Change management is essential to sustaining a culture of quality and process improvement. Process improvement efforts require not only an understanding of the methods and tools of improvement, i.e., Lean Six Sigma, but also the “softer skills” of change management. These “softer skills” include leadership, team building, culture, context and patient and family engagement. As physicians, medical directors, emergency and critical care nurses, educators and leaders embark on resuscitation program improvement efforts, sustainability is only possible if sufficient attention is given to both the “human” and the “process” sides of change.
Change management involves the selection of strategies to facilitate the transition of individuals, teams or organizations from a current state of operation to a new desired state. It entails a process and set of techniques to manage the feelings, perceptions and reactions of the people affected by change being introduced. Change management can be used in Emergency Medical and Hospital-Based Services to facilitate the transition to new policies, processes and/or protocols aimed at improving organizational operations and patient outcomes.
The process side of change management involves the specific activities required for moving from the current state to the desired state by addressing processes or systems. The human side of change involves strategies to help impacted team members understand and embrace change by reducing resistance and securing buy-in to the proposed process or systems change. While both aspects of change are integrated and occur simultaneously, leaders must consider each distinctly as they address challenges and impediments. An effective Change Management approach integrates the “process” and “human” considerations and strategies necessary to build a culture of quality into six foundational elements (leadership, employee empowerment, customer focus, teamwork & collaboration, QI infrastructure, and continuous process improvement) and across the six phases of a culture of quality (no knowledge of QI, not involved in QI activities, informal or ad hoc QI activities, formal QI activities implemented in specific areas, formal agency/organization-wide QI, and QI culture). Several Change Management frameworks exist and specific components of each framework vary but most models address the change process along three general phases: (1) preparing for change, (2) transitioning, and (3) institutionalizing change.
Arguably it may not be sufficient to merely scrutinize process to identify waste and inefficiencies in CPR training, simulations and EMS and hospital based resuscitation programs. To ensure sustainable process improvements, change management should be recognized as an integral component for best practice development of quality EMS and quality-based resuscitation programs.