Who else wants to help?
Improvement is about teamwork – you can’t improve things on your own. It’s important to build a team of people to work together as involving the right people from the start is more likely to lead to a sustained improvement.
together to review patient discharge pathways
What does a good team look like?
Teams will vary depending on what it is you are trying to do. The most important thing is to make sure that all interested parties are represented. A good team includes people from different groups – commonly missed groups include patients, IT, Finance and HR. A good team also has leadership – these are the leadership roles:
How to build your team
- Think about team roles: who will lead? Who will act as sponsor? Would an improvement coach be helpful?
- It’s really important to involve people affected by the change – the team will need each other’s support and ideas to move forward.
- Consider doing a stakeholder analysis – this will help to identify who the team needs to include and talk to
- Give people the opportunity to be involved, even if there is disagreement about what the team is trying to do
- Show everyone the evidence about why change is needed – a patient or staff story is useful and can be very powerful
- When you start, discuss as a team why this work is important
Involving others in change
All improvement is change. People react to change in different ways depending on what the change is and how they feel about it. How you identify and respond to people’s feelings on change is important to the success or failure of a project.
The Everett Rogers Innovation Curve helps us to understand the way in which we all react to something new. Not everyone will think that change is a great idea.
At the beginning are the innovators and early adopters who are comfortable with gut decisions and want to be the first – they‘re happy to jump straight in and try something new. Then there are the early and late majority, who want to see someone else try it first before they‘ll give it a go. At the end are the laggards, who’d rather not change at all. It’s useful to appreciate and accept that there will always be a minority of people who don’t want the change and that’s totally normal – it’s still helpful to listen to and address their concerns.
There is also a chasm between the early adopters and the majority – this chasm represents people’s fear & resistance to change. Something is needed to convince the majority to step over this chasm and get engaged with the change. One of the best ways to engage people is by appealing to what they believe – the why. Why are we doing this, why are we changing this – in healthcare it’s helpful to focus on advantages for patients and/or staff to explain the curve.
To learn more about this, you can watch these TED Talks:
- Simon Sinek: Start with “Why?” TED Talk: https://www.youtube.com/watch?v=u4ZoJKF_VuA
- Ernesto Sirolli: Want to help someone? Shut up and listen! TED Talk https://www.youtube.com/watch?v=chXsLtHqfdM
Stakeholder analysis
Stakeholder analysis is a tool that helps to identify who you should engage at what level and helps identify who should be part of your team. A stakeholder is anyone who can influence the change or anyone who may be affected by it. Change affects a range of stakeholders in different ways, which is why it’s important to identify and engage them from the start.
This is a stakeholder analysis tool, which can map your stakeholders into specific groups
The vertical axis represents power/influence so how much each stakeholder has power or influence over your improvement project.
The horizontal axis represents level of interest from low to high – how much each stakeholder is interested in the improvement project. This is often influenced by how much they’ll be impacted by the change itself e.g. if they’ll have to change how they work day-to-day.
You can brainstorm all the stakeholders and groups (could be individuals or staff groups) you think will be impacted or interested in the project. You can write each group/individual on a post-it and then then align each stakeholder to where you feel they sit on the graph – some stakeholders may overlap groups or move from one to another as the project progresses.
A lack of engagement from stakeholders can prevent projects from progressing, so it is essential that everyone is involved from the start.
If we don’t engage stakeholders, we get it wrong:
• Lack of engagement impedes change processes and ultimately what is achieved
• Resistance to the change – both direct and indirect
It’s important to get representation and input from all stakeholder groups. This includes patients and carers: we should include them as partners for change, to co-design and deliver changes that are relevant for everyone.
TOP TIP – Deciding on the scale of change
One way to help overcome some of the concerns around change is to consider the scale of the change you will eventually test.
This chart is a useful way of deciding the scale of your change:
The vertical axis represents the team’s confidence that the change will or will not result in an improvement – either a low or high degree of belief that the idea will lead to an improvement. You should also think about the impact of the change itself – to understand whether the cost of failure would be large or small. Cost of failure is subjective and will vary depending on your team and the change you want to test – you could think about clinical, operational or financial risks.
The horizontal axis represents the team’s level of engagement and their readiness to change – are they willing to try something new or are they resistant to change.
If there is a low degree of belief that the change will result in an improvement, large cost of failure and low commitment to change, start very small – maybe testing a new way of working with one patient or for one day and seeing what happens. However, if there is a high degree of belief that the change will result in an improvement, small cost of failure and the team has some or a strong commitment to trying something new, consider a larger scale test.
Once you start testing changes, even if you start very small, you’ll build your team’s confidence, belief and readiness to change. As your confidence and belief increases, you can increase the scale of tests and keep trying new ideas.
Before you test any changes (big or small), you should understand how things work in your area now. To learn more, click on the ‘Understand’ icon below.