Change Management: Classroom Slides

TeamSTEPPS® Long-Term Care Version, Module 8

The Long-Term Care version of TeamSTEPPS adapts the core concepts of the TeamSTEPPS program to reflect the environment of nursing homes and other other long-term care settings such as assisted living and continuing care retirement communities. The examples, discussions, and exercises below are tailored to the long-term care environment.

Contents


Slide 1: Change Management: How to Achieve a Culture of Safety

Change Management: How to Achieve a Culture of Safety.

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Slide 2: Objectives

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  • Identify and discuss the Eight Steps of Change.
  • Describe the actions required to set the stage for organizational change.
  • Identify ways to empower team members to change.
  • Discuss what is involved in creating a new culture.
  • Begin planning for the change in the nursing home.

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Slide 3: 8 Steps of Change

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Eight Steps of Change (from bottom up):

  • Create sense of urgency.
  • Build the guiding team.
  • Develop a change vision and strategy.
  • Understanding and buy-in.
  • Empower others.
  • Short-term wins.
  • Don't let up—Be relentless.
  • Create a new culture.

Image: Penguins are shown climbing up an iceberg. Each level is labeled as one Step of Change.

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Slide 4: Set the Stage and Create a Sense of Urgency

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  • Get people's attention!
  • Sell the need for change... sell the pain and the consequences of not changing.
  • Immerse people in information about the change.
  • Discuss ways to solve the problems people identify with the change.
  • Empower people to solve the "problem".

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Slide 5: Pull Together the Guiding Team

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  • Choose key players, especially staff-level managers.
  • Multidisciplinary.
    • Goal is informed; intelligent decisions are being made.
  • Credibility and integrity of change leaders.
  • Choose proven leaders who can drive the change process.
    • Strong position power, broad expertise, and high credibility.
  • Need both management and leadership skills.
    • Management skills control the process.
    • Leadership skills drive the change.

...TeamSTEPPS initiative should have a designated executive sponsor.

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Slide 6: Develop the Change Vision and Strategy

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Senior Leadership is responsible for:

  • Establishing the definition of a "culture of safety" aligned with expectations, core values, and shared beliefs.
  • Informing the organization of these values and evaluating the culture.
  • Leading the process of:
    • Establishing trust and accountability.
    • Translating values into expected behaviors
  • Communicating a commitment to shaping the culture.

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Slide 7: Communicate for Understanding and Buy-In

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  • Provide supportive actions for fear, anger, and resistance.
  • Encourage discussion, dissent, disagreement, debate ... keep people talking.
  • Tell people what you know—and what you don't know.
  • Acknowledge people's pain, perceived losses, and anger.
  • Value resisters:
    • They clarify the problem and identify other problems that need to be solved first.
    • Their tough questions can strengthen and improve the change.
    • They may be right—it is a dumb idea!

...communicate, communicate, communicate...

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Slide 8: Empower Others to Act

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  • Develop a shared sense of purpose.
  • Align structures with vision and goals.
  • Train employees so they have the desired skills and attitudes.
  • Align information systems and personnel with the vision and goals.
  • Confront high-level resisters.

An organization cannot be improved from the top only.

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Slide 9: Produce Short-Term Wins

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  • Provide further impetus for change.
  • Provide positive feedback:
    • Further builds morale and motivation.
  • Lessons learned help in planning next goal.
  • Create greater difficulty for resisters to block further change.
  • Provide leadership with evidence of success.
  • Build momentum:
    • Helps draw in neutral or reluctant supporters.

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Slide 10: Don't Let Up

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  • Acknowledge hard work.
  • Celebrate successes and accomplishments.
  • Reaffirm the vision.
  • Bring people together toward the vision.
  • Acknowledge what people have left behind.
  • Develop long-term goals and plans.
  • Provide tools and training to reinforce new behaviors.
  • Reinforce and reward the new behaviors.
  • Create systems and structures that reinforce new behaviors.
  • Prepare people for the next change.

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Slide 11: Create a New Culture

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  • Develop action steps for stabilizing, reinforcing, and sustaining the change:
    • Give people time to mourn their actual losses.
    • Provide skill and knowledge training.
    • Revise job descriptions.
    • Develop new reward systems.
    • Strengthen social connections and relationships.
    • Recognize and celebrate accomplishments.
  • Develop performance measures to continually monitor the results from the change and to identify opportunities for further improvements.
  • Make adjustments to the change vision and strategy to reflect new learning and insights.
  • Challenge people to be open to new challenges, forces, and pressures for the next change.

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Slide 12: Errors Common to Organizational Change

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  • Allowing for complacency.
  • Failing to create a sufficiently powerful Guiding Coalition and Change Team.
  • Not truly integrating the vision.
  • Allowing for obstacles.
  • Not celebrating "short-term wins".
  • Declaring victory too soon.
  • Neglecting to anchor changes firmly in the culture.

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Slide 13: Shift Toward a Culture of Safety

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Image: A decision chart shows the shift process in three phases.

Phase 1: Assessment. The elements of Pre-Training Assessment include Site Assessment, Culture Survey, and Data/Measures. Are these ready? If No, pass through to Climate Improvement and return to Pre-Training Assessment. If Yes, proceed to Action Plan, then move on to Phase 2.

Phase 2: Planning, Training and Implementation. Training leads to Intervention. Intervention includes testing and leads to Phase 3.

Phase 3: Sustainment. This phase includes Culture Change: Coach and Integrate, Monitor the Plan, and Continuous Improvement. Continuous improvement involves going back to Training to lead to more Culture Change.

The process is summarized at the bottom of the chart: Set the stage. Decide what to do. Make it happen. Make it stick.

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Slide 14: Culture Change Comes Last, Not First!

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  • Most alterations in norms and shared values come at the end of the transformation process.
  • New approaches sink in after success has been proven.
  • Feedback and reinforcement are crucial to buy-in.
  • Sometimes the only way to change culture is to change key people.
  • Individuals in leadership positions need to be on board.
    • Otherwise, the old culture will reassert itself.

...Reculturing takes time and it really never ends.

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Slide 15: Roadmap to a Culture of Safety

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Image: Penguins are trying to find their way to safety. The penguins leave the water because of a barking seal (catalytic event drives need for change). Penguins cluster by a road sign. One sign says "Status Quo." Another sign, labeled "Errorville," points back to the sea. Signs saying "CMS" [Centers for Medicare & Medicaid Services] and "Future" point forward. One penguin looks back and thinks, "I'm staying right here. Yeah, they'll be back." A second penguin looks forward thinking, "What are they doing? Why do we need change?" Some penguins move forward (build team, strategy, buy-in, establish goals) through an icy valley and mountain range labeled "Prepare the Climate." As they cross the ice field beyond the mountains and avoid a pool of killer whales, the penguins continue to "Develop Action Plan" and progress along the steps of "TeamSTEPPS Change Coaching" (implement action plan, train, empower others). The next stage of their journey is "Test intervention (outcomes)," until they arrive at "Celebrate wins! Staying the Course, and Sustaining." The final stage of the journey sees the penguins safely in their new home, "Monitor, Integrate, and Continuous Process Improvement."

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Slide 16: Sizing Up The Iceberg

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  • Break into groups.
  • Read through and answer the questions on the "Sizing Up the Iceberg Exercise Sheet" assigned to your group by the instructor.
  • As you answer the questions, consider the current state of your nursing home and the current safety climate.

Exercise icon: Penguin on a stationary exercise bicycle.

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Slide 17: Teamwork Actions

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  • Relate the Eight Steps of Change to your nursing home.
  • Within each change step, identify at least one key action to affect your nursing home.

"Create a new culture. Don't let up—Be relentless. Empower."
—John Kotter

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Current as of November 2012
Internet Citation: Change Management: Classroom Slides: TeamSTEPPS® Long-Term Care Version, Module 8. November 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/longtermcare/module8/slltcchangemgmt.html