The Common Sense Guide to Improving Palliative Care > 2.7 Making the Changes Stick

This extract from the online edition of The Common Sense Guide to Improving Palliative Care is used with permission.

Making the Changes Stick

After successfully implementing changes on a small scale, the challenge is to make them stick, so that old practices do not take over. Here are a few ideas on how to do this.

1. Establish and document the improved processes: procedures, guidelines, order sheets, forms, and so forth.
2. Revise job descriptions to make sure that someone is responsible for the new processes.
3. Assign responsibility to particular people to monitor repeated backsliding (e.g., to report at staff meetings every quarter).
4. Add the new processes to training materials for new staff.
5. Tell others in your organization and community about your progress, and make participants proud of it. Share positive feedback from patients and families.

Give Them Something to Talk About

Once you have made improvements, spread the good word to other units in your organization or to other organizations. You can help to spread improvement by taking the following steps:

• Make the case for change by posting storyboards that show your success, by presenting your work in meetings or at conferences, and writing about your work in newsletters.
• Make it easier for others to do the work by thinking of your procedures, forms, and protocols as a kit that someone else could quickly put to use.
• Develop the messengers by supporting team members who are good communicators, helping them package the message, and finding forums in which to share it.

Early on in your project, think about ways to spread the improvement, and plan for how you will do so. Keep in mind the opportunities and barriers that you will face, and decide on a strategy that can get the most done within the limits of personnel and time. Hammer out these three following issues with your team:

Spread what: What will we have that could be worth implementing elsewhere?

Spread where: Who would benefit most from our work? Is it another kind of patient or another part of our organization?

Spread when: At what point in your project should you begin sharing it with others in your organization? When do you know your changes are really improvements, and how will you decide that your ideas are worth trying elsewhere?

Based on your answers, you can now develop an implementation plan to spread your process improvement.

How to Motivate People to Take on the Process of Change Themselves

• Show evidence.
• Describe the benefits, tell patients' stories.
• Use your annotated time series to "tell the story."
• Target influential people and sites.
• Do not try to convince the most resistant people first.
• Build enthusiasm and commitment where you can.

Final Rules of Thumb

It seems like a lot to keep in mind while trying to manage your "day job," too. Here are a few basic pointers to encourage you along the way.

• What can we do by next Tuesday? Keep it simple, and get it started.
• Set stretch goals that will make it worthwhile.
• Go for the low-hanging fruit by starting with easier projects or in units where staff will be friendly.
• You can only fix what you can measure.
• If we keep doing what we have been doing, we will keep getting what we have been getting. To get something better, we have to start doing something differently.