Change Concepts Worksheet
Improving Diabetic Patient Education to Reduce Hospital Readmissions
A change concept is a general notion or approach to change that is useful in developing specific ideas for improvement. In the column to the right, “Ideas”, for each change concept you select (two or more, depending on your topic), generate a short list of change ideas related to that general concept. Be specific to your organization’s work environment and structure.
Modified from: change concepts were developed by Associates in Process Improvement. See The Improvement Guide (Langley GJ, Nolan KM, Nolan TW, Norman Modified from: CL, Provost LP. San Francisco, California: Jossey-Bass Publishers, Inc.; 2009) for examples of their application in process improvement, both inside and outside of health care.
| Change Concepts | Idea | |
| 1. Stakeholder Engagement – What strategies to improve support for the stakeholders you rated as “Disagree and Influential” on your Stakeholder map? | ||
| Build relationships
Recognize needs |
Build relationships: Schedule one-on-one meetings with Finance and IT department leaders to discuss concerns related to cost, workflow impact, and resource allocation, while presenting evidence on reduced readmission rates and long-term cost savings
Recognize needs: Present unit-specific readmission data during interdisciplinary meetings and align the QIP with organizational goals such as improved patient outcomes and reduced penalties for hospital readmissions |
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| 2. Improve Workflow – How can you change the workflow so that the process is less reactive and more planned? | ||
| Minimize handoffs
Find and remove bottlenecks |
Minimize handoffs: Incorporate diabetic education into the nurse’s discharge responsibilities to ensure continuity of care rather than transferring responsibility between multiple staff members
Find and remove bottlenecks: Identify delays in patient education delivery by auditing discharge processes and assigning a dedicated diabetes educator during peak discharge hours to improve efficiency |
|
| 3. Change the Work Environment – What would make the environment better able to support improvement? | ||
| Conduct training
Give people access to information. |
Conduct training: Provide mandatory in-service training sessions for nursing staff on standardized diabetic education protocols, including how to use teaching tools and document patient understanding
Give people access to information: Integrate patient education materials, checklists, and guidelines into the electronic health record system so nurses can quickly access them during patient care |
|
| 4. Design Systems to Avoid Mistakes – How can you reduce the probability of making an error for a given opportunity? | ||
| Use reminders
Embed new process/intervention into the electronic medical record system |
Use reminders: Implement automated electronic health record alerts that prompt nurses to complete diabetic education before initiating discharge procedures
Embed new process into system: Add a required documentation field in the discharge workflow that ensures diabetic education is completed before discharge orders can be finalized |
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Change Concepts Worksheet
Improving Diabetic Patient Education to Reduce Hospital Readmissions
A change concept is a general notion or approach to change that is useful in developing specific ideas for improvement. In the column to the right, “Ideas”, for each change concept you select (two or more, depending on your topic), generate a short list of change ideas related to that general concept. Be specific to your organization’s work environment and structure.
Modified from: change concepts were developed by Associates in Process Improvement. See The Improvement Guide (Langley GJ, Nolan KM, Nolan TW, Norman Modified from: CL, Provost LP. San Francisco, California: Jossey-Bass Publishers, Inc.; 2009) for examples of their application in process improvement, both inside and outside of health care.
| Change Concepts | Idea | |
| 1. Stakeholder Engagement – What strategies to improve support for the stakeholders you rated as “Disagree and Influential” on your Stakeholder map? | ||
| 1. Build Consensus
2. Work towards buy-in 3. Build relationships 4. Recognize needs 5. Use external stakeholders and consultants 6. Involved at some level 7. Don’t provoke them into action 8. Monitor (Textbook, Kelly Vana et al., page 479)
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Choose two change concepts, then add an idea for each one. Be specific to your organization.
3. Build relationships: Schedule one-on-one meetings with Finance and IT department leaders to discuss concerns related to cost, workflow impact, and resource allocation, while presenting evidence on reduced readmission rates and long-term cost savings 4. Recognize needs: Present unit-specific readmission data during interdisciplinary meetings and align the QIP with organizational goals such as improved patient outcomes and reduced penalties for hospital readmissions |
|
| 2. Improve Work Flow – How can you change the work flow so that the process is less reactive and more planned? | ||
| 9. Schedule into multiple processes
10. Minimize handoffs 11. Move the steps in the process close together 12. Find and remove bottlenecks 13. Use multiple processing units 14. Adjust to peak demand
|
Choose two change concepts, then add an idea for each one. Be specific to your organization.
10. Minimize handoffs: Incorporate diabetic education into the nurse’s discharge responsibilities to ensure continuity of care rather than transferring responsibility between multiple staff members 12. Find and remove bottlenecks: Identify delays in patient education delivery by auditing discharge processes and assigning a dedicated diabetes educator during peak discharge hours to improve efficiency |
|
| 3. Change the Work Environment – What would make the environment better able to support improvement? | ||
| 15. Give people access to information.
16. Use proper measurements 17. Conduct training 18. Implement cross-training 19. Invest more resources in improvement 20. Focus on the core process and purpose 21. Share risks 22. Develop alliances and cooperative relationships
|
Choose two change concepts, then add an idea for each one. Be specific to your organization.
17. Conduct training: Provide mandatory in-service training sessions for nursing staff on standardized diabetic education protocols, including how to use teaching tools and document patient understanding 15. Give people access to information: Integrate patient education materials, checklists, and guidelines into the electronic health record system so nurses can quickly access them during patient care |
|
| 4. Design Systems to Avoid Mistakes – How can you reduce the probability of making an error for a given opportunity? | ||
| 23. Use reminders
24. Shift huddles 25. Grand rounds to review interventions/processes 26. Embed new process/intervention into the electronic medical record system 27. Frequent review of the process 28. Elicit ongoing feedback from stakeholders 29. Manage uncertainty
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Choose two change concepts, then add an idea for each one. Be specific to your organization.
23. Use reminders: Implement automated electronic health record alerts that prompt nurses to complete diabetic education before initiating discharge procedures 26. Embed new process into system: Add a required documentation field in the discharge workflow that ensures diabetic education is completed before discharge orders can be finalized |
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