Why change is so hard and strategies for success in implementing your quality improvement plan.

Our highlight this week at Nia HEALTHCARE SOLUTIONS was engaging with the team at HealthX Africa to discuss their quality assessment findings and the improvement strategy.

It's always exciting to present healthcare improvement plans and propose a strategy for the way forward because this signifies a chance for creativity and innovation as the team comes up with solutions and tests them.

One of the areas we spoke about that we emphasize for all our clients is the importance of preparing the team for change before introducing any changes.

Quality improvement activities in healthcare cause a lot of changes that are mostly uncomfortable which if not checked lead to conflict, reduced productivity and resistance to change among other things.

Especially when the approach is ''the PDSA model of improvement'' which requires the team to collaborate in brainstorming the change ideas and testing each one of them to get the package that works best for them. This model is highly recommended for our resources restricted settings in Africa as it advocates for small incremental changes over time with context in mind.

Healthcare quality assessments are great because they show you the gap and what you need to bridge it. This is just 5% of the solution. 95% of the solution lies in the "how'' you get it done and heavily depends on context, team dynamics, culture,and resources available.

Why is change so hard?

1.   We are emotional beings. First, we are emotional beings. As much as we value our rational and logical brain, it is the last part of our brain to evolve. Our emotional part of the brain (the amygdala) has been around much longer and is more fine-tuned to what's going on. So if we need to get through change, we need to emotionally get through because logic isn't enough.

2.  We assume the worst Because of our emotional brains—we assume the worst. It is wired to jump into action in case of danger. Ours is more likely to assume failure than success in to protect us from impending threats.

3.  Loss of control: After a while we get used to doing things a certain way. A change implies doing things differently which comes with a feeling of losing control. 

4.  Old processes die hard:  Our brains are wired to conserve energy. Following established routines requires less mental effort than learning new things. This makes us naturally resistant to change. 

5.  Fear of the unknown: Change is scary because things may get worse. This is a very good justification to remain the same.

How can we support our teams to embrace the changes brought about by the improvement initiatives? 

1.  Set Clear Goals

Define what you want to change and why it matters. Make ample time to interact with your teams to ensure there is a very good understanding of the current status, the proposed plan and the goals.

Take extra time to show the team how they fit into all this and why its in their interest.

Sensitize the team through townhall meetings, emails, department specific meetings, posters etc.

 2. Start Small and build habits

Begin with manageable steps to avoid feeling overwhelmed and include behavioral changes in the daily routine work to make them stick. Avoid one-off training and talks as they do not give room for changing habits. Make the necessary changes in the environment as well not just on people.

3. Stay Consistent and track progress

Commit to regular action, even if progress is slow and keep a record of the improvements.

Remember to share the small wins as soon as possible for motivation.

Keep a record of your improvements to stay motivated.

 4. Be Patient

Give time, time. Change is a process, not a step.

 5. Embrace Failure:

Not all changes will lead to improvement but to improve, we need to change. Accept setbacks as learning opportunities and adapt accordingly.

Food for thought. 

When's the last time you tried changing your own habits? Now, Imagine changing habits for a group of people. Then Imagine changing habits in our very dynamic, complex and resource restricted healthcare systems in Africa.

Patience is key. Give time, time.

To successfully execute that quality improvement plan you have, take your time to address the team's emotional needs first because at the end of the day we are HUMAN first.

Finally,

To all leaders, managers, and improvement leads:

After 17 years of supporting facilities to make lasting changes in healthcare services delivery in Africa, we know that failure to take these steps is the reason why we have facilities with amazing improvement plans that never saw the light of day or have stalled.

How are you preparing your teams for the many changes taking place currently?