TeamSTEPPS 2.0: Module 8. Change Management
Slide 1: Change Management: How to Achieve a Culture of Safety
Slide 2: Objectives
Slide 3: 8 Steps of Change
Slide 4: Set the Stage and Create a Sense of Urgency
Slide 5: Pull Together the Guiding Team
Slide 6: Develop the Change Vision and Strategy
Slide 7: Communicate for Understanding and Buy-In
Slide 8: Empower Others to Act
Slide 9: Produce Short-Term Wins
Slide 10: Don't Let Up
Slide 11: Create a New Culture
Slide 12: Errors Common to Organizational Change
Slide 13: Culture Change Comes Last, Not First!
Slide 14: TeamSTEPPS Change Model
Slide 15: Change Management Models:
Slide 16: Roadmap to a Culture of Safety
- List the Eight Steps of Change.
- Identify errors common to organizational change.
- Discuss what is involved in creating a new culture.
- Begin planning your organizational change strategy.
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.
- Get people's attention!
- Sell the need for change... describe 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."
- Choose key players, especially staff-level managers.
- Identify a Guiding Team that is multidisciplinary.
- Consider the credibility and integrity of change leaders.
- Choose proven leaders who can drive the change process:
- Strong position power, broad expertise, and high credibility.
- Ensure the Guiding Team has both management and leadership skills:
- Management skills control the process.
- Leadership skills drive the change.
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:
- Translating values into expected behaviors.
- Establishing trust and accountability.
- Communicating a commitment to shaping the culture.
- 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 concerns, perceived losses, and anger.
- Model the expected behaviors.
- 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!
- Provide direction.
- Allow others to find their own team-driven solutions.
- Encourage others to speak up and take risks.
- Share the information you know.
- Encourage teamwork and collaboration.
- Encourage personal reflection and learning.
- Train employees so they have the desired skills and attitudes.
- Track activities and progress.
- Set short-term goals.
- Show visible success; further impetus for change.
- Provide positive feedback; recognize and reward contributions to wins:
- Further builds morale and motivation.
- Leverage lessons learned to help plan 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.
- 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.
- Develop action steps for stabilizing, reinforcing, and sustaining the change:
- Give people time to mourn their actual losses.
- Provide skill and knowledge training.
- Develop new reward systems.
- 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.
- Encourage people to be open to new challenges, forces, and pressures for the next change.
- Allowing for complacency.
- Failure to create a sufficiently powerful Guiding Coalition and Change Team.
- Not truly integrating the vision.
- Allowing obstacles to block change.
- Not celebrating short-term wins.
- Declaring victory too soon.
- Neglecting to anchor changes firmly in the culture.
- Most alterations in norms and shared values come at the end of the transformation process.
- New approaches sink in after success is shown.
- 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, or the old culture will reassert itself.
The shift process shown in this slide has three phases.
Phase I: Assessment. Pretraining assessment includes site assessment, culture survey and data/measures. Are these ready? If no, pass through climate improvement and return to pretraining assessment. If yes proceed to action plan and then move on to Phase II.
Phase II: Planning, training and implementation. Training leads to intervention. Intervention includes testing and leads to Phase III.
Phase III: Sustainment. This phase includes culture change: coach and integrate, monitor the plan, and continuous improvement. Continuous improvement includes going back to training to lead to more culture change.
In summary: Set the stage, decide what to do, make it happen and make it stick.
- PDSA: Plan, Do (TeamSTEPPS), Study, Act.
- DMAIC: Define, Measure, Analyze, Improve (TeamSTEPPS), Control.
- IHI Model for Improvement: Forming the Team, Setting Aims, Establishing Measures, Selecting Changes, Testing Changes, Implementing Changes (TeamSTEPPS), Spreading Changes.
- CUSP: Assemble the Team, Engage the Senior Executive, Understand the Science of Safety, Identify Defects through Sensemaking, Implement Teamwork and Communication (TeamSTEPPS).
- AHRQ Professional Education.
Image (Roadmap to a Culture of Safety): 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. One sign, labeled Errorville, points back to the sea. Signs saying JCAHO 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 prepare the climate. Penguins continue to develop action plan and TeamSTEPPS change coaching (implement action plan, train, empower others). The next stages are test intervention (outcomes), and celebrate wins, staying the course, and sustaining. The final stage of the journey is monitor, integrate, and continuous process improvement.