Overview

Some changes in process and practice are easy. They are easy because:

• The need is obvious
• There is no associated cost
• No resources are required for implementation

Unfortunately, in today's complex hospital environment, there are few process or practice changes that meet the definition of easy. The reality of the situation is that significant change is difficult. It often requires altering ingrained behaviors and deep-seated attitudes about the work requiring change.

Change is scary for many people and is often met with resistance. Additionally, change often requires an investment of money and resources, both of which are typically in short supply.

There are a number of factors critical to the success of a major hospital change initiative. Paying close attention to these factors will ensure that the targeted changes remain sustainable and deliver their full promise:

• Set appropriate expectations and measure against those expectations
• Work on the right projects
• Work on the right number of projects
• Obtain the active support and participation of the people who will make the changes work
• Create a collaborative environment among physicians, nurses and administrators
• Provide a clear escalation path for those times when barriers and resistance seem insurmountable

Tools such as Six-Sigma and Lean will not achieve their full potential without an implementation framework that has not fully considered these critical success factors.

Who sets the expectations? How many simultaneous projects can an organization handle? How to prioritize projects and align resources? These are all questions needing to be addressed by the senior leadership team. Supporting the senior leadership team are cross-functional teams with responsibility for specific process improvement projects.