1. Summary of Action Period 3 TN Patient Safety Collaborative: Reducing Physical Restraints Learning Session 4 April 6, 7, & 8, 2010 Beth Hercher, QI Specialist

2. Hardwiring Changes by Overcoming Barriers to Change Setting goals Developing and testing changes Team composition and functioning Organizational change issues

3. Setting Goals Barriers Goal is not a stretch Goal gets diluted over time Initial goal statement is unclear Solutions Enlist senior leaders Identify barriers, seek solutions Outline approach and timeline Repeat & review goals at team meeting

4. Developing and Testing Changes Barriers Disagreement on change concepts “We’ve tried this before” Disagreement on what to change first Fear that resources will not be available Solutions Establish process changes first. Include front line staff Identify why previous efforts have failed Testing ideas provides quick assessment of what will work Share plans with leaders and get feedback; be specific about skills and resources needed

5. Team Composition and Functioning Barriers Change may create additional work for front line staff Team meetings unproductive Team does not meet regularly Team does not follow through Solutions Make changes part of day-to- day routine; include front-line staff in designing changes Establish team rules Investigate reasons, lack of focus Clarify specific responsibilities and time frames for completing

6. Organizational Change Issues Barriers Interdepartmental Resistance to change Physician resistance Mergers, downsizing or reorganization No visibility for the project “That won’t work here” Solutions Bring them into the project Work with early adopters Identify one physician champion Align project with organizational goals Storyboard, facility newsletter/ poster Recruit resisters

7. Hardwiring Changes Summary Establish and document clear goal-setting Use concurrent monitoring/feedback Align the project with organizational goals Make reversal as difficult as possible Establish and reward ownership Leadership buy-in and support

8. “Today’s problems will not be solved with the same thinking that created them.” — Albert Einstein This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSource-TN-PS-2010-05

9. Thank You! TN Patient Safety Collaborative: Reducing Physical Restraints Learning Session 4 April 2010 Beth Hercher, QI Specialist bhercher@tnqio.sdps.org 901.273.2640