Process Improvement and Change Management
Improvement frameworks
The Model for Improvement poses three questions - what are we trying to accomplish, how will we know a change is an improvement, what changes will result in improvement - followed by Plan-Do-Study-Act cycles. PDSA is for small, rapid tests; the Study step is where learning happens, and skipping it is the most common failure. DMAIC and Lean (value, waste, standard work, 5S, A3) suit larger structured projects. Root cause analysis (5 Whys, fishbone) explains a past event; FMEA predicts failure before it happens. Choose tools by purpose, and expect items that swap them.
Aim statements and measurement
A strong aim names a metric, a population, a baseline, a target, and a date: “By June 30, reduce ED-to-inpatient handoff defects from 40% to 15% for admitted adults.” Track outcome, process, and balancing measures together so improvement in one area does not silently damage another.
Change management
Know Kotter's sequence (urgency, coalition, vision, communicate, remove barriers, short-term wins, build on change, anchor), ADKAR (awareness, desire, knowledge, ability, reinforcement), and diffusion of innovations (innovators through laggards; the chasm sits between early majority and late majority). Diagnose readiness, map stakeholders, plan communication, and expect resistance as information rather than disloyalty. Middle managers and frontline champions determine spread.
Sustainment
Hardwire with standard work, audit and feedback, ownership assignment, onboarding inclusion, and dashboard visibility. A pilot without a spread plan is a hobby.
Traps
Jumping to solutions before understanding the process; running PDSA cycles with no predicted outcome and no reflection; assuming training equals behavior change; mistaking urgency for crisis; ignoring the people who must adopt the change.
Rule of thumb
If an option describes testing a change on a small scale and measuring the result before expanding, it is usually correct on improvement items.