Toward a roadmap for sustainable lean adoption in hospitals: a Delphi study.

BACKGROUND: The benefits of lean adoption in healthcare include improved process efficiency and quality of patient care. However, research indicates that lean implementation in healthcare, and specifically hospitals, is often not sustained. Furthermore, there is a need for maturity models that guide lean implementation, specifically in hospitals. This study develops a prescriptive maturity model named the Sustaining of Lean Adoption in Hospitals Roadmap (SOLAR) that acts as a practical guideline for the sustainable adoption of lean in hospitals. METHODS: The SOLAR has three theoretical foundations, namely lean implementation success factors in hospitals, implementation science, and change management theory. A systematic literature review was conducted to determine the lean implementation success factors in hospitals as the first building block. Secondly, practices from implementation science were used to create the action items in the SOLAR. Ten change steps were elicited from change management theory as the third theoretical building block of the roadmap. We refined the roadmap through three Delphi rounds that verified its useability in hospitals. RESULTS: The final SOLAR consists of four maturity phases (prepare, plan, experiment and learn, and sustain) and includes action items for each phase related to the hospital's strategy, resources, engaging of people, and culture. The action items and change management steps shown in the SOLAR are not intended as an exhaustive list but provide guidelines on aspects hospitals must consider when they aim to adopt lean sustainably. CONCLUSIONS: The strong theoretical base of the SOLAR enables hospitals to safely experiment and learn which implementation methods are best suited to their unique environment. The SOLAR is, therefore, an actionable guideline that informs both academics and practitioners involved in lean adoption in hospitals. This roadmap can guide future retrospective longitudinal or action research.

What is known about the role of external facilitators during the implementation of complex interventions in healthcare settings? A scoping review.

OBJECTIVE: To synthesise current knowledge about the role of external facilitators as an individual role during the implementation of complex interventions in healthcare settings. DESIGN: A scoping review was conducted. We reviewed original studies (between 2000 and 2023) about implementing an evidence-based complex intervention in a healthcare setting using external facilitators to support the implementation process. An information specialist used the following databases for the search strategy: MEDLINE, CINAHL, APA PsycINFO, Academic Search Complete, EMBASE (Scopus), Business Source Complete and SocINDEX. RESULTS: 36 reports were included for analysis, including 34 different complex interventions. We performed a mixed thematic analysis to synthesise the data. We identified two primary external facilitator roles: lead facilitator and process expert facilitator. Process expert external facilitators have specific responsibilities according to their role and expertise in supporting three main processes: clinical, change management and knowledge/research management. CONCLUSIONS: Future research should study processes supported by external facilitators and their relationship with facilitation strategies and implementation outcomes. Future systematic or realist reviews may also focus on outcomes and the effectiveness of external facilitation.

Improving the Discharge Process at the VA Palo Alto Through Change Management and Implementation of Project Re-Engineered Discharge.

ABSTRACT: This quality improvement project demonstrates that nursing leadership with Project Re-Engineered Discharge can effect change in the discharge process and improve patient outcomes.

Approaches to Design an Efficient, Predictable Global Post-approval Change Management System that Facilitates Continual Improvement and Drug Product Availability.

The complexity and inter-connectedness of operating in a global world for drug product supply has become an undeniable reality, further underscored by the COVID-19 pandemic. For Post-Approval Changes (PACs) that are an inevitable part of a product's commercial life, the impact of the growing global regulatory complexity and related drug shortages has brought the Global PAC Management System to an inflection point in particular for companies that have their products marketed in many countries.This paper illustrates through data analyzed for the first time from 145,000 + PACs for 156 countries, collected by 18 global pharma companies over a 3-year period (2019-2021), how severe the problem of global regulatory complexity is. Only PACs requiring national regulatory agency (NRA) approval prior to implementation were included in the data set. 1 of the 156 country NRAs approved all submitted PACs within a period of 6 months. The 6-month timeline was chosen because it is the recommended review timeline for major changes in the WHO guidance for vaccines and biotherapeutic products. 10 out of the 156 (6%) countries had no more than 10% of the PACs reviewed and approved in > 6 months. In 33 (22%) countries more than half of the PACs took > 6 months for approval. It is rare that the same PAC is approved globally within 6 months as individual NRAs take from a few months to years (in some cases > 5 years) for their review.The global PAC management complexity has steadily grown over the past 20 years. Attempts thus far to solve this problem have not made any meaningful difference. Senior leaders and decision-makers across the interdependent components of the complex Global PAC Management System (industry and regulators) must come together and collaboratively manage the problem holistically with the objective of ensuring global drug product availability instead of continuing with distinct stakeholder or country-focused solutions, which can tend to worsen the problem.In this paper, the Chief Quality Officers (CQOs) from 18 of the largest innovator pharma companies (see Acknowledgements) are speaking with One-Voice-of-Quality for PACs (1VQ for PACs Initiative). They are recommending a set of 8 approaches to activate a holistic transformation of the Global PAC Management System. This article presents their view on the problem of global regulatory complexity for managing PACs, it's impact on continual improvement and the risk to drug product supply, as well as approaches that can help alleviate the problem.

Say Goodbye to the 'Paper on Screen', Rethinking Presentation of and Interaction with Medical Information.

Traditionally, Electronic Medical Records (EMR) have been designed to mimic paper records. Organizing and presenting medical information along the lines that evolved for non-digital records over the decades, reduced change management for medical users, but failed to make use of the potential of organizing digital data. We proposed a method to create clinical dashboards to increase the usability of information in the medical records. Official clinical guidelines were studied by a working group, including dashboard target users. Necessary clinical concepts contained in the medical records were identified according to the clinical context and finally, dedicated technical tools with standard terminologies were used to represent categories of information. We used this method to generate and implement a dashboard for sepsis. The dashboard was found to be appropriate and easy to use by the target users.

Toward a Theory of Organizational DNA: Routines, Principles, and Beliefs (RPBs) for Successful and Sustainable Organizational Change.

Organizational change is a key mechanism to ensure the sustainability of healthcare systems. However, healthcare organizations are persistently difficult to change, and literature is riddled with examples of failed change endeavors. In this chapter, we attempt to unravel the underlying causes for failed organizational change. We distinguish three types of change with different levels of depth that require different change approaches. Transformations are the deepest forms of change where beliefs and principles need to be modified to successfully influence routines. Renewals are deep forms of change where principles need to be modified to successfully influence routines. Improvements are shallow forms of change where only modifications at the level of routines are needed. Using deoxyribonucleic acid (DNA) as our metaphor, we propose a theory of "organizational DNA" to understand organizations and these three types of organizational changes. We posit that organizations are made up of a double helix consisting of a so-called "social string," which contains the "soft" interaction or communication among the organization's members, and a so-called "technical string," which contains "hard" organizational aspects such as structure and technology. Ladders of organizational nucleotides (i.e., Routines, Principles, and Beliefs) connect this double helix in various combinations. Together, the double helix and accompanying nucleotides make up the DNA of an organization. Without knowledge of the architecture of organizational DNA and whether a change addresses beliefs, principles, and/or routines, we believe that organizational change is constrained and based on luck rather than change management expertise. Following this metaphor, we show that organizational change fails when it attempts to change one part of the DNA (e.g., routines) in a way that renders it incompatible with the connecting components (e.g., principles and beliefs). We discuss how the theory can be applied in practice using an exemplar case.

Measure Twice, Change Once: Using Simulation to Support Change Management in Rural Healthcare Delivery.

Barriers to adequate healthcare in rural areas remain a grand challenge for local healthcare systems. In addition to patients' travel burdens, lack of health insurance, and lower health literacy, rural healthcare systems also experience significant resource shortages, as well as issues with recruitment and retention of healthcare providers, particularly specialists. These factors combined result in complex change management-focused challenges for rural healthcare systems. Change management initiatives are often resource intensive, and in rural health organizations already strapped for resources, it may be particularly risky to embark on change initiatives. One way to address these change management concerns is by leveraging socio-technical simulation models to estimate techno-economic feasibility (e.g., is it technologically feasible, and is it economical?) as well as socio-utility feasibility (e.g., how will the changes be utilized?). We present a framework for how healthcare systems can integrate modeling and simulation techniques from systems engineering into a change management process. Modeling and simulation are particularly useful for investigating the amount of uncertainty about potential outcomes, guiding decision-making that considers different scenarios, and validating theories to determine if they accurately reflect real-life processes. The results of these simulations can be integrated into critical change management recommendations related to developing readiness for change and addressing resistance to change. As part of our integration, we present a case study showcasing how simulation modeling has been used to determine feasibility and potential resistance to change considerations for implementing a mobile radiation oncology unit. Recommendations and implications are discussed.

Implementing Systemwide Physician Change Management in an Integrated Health Care Setting: Improving Physician Participation in an Advanced Care at Home Model.

INTRODUCTION: Advanced Care at Home is a clinical model that delivers hospital-level care in a patient's home. This model of care has been studied for decades, but there have been difficulties scaling the model to a higher census because of poor physician participation. Kaiser Permanente at Home, an Advanced Care at Home model created by Kaiser Permanente Northwest, was able to quickly increase its patient census by using several different change management interventions. The aim of this study was to describe the specific physician change management interventions used and to determine their relative impacts on physician participation with Kaiser Permanente at Home. METHODS: This study used a retrospective qualitative approach. Hospitalist and emergency department (ED) physicians completed an online survey in December 2021. This was followed by focused, one-on-one interviews that were held in February 2022. Content analysis was performed using a general inductive approach to identify core themes. RESULTS: Of 78 ED and 79 hospitalist physicians recruited, 35% submitted responses. Of these respondents, 16 (29%) were ED physicians, and 39 (61%) were hospitalist physicians. Of these respondents, 90% rated Kaiser Permanente at Home favorably over the course of a year. More than 90% of respondents rated a combination of multiple approaches as impactful, but respondents overwhelmingly noted that physician-to-physician engagement was the most important (51%). CONCLUSION: In the development of the Kaiser Permanente at Home, physicians highlighted that a multifactorial change management approach centered on peer-to-peer engagement had the most substantial effect on their participation, a process that could extend up to a year.

A practical tool for managing change: cross-sectional psychometric assessment of the safe surgery organizational readiness tool.

BACKGROUND: Strengthening health systems through planned safety and quality improvement initiatives is an imperative to achieve more equitable, resilient, and effective care. And yet, years of organizational behavior research demonstrate that change initiatives often fall short because managers fail to account for organizational readiness for change. This finding remains true especially among surgical safety and quality improvement initiatives in low-income countries and middle-income countries. In this study, our aim was to psychometrically assess the construct validity and internal consistency of the Safe Surgery Organizational Readiness Tool (SSORT), a short survey tool designed to provide change leaders with insight into facility infrastructure that supports learning and readiness to undertake change. MATERIALS AND METHODS: To demonstrate generalizability and achieve a large sample size ( n =1706) to conduct exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), a collaboration between seven surgical and anesthesia safety and quality improvement initiatives was formed. Collected survey data from health care workers were divided into pilot, exploration, and confirmation samples. The pilot sample was used to assess feasibility. The exploration sample was used to conduct EFA, while the confirmation sample was used to conduct CFA. Factor internal consistency was assessed using Cronbach's alpha coefficient. RESULTS: Results of the EFA retained 9 of the 16 proposed factors associated with readiness to change. CFA results of the identified 9 factor model, measured by 28 survey items, demonstrated excellent fit to data. These factors (appropriateness, resistance to change, team efficacy, team learning orientation, team valence, communication about change, learning environment, vision for sustainability, and facility capacity) were also found to be internally consistent. CONCLUSION: Our findings suggest that communication, team learning, and supportive environment are components of change readiness that can be reliably measured prior to implementation of projects that promote surgical safety and quality improvement in low-income countries and middle-income countries. Future research can link performance on identified factors to outcomes that matter most to patients.

Using the information-motivation-behavioral skills model for targeting older adults' climate change management practices: in the road of COP27.

BACKGROUND: Climate change is a rapidly evolving public health problem warranting global attention in the 21st century. The World Health Organization declared that climate illiteracy is highly prevalent among older adults, especially in lower- and middle-income nations. AIM: To determine the effect of the Information-Motivation-Behavioral Skills Model-based intervention for climate change management practices among older adults. DESIGN: A quasi-experimental employed a pre-posttest, two-group research design. PARTICIPANTS: The studied sample comprised 80 older adults (aged 60 years and above), assigned to study and control groups (n = 40 each) after completing a baseline survey of six validated measures. RESULTS: The study group of proposed intervention based on IMB model demonstrated significant improvement in the mean scores of information (98.62 ± 3.56), motivation (90.14 ± 3.02), actual skills (84.13 ± 8.76), and practices (85.80 ± 3.94), p = 0.001. CONCLUSION: The intervention based on the Information-Motivation-Behavioral Skills Model has demonstrated credible feasibility in significantly improving the climate change-related information, motivation, skills, and management practices of older adults immediately after the posttest. It should be emphasized that this improvement showed a significant decline at the six-week mark; albeit the study participants' scores remained significantly higher than their pre-test values, there is clearly a need for reinforcement to maintain positive outcomes over the long term. The existing outcomes call for replication of this intervention in other cohorts, such as uneducated older adults and those residing in assisted-living facilities.

Laboratório de Mudança na Polícia Militar de Santa Catarina: mapeando e enfrentando contradições na atividade e suas manifestações nos espaços de trabalho / Change Laboratory at Santa Catarina's Military Police: mapping and handling contradictions in activities and its manifestations in the workspace

Introdução: A atividade de policiais militares tem sido objeto de investigações científicas que indicam tratar-se de um trabalho carregado de tensões que impactam sua segurança, seu bem estar e sua saúde, sendo constatada uma correlação entre essa atividade e o adoecimento mental desses profissionais. A base e a demanda da pesquisa têm relação com essa temática específica e busca entender as razões organizacionais por trás desses fenômenos. Este estudo aborda as hipóteses de contradições identificadas no Sistema de Atividade (SA) da Polícia Militar (PM) e apontadas pela prática do método de intermediação formativa, conhecido por Laboratório de Mudança (LM), junto a um Batalhão da Polícia Militar de Santa Catarina (PMSC), Brasil. Objetivo: Descrever as hipóteses de contradições identificadas pelos trabalhadores participantes da pesquisa, compreender suas influências no surgimento de problemas por eles reconhecidos e estimular a proposição de planos coletivos de ações transformativas da atividade. Método: Consiste em uma pesquisa de cunho qualitativo que segue os passos daquilo que o método LM preconiza. A primeira fase compreende uma negociação para a viabilização da pesquisa. A segunda etapa etnográfica visa conhecer o SA da PMSC selecionada como uma unidade de análise que envolve visitas e observações do trabalho, entrevistas abertas, elaboração de quadros históricos e encontros coletivos para falar sobre a atividade. Os dados coletados na etapa etnográfica são utilizados como estímulos para o debate e formulação coletiva de propostas de transformações na atividade. A terceira fase inclui a realização de oficinas e sessões preconizadas na prática do método do LM, e planejadas a partir do ciclo de aprendizagem expansiva. Resultados: Os discursos dos participantes possibilitaram a identificação de contradições históricas que impactam o Sistema de Atividade da PM e apontam para problemas que influenciam negativamente no desenvolvimento de suas atividades bem como nas ações expansivas de aprendizagem. Além de seu lugar num dos vértices do SA, os espaços e ambientes físicos destinados ao trabalho podem se constituir em manifestações dessas contradições apontadas pelo discurso ao longo de toda a pesquisa. Conclusões: Este estudo contribui com a produção de conhecimento acerca da formulação de contradições manifestadas discursivamente, as quais envolvem o Sistema de Atividade, ajudando a explicar a insatisfação e os sentimentos negativos relacionados ao trabalho. Ao serem trazidas à luz, revelam problemas que podem vir a ser objetos de análise e transformações protagonizadas pelos trabalhadores. Os espaços oferecidos para o trabalho, ou a sua inexistência, os quais foram desvendados pelo discurso, são trazidos à tona quando analisados dentro do contexto de manifestações de contradições do SA.

Introduction: The activity of military police officers has been the subject of scientific investigations that indicate that it is a job fraught with tensions that impact their safety, well-being and health, with a definite correlation between this activity and mental health illnesses among these professionals. The basis and demand for this research are related to that specific theme and seeks to understand the organizational reasons behind these phenomena. This study addresses the hypotheses of contradictions identified in the Activity System (SA, in the Portuguese acronym) of the Military Police (PM, in the Portuguese acronym), and recognized in their compliance with the formative intermediation method, known as Change Laboratory (LM, in the Portuguese acronym), within a Battalion of the Military Police of Santa Catarina (PMSC), in Brazil. Objective: To describe the hypotheses of contradictions identified by the professionals who participate in the research, understand their influences on the emergence of problems recognized by the participants and encourage the proposal of collective transformative action plans for the activity. Method: It comprises a qualitative research that follows the steps of that which the LM method recommends. The first phase consists of negotiations to make this research feasible. The second ethnographic stage aims to get to know the SA of the selected PMSC as a unit of analysis that involves visits and observations of their work, open interviews, development of historical tables, and collective meetings to talk about the activity. The data collected during the ethnographic stage are used to promote debates and collective formulation of proposals for transformations in the activity. The third phase includes workshops and sessions recommended and in compliance with the LM method, and planned based on an expansive learning cycle. Results: The participants' statements enabled the identification of historical contradictions that impact the Military Police Activity System and suggest problems that negatively influence the development of the activities as well as the expansive learning actions. Apart from their place in one of the vertices of the SA, spaces and physical areas intended for work can constitute manifestations of these contradictions as suggested by the participants' discourse throughout the research. Conclusions: This study contributes to the production of knowledge about the formulation of hypotheses of contradictions which were verbally expressed and which involve the Activity System, contributing to the explanation of the feelings of negativity and dissatisfaction related to work. When exposed, they reveal problems that may become the subject of analysis and transformations carried out by the workers. The spaces available for working, or the lack thereof, which were brought up by the workers', are exposed when analyzed within the context of the manifestations of SA contradictions.

Nurses' perceptions of leadership in Brazilian hospitals during COVID-19 through Kotter's conception / Percepções de enfermeiros sobre liderança em hospitais brasileiros na COVID-19 pela concepção de Kotter / Percepciones de los enfermeros sobre el liderazgo en hospitales brasileños durante la pandemia de COVID-19 según la concepción de Kotter

Abstract Objective: to understand nurses' leadership perceptions during the COVID-19 pandemic in Brazilian university hospitals, through the lens of John Kotter's concepts and his eight-step change model. Method: a multicenter qualitative research with an analytical design. The sample comprised 139 nurses working in COVID-19 settings, interviewed using a semi-structured interview guide. Data were categorized through Bardin's content analysis based on John Kotter's concepts and his eight-step change model. Results: the findings yielded significant insights into nurses' perceptions of leadership during the COVID-19 response, which exhibited characteristics consistent with Kotter's principles. There is evidence of leadership based on the pursuit of knowledge, grounded in polished communication, facilitating teamwork through a relationship of trust and respect. The recognition of the complexity and difficulty of exercising nursing leadership, particularly in crisis contexts, is apparent. Conclusion: nurses' perceptions reinforce essential elements for leadership practice, such as the importance of seeking diverse knowledge, polished communication, relationships based on trust and respect, and recognition of the complexity of leadership, thus presenting characteristics in line with Kotter's principles.

Resumo Objetivo: conhecer as percepções de liderança de enfermeiros durante a pandemia da COVID-19 em hospitais universitários brasileiros, pela concepção dos conceitos do referencial de John Kotter e seu modelo de mudança de oito etapas. Método: pesquisa multicêntrica de natureza qualitativa e delineamento analítico. A amostra foi constituída por 139 enfermeiros atuantes na COVID-19 entrevistados mediante um roteiro de entrevistas semiestruturadas, categorizadas por meio de análise de conteúdo de Bardin com base nos conceitos de John Kotter e seu modelo de mudança de oito etapas. Resultados: os achados resultaram em importantes percepções dos enfermeiros acerca da liderança durante o enfrentamento da COVID-19, que apresentaram características condizentes com os preceitos de Kotter. Evidencia-se uma liderança baseada na busca pelo conhecimento, pautada em uma comunicação polida, facilitando o trabalho em equipe por meio de uma relação de confiança e respeito. O reconhecimento da complexidade e dificuldade que é exercer a liderança do enfermeiro, principalmente, em contextos de crise. Conclusão: as percepções dos enfermeiros reforçam elementos essenciais para a prática da liderança, como a importância pela busca de conhecimentos múltiplos, comunicação polida, relação baseada na confiança e respeito, e o reconhecimento da complexidade em liderar, apresentando, assim, características acerca dos preceitos de Kotter.

Resumen Objetivo: comprender las percepciones sobre liderazgo de los enfermeros durante la pandemia de COVID-19 en hospitales universitarios brasileños, a través de la concepción de los conceptos del marco de John Kotter y su modelo de cambio de ocho pasos. Método: investigación multicéntrica de carácter cualitativo y diseño analítico. La muestra estuvo compuesta por 139 enfermeros que trabajaban durante la pandemia de COVID-19 entrevistados mediante una guía de entrevistas semiestructuradas; categorizadas a través del análisis de contenido de Bardin basándose en los conceptos de John Kotter y su modelo de cambio de ocho pasos. Resultados: los hallazgos revelaron importantes percepciones de los enfermeros sobre el liderazgo en la lucha contra el COVID-19, que presentó características consistentes con los preceptos de Kotter. Se observa un liderazgo basado en la búsqueda del conocimiento y una comunicación respetuosa, que facilita el trabajo en equipo por medio de una relación de confianza y respeto. Se reconoce lo complejo y difícil que es ejercer el liderazgo como enfermero, especialmente en contextos de crisis. Conclusión: las percepciones de los enfermeros destacan elementos esenciales para la práctica del liderazgo, como la importancia de adquirir múltiples conocimientos, tener una comunicación respetuosa, relaciones basadas en la confianza y el respeto, y reconocer la complejidad del liderazgo, que representa las características de los preceptos de Kotter.

Arcabouço teórico-metodológico, funções e efeitos do apoio institucional à saúde no contexto do Sistema Único de Saúde / Theoretical-methodological framework, functions, and effects of institutional support in health within the Brazilian National Health System (SUS)

Resumo Os arranjos de apoio institucional têm se destacado como um modo inovador de gestão. Este artigo objetivou sumarizar e analisar o arcabouço teórico-metodológico e os efeitos do apoio institucional no contexto do Sistema Único de Saúde (SUS) e sintetizar os conceitos, as funções e as habilidades do apoiador institucional. Uma revisão de escopo foi empreendida em diferentes bases científicas, resultando em 89 publicações, cuja análise indicou que os conceitos e métodos de apoio se ancoram no Método Paideia, que intenciona a democratização da gestão. Os apoiadores institucionais, com esse objetivo, atuam como articuladores dos diversos jeitos de gerir a micropolítica dos espaços coletivos, fornecendo suporte para o movimento de ampliação da descentralização do poder e para a geração de autonomia. Os efeitos de sua aplicação expressam processos de democratização institucional, que se traduzem como dilatação da autonomia dos sujeitos nos processos decisórios, da reflexão crítica e compreensão dos processos instituídos. Esses efeitos também expressam novos modos de produzir saúde, que buscam romper com as práticas de saúde repetitivas, cristalizadas e cronificadas. As evidências publicadas não nos permitiram refletir a respeito dos limites macro e microinstitucionais concretamente encontrados na implementação do apoio, colocando-nos o desafio de adentrarmos cientificamente nas práticas de socialização de recursos de poder operadas pela função apoio.

Abstract Institutional support arrangements have stood out as an innovative mode of management. This study aimed to summarize and analyze the theoretical-methodological framework and the effects of institutional support within the Unified Health System (SUS) and synthesize the concepts, functions, and skills of the institutional supporter. A scoping review was undertaken on several scientific bases, retrieving 89 publications, the analysis of which indicated that the concepts and supporting methods are anchored in the Paideia Method, which aims to democratize management. Institutional supporters, with this objective, articulate different ways of managing the micropolitics of collective spaces, supporting the movement to expand the decentralization of power and generate autonomy. The effects of its application express processes of institutional democratization, which expand the autonomy of subjects in decision-making processes, offer critical reflection and understanding of the established processes, and new ways of producing health to break with repetitive, crystallized, and chronic health practices. The published evidence prohibits us to reflect on the macro- and micro-institutional limits concretely found in the implementation of support, posing the challenge of scientifically entering the practices of socialization of power resources operated by the support function.

Change Management and Health Care Culture.

Change management in health care is the process of implementing new policies, procedures, and practices in order to improve the quality of patient care. It involves understanding the need for change, identifying the stakeholders involved, and developing a plan to implement and manage the change. Change management in health care requires a comprehensive and collaborative approach to ensure that changes are properly implemented, communicated, and monitored. It is essential for health care providers to be aware of the current trends in health care and to stay up to date with the latest technology in order to provide the best care possible.

A Trainee-Led Quality Improvement Project Using Change Management Theory to Improve Bedside Rounding.

OBJECTIVE: The coronavirus disease 2019 pandemic disrupted the practice of family-centered rounds. After the height of the pandemic, a trainee-led team identified a low percentage of bedside rounds on general pediatrics resident teams and combined a quality improvement framework and change management theory to increase bedside rounds. Initial efforts focused on a single general pediatrics team with the aim to increase bedside rounds from 18% to 50% within 6 months and sustain improvement for 12 months. A second aim was to increase bedside rounds from 7% to 50% for all general pediatrics resident teams within 6 months of spread. METHODS: The Model for Improvement informed the identification of 3 primary drivers of bedside rounds: knowledge, culture, and logistics. Twelve plan-do-study-act (PDSA) cycles were implemented. Measures included the percentage of bedside rounds (primary outcome), caregiver attendance (secondary outcome), and nurse attendance and rounding time (balancing measures). RESULTS: For the initial team, 13 522 patient days were analyzed for the primary outcome with the average percentage of weekly bedside rounds increasing from 18% to 89% with 12 months of sustained improvement. The spread of the intervention to all teams revealed an increase in bedside rounding from 7% to 54%. The most significant improvements occurred after PDSA cycle 2, a communication bundle, and PDSA cycle 5, when the project was spread to all teams. CONCLUSIONS: This trainee-led initiative reveals the strength of the incorporation of change management theory within a quality improvement framework, resulting in rapid and sustainable increase in bedside rounds.

Successful Change Management Strategies for Improving Diabetes Care Delivery Among High-Performing Practices.

PURPOSE: To learn how the highest-performing primary care practices manage change when implementing improvements to diabetes care delivery. METHODS: We ranked a total of 330 primary care practices submitting practice management assessments and diabetes reports to the Understanding Infrastructure Transformation Effects on Diabetes study in 2017 and 2019 by Optimal Diabetes Care performance. We ranked practices from the top quartile by greatest annual improvement to capture dynamic change. Starting with the top performers, we interviewed practice leaders to identify their most effective strategies for managing change. Interview transcripts were qualitatively analyzed to identify change management strategies. Saturation occurred when no new strategies were identified over 2 consecutive interviews. RESULTS: Ten of the top 13 practices agreed to interviews. We identified 199 key comments representing 48 key care management concepts. We also categorized concepts into 6 care management themes and 37 strategic approaches. We categorized strategic approaches into 13 distinct change management strategies. The most common strategies identified were (1) standardizing the care process, (2) performance awareness, (3) enhancing care teams, (4) health care organization participation, (5) improving reporting systems, (6) engaging staff and clinicians, (7) accountability for tasks, (8) engaging leadership, and (9) tracking change. Care management themes identified by most practices included proactive care, improving patient relationships, and previsit planning. CONCLUSIONS: Top-performing primary care practices identify a similar group of strategies as important for managing change during quality improvement activities. Practices involved in diabetes improvement activities, and perhaps other chronic conditions, should consider adopting these change management strategies.

Introducing change management education program for family medicine residents: a demonstration project.

Implication Statement: The project presents an innovative mixed learning approach program to provide basic change management training for family medicine residents. Developed by a team of faculty experts in the Department of Family Medicine at the University of Manitoba, this three-to-four-hour training program provided residents an understanding of an approach to change management that systematically plans, implements, and evaluates new initiatives in healthcare settings. Students reported that change management is important for their success as healthcare professionals. This program could easily be replicated. Énoncé des implications de la recherche: Ce projet consiste en programme novateur fondé sur une approche d'apprentissage mixte visant à offrir une formation de base en gestion du changement aux résidents en médecine familiale. Élaborée par une équipe de professeurs experts du département de médecine familiale de l'Université du Manitoba, cette formation d'une durée de trois à quatre heures a permis aux résidents de se familiariser avec une approche de la gestion du changement qui consiste à planifier, à mettre en œuvre et à évaluer systématiquement de nouvelles initiatives en milieu clinique. Les étudiants estiment que la gestion du changement est un facteur important pour leur réussite en tant que professionnels de la santé. Ce programme peut aisément être reproduit ailleurs.

Design thinking sprints as a facilitation process to enact change in the residency match process and beyond.

Implication Statement: Enacting change in medical education requires effective facilitation processes. Medical education lags behind other fields in systems innovation and radically disruptive approaches to the challenges we encounter. Design thinking "sprints," widely used in many other settings, serve as an opportunity to fill the gap as a facilitation process during periods requiring extensive and/or rapid change. Though resource-intensive, our experience using design thinking sprints for a situation requiring urgent change management with high-stakes implications for Canadian medical education to demonstrate their utility. A more widespread, adoption can contribute to innovation within all aspects of education including curriculum design, policy development, and educational process renewal. Énoncé des implications de la recherche: La mise en œuvre de changements dans la formation médicale exige un processus de facilitation efficace. Comparée à d'autres disciplines, l'éducation médicale est à la traîne en ce qui concerne l'innovation des systèmes et l'adoption d'approches radicalement transformatrices en réponse aux défis rencontrés. Le sprint de conception creative (design thinking sprints), approche largement utilisée dans de nombreux contextes, pourraient permettre de combler le manque de processus de facilitation lorsque des changements importants ou rapides sont à l'œuvre. Notre expérience de l'utilisation de tels sprints dans une situation nécessitant une gestion urgente de changements à enjeux importants pour l'éducation médicale au Canada démontre son utilité, malgré les ressources considérables qui ont dû être mobilisées. Une adoption plus large de cette approche peut contribuer à l'innovation dans tous les aspects de l'éducation, y compris la conception des programmes d'études, l'élaboration de politiques et le renouvellement des processus éducatifs.