Change Is Hard - How do you change things?

Link: Switch: How to Change Things When Change is Hard

On February 16th, a new book by Chip and Dan Heath, Switch: How to Change Things When Change is Hard will be released. Authors discuss the psychological impact of change and its relationship to the environment. TechCrunch describes this phenomena as "The War on Interruptions."

... people behave differently when their environment changes. When we’re in a place where people are quiet (church), we’re quiet. When we’re in a place where people are loud (stadiums), we’re loud. When we’re driving and the lanes narrow, we slow down. When they widen, we speed up again. This may seem obvious, but when we try to make change at work, we often make the mistake of obsessing about the people involved rather than their environment. Often the easiest way to drive change is to shape the environment.

The excerpt continues with discussion about the relationship between change and the environment. A researcher at Kaiser Permanente studied the effect of "quiet time" for medication dispensing by nurses. Nurses wore a bright colored vest (which they hated) when dispensing medications and all other personnel at the hospital were instructed not to disturb nurses wearing these vests. During the research period, medication errors were down for all groups, except for the group that did not participate in the study; their error rate increased.

I participated as a researcher in the effects of working conditions on nurses. We found that working conditions affected the ability of nurses to perform. When things were not quite right, nurses found workarounds to meet their objectives. Problems were often encountered in areas that were noisy, filled with multiple interruptions and/or distractions, and when supplies were not readily available, among other things. Depending on the magnitude of the workaround, patients could have been at risk for adverse events.

As a nurse, I encountered similar problems. So, when I was dispensing medications I permitted no distractions. Interestingly, here's how it was interpreted by at least one nurse. She said, "People think you are rude when you hold up your hand at the medication dispense unit."

I thought that was interesting, so I asked her what she thought would be a better indicator of the fact that I did not wish to be interrupted at that moment. She said, "Hold up 1 finger to let them know you will be available in 1 minute." On my way home from work that day, I chuckled....which finger should I hold up? Now that would be rude!

To read more about working conditions and their impact on nurses, read this report from AHRQ on Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

The bottom line is that change, in any environment, is a wicked problem due to its inherent social complexity and the fact that every person, in every environment, is unique. Change is slow. The ability to affect changes in the way that people interact in their environment will take, among other things, time and patience.

We face these challenges now, in the life cycle of EHR adoption and from the HITECH Act.

---

Looking for a best of breed HIPAA Compliance Software?

To stay current on the HITECH Act and its quickly changing regulatory scheme visit the HITECH Survival Guide website and/or sign up for our free monthly compliance newsletter. Also, check out our FREE EHR Checklist.

If you need tools that will help with your compliance initiatives then check out the HSG Store.

with your compliance initiatives? If so then check out the HSG Store.

Comments

[Ilyas Iyoob]

This information helps in correlating the impact of back-end IT changes on the overall business i.e. citizen satisfaction.

I've been assuming linear correlations for most of the 'events' but this article says otherwise. I appreciate this information because now we can better plan IT for the Healthcare Reform Event (which we are already doing for the state of Texas).

[family practice emr]

Thanks for the good info!Implementing new technology is the key to success in medical business. Maintaining the medical records of the patient as Electronic Medical Records (EMRs) is one of the recent technologies that would help the growth of the medical business.Technology truly has a big impact on health in the developing world.

[Call Center Philippines]

It’s great to read such topical stuff on the web as I have been able to discover here. Thanks for publishing such great reading material and for investing the time to write it and post it here, I am sure that it will help many.

Regards,
Tina