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Using change management to improve patient care

Dr Raj Thakkar explains how the principles of change management can be used to improve patient care and develop new services.

Why is change management important?

I suspect we all often think of great ideas which can improve and perhaps even transform patient care. Most ideas, however, remain as ideas; either because we don’t have the energy to do anything about it, the buy-in from the partners in the practice is lacking or the resource to deliver the project is unavailable.

Perhaps we don’t have the skills or the confidence to take on a project. Change management is about ‘operationalising’ an idea and turning it to real and measurable change on the ground. Once you’ve achieved that change, it’s incredibly satisfying and, more importantly, it creates quality improvement with real patient outcomes.

For GPs, appraisal and ultimately revalidation is moving towards to encouraging us to engage in quality improvement (QI) projects with demonstrable patient outcomes. As such, several CPD points can be gained from QI projects and they should satisfy the meanest of appraisers.

The CQC also values good leadership in a practice and a good QI programme can go a long way to demonstrate this.

Doing the groundwork

Once you have an idea, it is well worth doing your groundwork. This means:

  • having complete clarity about what the idea is
  • why it is important to the practice or patients
  • what potential gains of the project are
  • what the evidence base is
  • what the potential solutions may be and how difficult would it be to achieve.

It’s important to have a coherent and cogent story you can impress onto your colleagues that you genuinely believe in and are passionate about.  

Lobbying

It’s really worth sounding out some of the key decisionmakers in your practice and perhaps even your CCG. Having one-to-one informal discussions helps you to refine your ‘sell’ of the idea and gauge your colleague’s appetites to support your it.

Pick your moment and go for it. Don’t be despondent if you get a flat response, learn from it, make your story more compelling and try it again. If it’s a great idea, you may find yourself having a really enthusiastic discussion and better still, the offer of support.

Lobbying a few people will ensure the topic is not a surprise when it comes to your business meeting and will significantly increase your chance of the practice approving your project. By lobbying and selling the virtues of your idea, you’re already and covertly creating that urgency to change.

Speaking to the CCG is definitely a good idea. It may be they can offer additional support, connect you with others running similar projects, share learning from elsewhere or else offer you an opportunity to run your brilliant project in your locality.

Selling the story and co-owning the problem

By the time you’re ready to present the idea at your business meeting, you already will have lobbied and gained support, created a sense that change is needed urgently and practiced your arguments for getting your idea approved. That will ensure getting buy-in from the rest of the team a lot easier.

There is no one way to present your case, but it’s worth ensuring there are a few essential ingredients.  Let’s take the topic of falls. A few ‘wow’ facts to engage are required to get your audience’s attention. Maybe even a quiz.

Q: How much do you think falls cost the NHS?
A: A staggering £2.3 billion.

Q: How many over 80 year olds will fall at least once a year?
A: 50%

You may then want to present some data from your practice or locality. That really will drive the messages home and make it relevant. A little bit of education can be chucked in. For example, on the causes of falls:

Q: How many falls occur due to environmental factors such as poorly fitting slippers?
A: 1 in 3

Q: What is the increased risk of falls in a patient on 4 or more drugs?
A: If they live in a nursing home 400%, if they live in the community, 30%

By now you should have got people interested and thinking about the solutions. The ‘so what?’ question may well be asked by some ‘resisters’. Good preparation would mean you can talk about potential options to solve it, or else, reflect the question back ‘What do you think we should do?’

Hopefully by now you have hooked people in, got them thinking about the size of the problem and how they can solve it. If you get your team to feel a sense of ownership of the problem you have highlighted and to start to discuss the possible solutions, you’ve cracked it.

Ideally they will agree it’s a project worth putting time and effort into. Not every idea will be approved. It not, think about why not and whether you should drop it or else lobby your CCG to take it on.

Can you do it yourself?

The short answer to this is usually a no. Having a group to help you deliver your project would be far easier than doing it on your own. Decide in your practice meeting whether they are happy for you to have a working group or whether they all want to be involved.

Other important stakeholders may include your local nursing home manager, the ambulance trust, public health etc.

The working group would be there to create a strategy and then help put it into action.

Bringing your practice team with you

Putting the project on your practice meeting agenda as a monthly standing item is a great idea. It’s worth presenting your strategy to the team initially so that you get feedback, everyone feels involved, they are reminded of the project and they have a sense of responsibility for the project’s success.

Once the strategy is approved, the working group can get on and do the doing. Regular monthly updates help to keep the project live and at the forefront of people’s minds.

Using the falls example, interventions to reduce falls may include:

  • Education for patients, nursing home and staff
  • Screening all patients over the age of 80 by means of an alert on the clinical system
  • A falls assessment where required
  • Medication optimisation
  • Posters and prescription messages
  • Articles in your local press
  • A talk in the local community
  • Dementia screen
  • Monitoring

It’s important to be able to measure the impact of your project. Measuring the right thing and finding an easy way to collect the data is important. The CCG may be able to help you here. If your project isn’t showing an impact, it’s important to try and find out why not, and fix it.

Celebrating your success

Writing up your project, congratulating your team and letting patients and other practices know what you’ve achieved are all important. Certainly let the CCG know and consider entering your practice into competitions to be recognised for what you’ve achieved.

Sustainability

Keeping an eye on the data and intermittently presenting it will help to ensure your changes are entrenched as business as usual and your practice performance remains better than other practices offering standard care.

Next steps

Change management may be considered a dry subject but in reality, it’s exciting, challenging and highly satisfying.

Strong leadership skills are needed to manage a process from idea to real change at the coalface. It requires clarity about what you want to achieve, planning, the ability to sell a story and enthuse others, to galvanise a team, to keep the momentum going and embed change as business as usual.

It may be worth starting on a small project such as ensuring all patients with a chest infection have a CRB65 score performed or screening all patients for atrial fibrillation in your flu clinic. Whatever you chose, give it a go, the rewards for you and your patients are immense, and it may even win you an award.

  • Dr Raj Thakkar is a GP in Buckinghamshire and clinical commissioning director for planned care at Chiltern CCG

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