition Testability of the change Ability to observe the change and its impact

Spread Exercise Choose one specific change (not just a vague concept) from your improvement work. Evaluate this change on the five attributes. Rate the change from a “ spread target ” point of view (not your point of view!). Use a 1- 5 scale: 1 - change is very weak relative to this attribute 3 - change is okay relative to this attribute 5 - change is very strong relative to this attribute Relative advantage Compatibility with current system Simplicity Testability of the change Ability to observe the change and its impact Total the evaluations for each of the attributes

What does the score mean? How easy will it be to spread the change: 25 = it will spread like wild fire 5 = no chance of spreading in present form Which attributes would you work on to increase the chance of spread? How?

Now to theory Set-up

Questions to Consider Target population: What changes do you plan to spread and to whom? Adopter audience: Who makes the adoption decisions for the improvements you plan to spread? Will adoption be voluntary for units, staff, providers?

Questions Do you need to tailor your message to specific adopter groups: patients, families, clinicians, providers, community, cross continuum partners, others? Does health literacy play a role or influence your communication strategy? Key partners: Do you have sufficient physician involvement? Have you identified partners and/or thought leaders in the target areas? Family and patients on team?

Social System

Late Majority Early Majority Early Adopters Innovators Types of Adopters 2%13% 35% 15% Traditionalists

The “ Tipping Point ” “ The name given to that one dramatic moment in an epidemic when everything can change all at once. ” - M. Gladwell “ The part of the diffusion curve from about 10 percent to 20 percent adoption is the heart of the diffusion process. After that point, it is often impossible to stop the further diffusion of a new idea, even if one wished to do so. ” - E. Rogers Tippin g point

Key Messengers Decision makers Thought leaders Innovators / early adopters Communities of practice / work groups

Adapted from Ashkenas, 1995 SHARE INFORMATION SHAPE BEHAVIOUR General Publications flyers newsletters videos articles posters Personal Touch letters cards postcards Interactive Activities telephone visits seminars learning sets modeling Face-to- face one-to-one mentoring seconding shadowing Ways to Communicate (C) 2001, Sarah W. Fraser Public Events Road shows Fairs Conferences Exhibitions Mass meetings

Measurement and Feedback

Data collection Outcome and/or process measures Progress of spread of specific ideas Reporting Evidence of progress / success Two-way communication with senior leaders, families, staff, community: – Progress reports to senior leaders & others – Senior leaders seek, hear and use feedback

Outcome Measurement over Time

Tracking Spread Progress

Knowledge Management

Managing Knowledge to Enable Spread Make the case for the new system – The reasons people would want to make the changes Describe the new system –“ What is being spread ” – The concepts and ideas that form the content of the new system Transition materials – Specific methods, tools, examples, and documents to assist people in adopting the content Technical Support – Where people can go with questions regarding the changes

Leadership Requirements for Spread Topic is a key strategic initiative Goals and incentives aligned Executive sponsor assigned Day-to-day managers or designated responsibility identified

Topic is a Key Strategic Initiative Topic is included in strategic aims and plans of practice or health center Leader(s) frequently reinforce the need to close the gap Senior executive(s): – Provide progress reports to the Board or Community – Calendar regular attention to the spread work

Goals and Incentives are Aligned Assure appropriate resources are assigned and engaged Recommend alignment of incentives sufficient to motivate leaders and new adopters

Day to Day Responsibility Identified Manager, staff, physicians may lie outside the original collaborative team Assign great performers Make it an important part of their regular jobs, not added work

Summing it Up: Managing Spread Create plan – Completeness vs. coverage -all changes vs key changes Set schedule Anticipate needed support services – IT – Case management/community liaison – Technical expertise Eliminate barriers – Accessible knowledge Measurement and feedback

Spread Strategy Matrix MayJuneJulyAugSept JonesABCD+ GutierrezA BCD WongABCD KreyCAB D West ClinicAB A= Isolation technique B=Hand cleaning C= xzy. D=abc

Set-up Target population Adopter audience Key partners A Framework for Spread Social System Adopter types Key messengers Communication Strategies Knowledge Management Measurement and Feedback Leadership Topic is a key strategic initiative Goals and incentives aligned Executive sponsor assigned Day-to-day managers identified Better Ideas Successful tests Positive attributes

References Attewell, P. Technology Diffusion and Organizational Learning, Organizational Science, February, 1992 Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, N.J.: Prentice Hall, Inc Brown J., Duguid P. The Social Life of Information. Boston: Harvard Business School Press, Cool et al. Diffusion of Information Within Organizations: Electronic Switching in the Bell System, 1971 –1982, Organization Science, Vol.8, No. 5, September - October Dixon, N. Common Knowledge. Boston: Harvard Business School Press, Fraser S. Spreading good practice; how to prepare the ground, Health Management, June Gladwell, M. The Tipping Point. Boston: Little, Brown and Company, Kreitner, R. and Kinicki, A. Organizational Behavior (2 nd ed.) Homewood, Il:Irwin,1978.

Upcoming Opportunities  Partnership CDI Prevention Collaborative for Acute Care Hospitals and Long Term Care Facilities  November 15 th Learning Session: Westborough  Final reports and follow up calls.