Training is essential for change management

Nacho Vallejo

The actors who intend to get involved in the orchestration of changes in our healthcare system tend to agree on the difficulties and barriers that limit the development of improvement strategies for healthcare organizations. We have already seen it in previous posts on this blog, where we asked ourselves what has become of the professional's experience and how to "unclog" our institutions.

In the clinical field, progress and improvements seem essential, but the adaptation of organizations to the needs of people and professionals frequently shows resistance. One of the main reasons is the complexity of our healthcare system compared to the reality of other sectors. This is one reflection proposed in the article “Changing how we think about healthcare improvement”, published in The BMJ. For the change to be effective, it’s relevant not only to insist on this need for improvement but also to increase knowledge about the complexity of organizations. No other industry or sector has so many variables: financing, regulation, suppliers, "clients" with different needs and different intervention options. Even in the clinical setting, we must individualize healthcare for each patient. In this situation, when looking for implementing a change, sometimes the system doesn’t react predictably. The results don’t always come from positive experiences in the past either.

In this framework, professionals are often uncomfortable with this line of analysis and proposals and we rely on the clinic and our experience to try, frequently, to implement improvements that allow us to continue advancing through trial and error. Knowing the elements that make it easier for us to have help tools in this task becomes, therefore, a value strategy.

The School for Change Agents

The School for Change Agents is a free course promoted by the Horizons division of the English NHS. It’s taught once a year in a virtual learning environment. It’s open to any professional profile (belonging to the NHS or not) who is interested in promoting improvements and making a difference. The School develops an interesting proposal to facilitate the acquisition of skills and competencies in change management, as identified in the trailer for its 2019 edition.

It’s structured in six weeks of learning, to use an online platform with a pace of work set by the student. During the instruction, scheduled sessions are interspersed by videoconferences, lasting approximately one hour, led by professionals with extensive experience in change management. The School also facilitates the possibility of sharing, learning and connecting with a wide community of professionals about 15,000 people worldwide, using Twitter, Facebook and the Futurelearn learning platform itself. The community develops during the course the analysis of practical examples of change and is led by Helen Bevan and Kathryn Perera, two renowned professionals in this field. For all who are interested, it’s a highly recommended training strategy. If there is a language barrier, it’s possible to use the translators integrated into web browsers and have the seminars available on the YouTube platform, which also facilitates the translation of subtitles for non-English speakers, to follow the course easily. The School has the added incentive, once the training is completed, to continue in contact with its professionals through the Horizons website, which has many interesting resources such as, for example, the weekly review of content and experiences on its social networks in the Tweets of the weak section. Also, for a minimum cost, you can get a certification use and there is the possibility of maintaining access to its contents on the platform, once the activity is finished. As a complement to this strategy, it may be helpful in planning improvements to look at the guide The Change Model, an eight-component model for change that pivots around a “common purpose”, a very important aspect recurrent in which one works at the School. It’s also developed in the NHS and available for consultation on the following website. In this direction, we can also find abundant resources and additional readings.

The Institute for Healthcare Improvement

The North American organization The Institute for Healthcare Improvement is also a very interesting source of resources that offers, for example, general technical reports such as the IHI Framework for the Psychology of Change. This document points to strategies to facilitate changes:

• Keeping professionals' intrinsic motivations in mind can increase their individual and collective commitment.

• Involving all stakeholders in the design of the changes can facilitate greater involvement by professionals.

• Authenticity in professional relationships helps make co-production and change more likely to succeed.

• Distributing responsibilities among all professionals involved in the changes can contribute to progress.

• Making the experience of change itself a motivating element helps collective learning and makes the transformation more effective.

In a more particular area, the Care Redesign Guide web, from the same institution, carries out a thoughtful and structured exercise, in this case, aimed at improving and redesigning the care of people with complex needs and high cost.

The New England Journal of Medicine Catalyst

The NEJM Catalyst platform, from the NEJM group, is another reference that contains various proposals and reflections on the improvement of health care for both clinicians and managers. It offers a wide range of practical ideas and solutions from four job perspectives: leadership, patient engagement, redesign of care, and fresh opportunities in care - and it does so openly through regular articles from opinion leaders and prestigious experts.

Finally, social networks are another element of change that is worth considering. Communities that chat on twitter around the hashtags #lateralsalud or #cambiahospital concentrate the concern of professionals, managers and patients regarding innovation and change management, proposing reflections, references or putting different people (also patients) in contact with the same purpose: the improvement of our health system.

Undoubtedly these resources and movements invite action. Now we only have to bet on it and take the step, surely our patients will benefit and professionals and managers will be more satisfied and motivated.