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The Fourth Time’s the Charm: The Value of Change Management

07.26.2018

I’ve spoken with dozens of social needs program managers from effective social needs initiatives that differ in aim, scope, size and design. The one thing they all have in common? A change management strategy that meaningfully engages the whole care community – leadership, patients, providers and care-teams.

When this vital link is missing, social needs interventions often struggle to take root. They become “an additional burden” rather than an integral component to preventative care. When Arkansas Children’s Hospital began screening patients for social needs in the Circle of Friends clinic in 2015, it was their fourth attempt to do so in recent years. Past efforts had fizzled out after experiencing little or no follow-through. But this time, in their first 21-months, they screened during 76% of all patient visits —almost 30,000 visits. 

What made the difference?

Constant, inclusive conversation. Learning from their past attempts, the implementation team intentionally set out to include all levels of staff in the design and refinement of the screening process –listening to concerns and receiving and acting on feedback in real time:

  • Nurses – who acknowledged their workflows would be most impacted – co-designed the new workflows to minimize disruption.
  • Frontline staff called out the challenge in keeping track of an additional screener amidst a stack of white papers. The solution? A vibrant green color-coded document.
  • Physicians who kept forgetting where to place the screeners received a matching color-coded data collection box as a reminder.

The constant engagement and intentional process for building buy-in has paid off in powerful ways. Recently, on a week when the supply in the food pantry did not meet the needs of all their patients, the nursing staff that was initially most reticent about addressing food insecurity were the first to say that the shortage was unacceptable.

I recently partnered with the team at Arkansas Children’s to share their change management experiences in a co-authored case-study, Introducing A Social Needs Screen. They offered key takeaways on the implementation process from design to partnerships and funding, including:

  • Engage staff at all levels around the design of the clinical workflow. By developing an inclusive design process, Arkansas Children’s was able to circumvent potential barriers that are inevitable when the work feels imposed on staff, rather than staff-driven.
  • Establish direct feedback loop to problem-solve barriers. During the initial pilot stages, the implementation team aimed to address all concerns within the first 24 hours, demonstrating their commitment to easing the burden of the new process. This rapid feedback showed both an organizational commitment to success and acknowledged the extra work staff were putting in to ensure the new processes took hold.
  • Keep the scope achievable and celebrate successes. The Arkansas Children’s screening tool is intentionally scoped to ask a limited number of questions that the health system was set up to answer: food insecurity, housing needs, education needs, financial concerns. The limited scope decreased the amount of additional work and reduced the potential of frustration for both staff and patients.

Check out the full case study to learn more about how Arkansas Children’s continues to learn from and improve their screener through continual feedback opportunities. Do you have any advice for organizations navigating a moment of change? Let us know in the comments below!

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