Summary of Action Period 3

TN Patient Safety Collaborative: Reducing Physical Restraints

Learning Session 4

April 6, 7, & 8, 2010Beth Hercher, QI Specialist

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

Setting GoalsBarriers•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

Developing and Testing ChangesBarriers•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

Team Composition and FunctioningBarriers•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

Organizational Change IssuesBarriers•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

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

“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

Thank You!

TN Patient Safety Collaborative: Reducing Physical Restraints

Learning Session 4

April 2010

Beth Hercher, QI Specialistbhercher@tnqio.sdps.org901.273.2640