How to Hardwire Change

    • June 4, 2008

The Goal
Implement changes as a part of the institutional culture so they become standard process.

Why It's Important:
Transformational change requires a commitment to incremental, sequential changes inspired by ideas generated by the staff closest to the work on medical/surgical units. Sustained change requires leadership support from both unit leaders and senior leaders in order to integrate both the capacity for ongoing improvement and the integration of successful changes into the culture and fabric of the unit. Hardwiring change is a concept that requires leaders to make it "easy to do the right thing."

How To Do It:

1. Start with a change that will be easy to hardwire and is readily accepted by staff. When hardwiring changes across an entire hospital that involve multiple units, it's important to begin with changes that are most easily adoptable and require limited investment.

  • Examples of changes that may be easiest to spread could be a new system to alert care teams when to turn patients and white/information boards in patient rooms.

2. Understand what long-term practices have been in place and make a strong case for how the change will be beneficial. It is particularly difficult to change practices that have a long history on the unit, even if these practices are inefficient or fail to support evidence-based practice.

  • When possible, unit leaders should integrate support for the appropriate evidence-based changes into information technology and decision support processes.

3. Identify upfront investments necessary to implement change.
In many cases, hardwiring change across an entire hospital involves funding capital changes, process changes and cultural changes. Understanding the long-term costs and benefits of making an initial investment is critical to making the case for overall savings.

  • Purchasing new equipment or supplies to redesign storage and access may involve up-front costs but making the case for how nurses and frontline staff improve quality and spend more time with patients may easily justify the costs.

4. Obtain buy-in from hospital leadership and unit managers to make the necessary changes to implement a new change. Hardwiring change may require redesign of the actual physical structure of the unit, or it may require changing processes to ensure reliable patient safety or improved efficiency.

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