see also:

• welcome to the OzEMedicine Wiki

• there is ALWAYS a cost to any change
• if it ain't broke, don't fix it!
• change always creates a new process and new processes have a habit of causing anxiety, fear, and confusion
• frequent changes are even more problematic
• there may be staff who are dissenters or easily persuaded by dissenters to be negative about the change, and this needs to be actively managed early, or ignored at the project's peril

• identify the need for change
  • is this is the highest priority, and if not, will the cost be minimal?
• can the solution be justified and is it credible?
  • creating a change just to improve a KPI without improving patient care is unlikely to be credible or justifiable!
  • this requires a risk-benefit analysis of the change and preferably proof of benefits
• can the solution be accepted?
  • this requires the above conditions to be met AND staff actively managed to ensure adequate buy in
  • one will probably never convince the strong dissenters, but one should ensure those sitting on the fence are brought along and have buy in while the strong dissenters addressed to ensure they do not risk the project (assuming their concerns are NOT valid)
  • it is important the leaders accept the change and believe it is credible and justifiable so that they can lead the change Mx
• what are the potential unintended consequences?
  • things are not always what they seem
  • trials and deep thought cognitive exercises are important to detect these consequences early
• beware of increasing complexity!
  • the ED is far too complicated - any increase in complexity is likely to have unintended adverse outcomes
• identify other barriers to the change
  • these may be IT related or physical or out of scope issues which cannot be managed
• is the timing right for change?
  • there is no point trying to bring in complex change when staff are extremely stressed and overburdened such as during Winter demand periods
  • is the staff ready for the change?
• ensure the change is sustainable
  • there is no point going through all the hard work and pain of change Mx only to find that lack of resources or unintended consequences results in the change being abolished
  • most projects need additional resources to keep training new staff, monitor compliance and issues, and troubleshoot these to ensure a continual improvement cycle is possible - EDs are not static environments - most change needs ongoing tweaking to fit the changing business needs
• build in early potential successes
  • these help perpetuate the change and increase buy in from the fence sitters as well as provide motivation to staff to continue the good work