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Improvement projects in hospitals frequently fail to deliver the expected levels of improvement. From our work around the world we have identified 8 key characteristics that the more successful organisations demonstrate. These steps are associated with a greater internal organisational improvement capability.

1. Focus on the innovators and the early adopters first
There are always going to be people who are resistant to change in any workforce. Unfortunately, too much time is spent placating these. Meanwhile, those who are willing to try new ways of working are overlooked. Nurture the forward thinkers – they are likely to be an untapped resource. Do not ignore the laggards, just do not make them the focus of the team.

2. The power of words
Celebrate success. When something has made a positive impact celebrate it. Sharing the positive stories will motivate the entire workforce. Success belongs to the workforce, not the leaders. Give them the credit.

3. Identify key issues that motivate your workforce
All too often improvement projects are pursued that are not the most pressing problems for the frontline staff. This reinforces the feeling that change is done to, rather than with, people. These kinds of projects are unlikely to inspire the workforce and are likely to fail. If you focus on those issues that matter to people they will want to work on them and improve the care they deliver.

4. Do not try and boil the sea
Do not attempt something that is too big or unrealistic through one initiative. If there was one solution, you would probably already be doing it. Large scale change is brought about through numerous small incremental steps. The secret to resolving large issues is a piecemeal approach. By focussing on small, but significant projects, success is achieved through small steps.

5. You need senior support
Effective change agents influence others through their relationships, ability and expertise, but occasionally they will come up against resistance that seems impossible to overcome. Despite our best efforts improvement stalls. This is usually due to human factors rather than a problem with strategy. Quite often this is due to a lack of one’s positional power. Continually pushing against this kind of resistance often leads to frustration, anger and disengagement. To counter situations like this it is important to find and develop relationships at senior levels of the organisation. Used sparingly, senior colleagues helping to unblock a problem works well. However, overuse of senior power runs the risk of the work force feeling they are having change done to them. Knowing when and how to use senior support is a delicate art.

6. The only person you can change is yourself
As change agents we often have to influence others. The only real way of changing the behaviour of others is for us to change the way we as individuals behaviour. Our conversations have to support the change we wish to bring about. If our behave does not support what we want to do, or we create adversaries who feel threatened then it is unlikely that any improvement will be realised. Hospitals are very tribal. There are many departments, professions and disciplines, each having their own rules and culture. Navigating this political landscape requires a great deal of sensitivity.

7. Keep momentum
We mention previously that large strategic goals are achieved by incremental small steps. We have also said celebrate your successes, however, there comes a point when the next step has to be taken. This is often a tricky judgement call as change fatigue and disengagement can set in if the pace is too unrelenting. Equally, resting on one’s laurels means that projects stall.

8. No secrets, instead bring fun into the workplace
Delivering frontline patient care is emotionally draining and exhausting. Some patient stories can be harrowing and as a clinician you can not fail to be affected by these. So motivating the clinical workforce can seem difficult. The role of fun in the workplace may seem incongruous in such a setting, but it is absolutely necessary. If improvement projects are seen as extra work I do not have time to do and there is no thanks at the end of it then it is the perfect recipe for disengagement. The other things that rob people of their joy are secrets. Vague answers and avoidant behaviour can significantly knock the confidence of the team and as a result any ambiguity or perceived threat can derail the improvement process. Transparency and laughter are more likely to motivate a team to succeed.

Building an internal improvement capacity within a healthcare organisation is primarily about supporting the workforce rather than endless levels of training. Of course, there will be a need for some skills development, but most teams know what the problems are and what needs to be done. However, to do this they need time, space and support. If organisations are able to apply these three things our reliance upon external management consultancies will diminish.
By Dr Paul Jarvis