QUERI – Quality Enhancement Research Initiative

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Quality Improvement Methods

6. Change Management

a. Definition: An approach to assure that an operational or organizational transition takes place successfully. There are a set of ideas and methods recommended regardless of the particular change being made. The environment for change is important, including the current culture, motivation, support, understanding and reinforcement needed.

Change management principles cover a wide range of items. Generally considered key components are:

  • Formalize the change describing precisely and in writing what is to be done, responsibilities, etc.
  • Communications to stakeholders so that they are aware of a change including the benefits, responsibilities and other specifics
  • Dealing directly with the personal issues of the individuals affected by a change
  • Assure that individuals are motivated and sufficiently trained regarding the change
  • Monitoring progress (see Section 32 on Project Management)
  • Prepare for unexpected events, changes and problems

Many believe that change is best done in an incremental and continuous manner of predefined Steps. The Deming Cycle, named after Dr W. Edwards Deming, also referred to as the PDCA Cycle (see Section 33 ) or Shewhart Cycle (named after Walter Shewhart) is a four step change sequence.

b. Literature:

  • Kotter, John P. Leading change. Harvard Business Press, 1996.
  • Bridges, William. Managing transitions: Making the most of change. Da Capo Press, 2009. Scott, W. Richard. Institutional change and healthcare organizations: From professional dominance to managed care. University of Chicago Press, 2000.
  • Gill, Roger. "Change management--or change leadership?" Journal of Change Management 3.4 (2002): 307-318. Grol, Richard, and Jeremy Grimshaw. "From best evidence to best practice: effective implementation of change in patients' care." The Lancet 362.9391 (2003): 1225-1230. Is "an overview of present knowledge about initiatives to changing medical practice".
  • Anderson, Dean, and Linda Ackerman Anderson. Beyond change management: How to achieve breakthrough results through conscious change leadership. John Wiley & Sons, 2010.

c. Example: Change management means that in order for a change to occur as intended, and for it to be sustained, it must be done in a rational and structured way - more than just project management to track the schedule. By including the basic ideas of change management in the execution of a change, the effort is much more likely to meet with success. Some of these ideas that are not always used in healthcare or research are:

  • Assign a Change Management Coordinator, particularly if the change is relatively large.
  • Select system owners for each of the areas affected, such as radiology, pharmacy, accounting, etc.

Also, be sure to involve all functional areas affected by the change.

  • Set a weekly schedule to review progress against established milestones.
  • Make sure that all areas are fully committed and not limiting the responsibility to just management, just nursing, or just IT, etc.

d. Steps:

1) Recognize and identify the changes in the broader business and social environment

2) Determine the Steps or stages of change.

3) Develop the necessary adjustments for the company's needs and prepare for the changes including the roles for those involved in the change

4) Train employees on the appropriate changes

5) Win the support of employees with the persuasiveness regarding the appropriate adjustments and train accordingly

6) Make the changes in an organized controlled way, such as the incremental PDSA process, and be sure to consider appropriate rewards for those involved

7) Monitor the effects and details of the change to assure that it is complete and will be sustained

The concept of change management may seem simple but successful and sustained change is extremely difficult, particularly in the complex healthcare setting. By developing a good change management plan, success is more likely to occur.