Hospital Change — How to Make it Stick

Amanda Brewster, Ph.D., GHLI research and education associate 

Health care professionals constantly invest time, effort and expense trying new methods to improve care only to see promising innovations evaporate rather than become part of everyday work habits. When this happens, hospitals miss potential performance improvements, waste money and time, and feed quality improvement fatigue among staff.

New evidence published in Implementation Science from the Yale Global Leadership Health Institute shows that there are predictable patterns in what it takes to make change “stick.” Reviewing data from hospitals that participated in the State Action on Avoidable Rehospitalizations (STAAR) initiative, GHLI researchers examined different strategies hospitals tried to reduce readmissions.

The research showed that getting new practices integrated depended on how the integration process was executed. When hospitals appointed staff to oversee that a new practice was performed regularly for several months up to a year, more permanent integrating mechanisms had time to start working. Staff had a chance to feel direct benefits from the new practice – like greater job satisfaction or less stress – which motivated them to keep doing it even without close oversight. Or failing that, job expectations had a chance to catch up with the new practice, making it a non-negotiable part of work.

What should hospital leaders make of these results? Truly integrating a new practice takes patience and extended effort over time. And, staff members’ own desires to improve patient outcomes can give a powerful boost to quality improvement. Ensuring that staff responsible for implementing a new practice have the opportunity to see the positive impacts – through data feedback as well as personal interactions – can enlist them as partners in integrating the innovation into the permanent fabric of the organization.  Finally, the work does not ever go on auto-pilot, but incorporating the effort into ongoing management oversight efforts allow champions to move onto the next burning platform.  

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