Changes in Clinical Pathways
Published on Nov 21, 2015
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MORE DECKS TO EXPLORE
PRESENTATION OUTLINE
WE HAVE PLENTY
OF CHANGE
I have been asked to give a 15 min presentation on about how I would go about bringing A change in a clinical pathway .
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CHANGES
- Plenty of experience to draw from
- Transitional change
- Transformational change
- A constant part of life
- Rarely come 1 at a time
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PERSONAL LIFE
- Getting married
- Having children
- Learning about being a parent
- Rise of personal computers
- Internet useage & smartphones
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CLINICAL
- QOF
- Blood tests eg BNP
- Ways of requesting blood tests
- Computer based records
- Changes in clinical pathways eg DVT
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MASLOW'S HIERARCHY OF NEEDS
Photo by Anthony K. Valley
Untitled Slide
Untitled Slide
PRE-IMPLEMENTATION
- Why the change ?
- QIPP
- Authority?
- Appreciate & believe in it ?
- Knowledge , skills & attitude
All parties that will be responsible for using the pathway need to appreciate and believe in the reasons for the change .
Why ? Many reasons , pretty much all of the will feature one or more of the ingredients in QIPP
QIPP Quality, Innovation, Productivity and Prevention
Ease of introduction of a change in clinical pathway will depend on what change is , the reasons for the change, and the impact on the individuals concerned .
What is the authority of the change ?
pre implementation checklist ;
evidence based ?
Impact assessed ? time , money , manpower available.
Are the skills or equiptment - do the participants already have them or is training required or does this require a the purchase of new kit.
culture ; hostile or friendly ?
Change fatigue ? is now the right time for this particular change ?
Is this going with the grain or against it ? Are there already a significant number of clinicians doing the activity ? how long have they been doing this for ?
Opportunity for feedback and discussion ?
Have all parties been made aware of the changes , does everyone understand their role ? or know where to go for help ?
Yardstick ? how will we know if the pathway is being adopted ? what metrics do we have ? how will we receive the results ? who will be responsible for collating the metrics ?
Do we need to consider dismantling part of a previous pathway , or modifying access to a particular service ? if so , what is the timetable like ?
Why ? Many reasons , pretty much all of the will feature one or more of the ingredients in QIPP
QIPP Quality, Innovation, Productivity and Prevention
Ease of introduction of a change in clinical pathway will depend on what change is , the reasons for the change, and the impact on the individuals concerned .
What is the authority of the change ?
pre implementation checklist ;
evidence based ?
Impact assessed ? time , money , manpower available.
Are the skills or equiptment - do the participants already have them or is training required or does this require a the purchase of new kit.
culture ; hostile or friendly ?
Change fatigue ? is now the right time for this particular change ?
Is this going with the grain or against it ? Are there already a significant number of clinicians doing the activity ? how long have they been doing this for ?
Opportunity for feedback and discussion ?
Have all parties been made aware of the changes , does everyone understand their role ? or know where to go for help ?
Yardstick ? how will we know if the pathway is being adopted ? what metrics do we have ? how will we receive the results ? who will be responsible for collating the metrics ?
Do we need to consider dismantling part of a previous pathway , or modifying access to a particular service ? if so , what is the timetable like ?
QUALITY
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PRODUCTIVITY
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PREVENTION
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KNOWLEDGE
- Evidence base
- What ? Why?
- Topical ?
- Widely accepted belief?
All parties that will be responsible for using the pathway need to appreciate and believe in the reasons for the change .
Why ? Many reasons , pretty much all of the will feature one or more of the ingredients in QIPP
QIPP Quality, Innovation, Productivity and Prevention
Ease of introduction of a change in clinical pathway will depend on what change is , the reasons for the change, and the impact on the individuals concerned .
What is the authority of the change ?
pre implementation checklist ;
evidence based ?
Impact assessed ? time , money , manpower available.
Are the skills or equiptment - do the participants already have them or is training required or does this require a the purchase of new kit.
culture ; hostile or friendly ?
Change fatigue ? is now the right time for this particular change ?
Is this going with the grain or against it ? Are there already a significant number of clinicians doing the activity ? how long have they been doing this for ?
Opportunity for feedback and discussion ?
Have all parties been made aware of the changes , does everyone understand their role ? or know where to go for help ?
Yardstick ? how will we know if the pathway is being adopted ? what metrics do we have ? how will we receive the results ? who will be responsible for collating the metrics ?
Do we need to consider dismantling part of a previous pathway , or modifying access to a particular service ? if so , what is the timetable like ?
Why ? Many reasons , pretty much all of the will feature one or more of the ingredients in QIPP
QIPP Quality, Innovation, Productivity and Prevention
Ease of introduction of a change in clinical pathway will depend on what change is , the reasons for the change, and the impact on the individuals concerned .
What is the authority of the change ?
pre implementation checklist ;
evidence based ?
Impact assessed ? time , money , manpower available.
Are the skills or equiptment - do the participants already have them or is training required or does this require a the purchase of new kit.
culture ; hostile or friendly ?
Change fatigue ? is now the right time for this particular change ?
Is this going with the grain or against it ? Are there already a significant number of clinicians doing the activity ? how long have they been doing this for ?
Opportunity for feedback and discussion ?
Have all parties been made aware of the changes , does everyone understand their role ? or know where to go for help ?
Yardstick ? how will we know if the pathway is being adopted ? what metrics do we have ? how will we receive the results ? who will be responsible for collating the metrics ?
Do we need to consider dismantling part of a previous pathway , or modifying access to a particular service ? if so , what is the timetable like ?
SKILLS
- New Skill set required
- Training needs
- New equipment
- Capacity & capability
UPSKILL
- Info on website / PDF
- Info clear & accessible
- Not behind passwords
- Locality based learning
- Add value - certificates
ATTITUDE
- Sufficient communication ⏩ buy inn ?
- Previous experience?
- Innovative / conservative?
- Culture of organisation
- Leaders / individuals
COMMUNICATION
- ALL stakeholders consulted?patients & staff
- Opportunity for feedback?
- +3 types of comms
- Meetings, newsletter, posters, websites
- Videos, podcasts, clinics.
IMPACT ASSESSMENT
- Who will be working differently?
- Costs in time & money ?
- Consumption of other resources?
- Unintended consequences?
- Common pool resources
MOTIVATE
- Offer Support for appraisals
- Certificate of competency
- Online course / close down?
- E-learning / group work ?
- Log of referrals along pathway?
CHECKLIST
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IMPLEMENTATION
- Feedback metrics
- What's working & why?
- What's not & why ?
- User experience ...
- CESFB ❤ 👥
MAINTENANCE
- Reward / recognise adopters
- Highlight achievements
- £ saved, reduction in waiting times
- adoption of pathway follow trends ;
- Early adopters , majority adopters etc.
MAINTENANCE
- Metrics identify problems
- Aim for 100% concordance
- Expect to more input &
- resources for late adopters
- Granular approach
REMEMBERING THAT
- All workers have different ;
- Knowledge
- Skills
- Experience
- Learning styles
