Implement Changes

Implementation is the permanent change to a new way of working in one area or throughout an entire organization. Using small cycles of change to try out new processes helps with implementation by engaging those who will be affected by the change and demonstrating success with the new process. However, implementation requires permanently altering ingrained habits and processes and can be very challenging. Resistance to change is often greater during implementation than during testing. Careful planning that includes developing strategies to overcome resistance and manage the social aspects of change is critical; early and ongoing communication is key (see Table 3). Use learnings from the testing cycles to anticipate issues that will need to be dealt with during implementation. Develop processes to support individuals in the new way of doing things, such as altering job descriptions, adjusting policies and procedures, and introducing training.

Table 3. Communication strategies to mitigate resistance to change3
  • Share information on why change is needed.
  • Demonstrate support from champions throughout the organization.
  • Inform people about how the change will specifically affect them.
  • Be open to questions, requests for clarification, or ideas about the change.
  • Highlight the collaborative nature of the project, that solutions are developed with the input and support of those who will be affected the most.
  • Publicize the ongoing results of the change process.

Implementation can be accomplished with a series of cycles accompanied by measurement, similar to the testing phase.3 Three main approaches to implementation are:

  • “Just do it” – A date is set on which the new process becomes the expected way of doing things. This is most suitable for a simple change that will have limited impact outside the area where the change is being introduced.
  • Parallel implementation – The new process is phased in while the old system is continued before being phased out.
  • Sequential implementation – The new process replaces the old process gradually in terms of completeness or coverage. This is advisable for complex changes. Learning from continued measurement throughout implementation can be used to adjust the implementation process or tweak the change to respond to new issues that were not detected during testing.

U for Units: Implementation Strategy

The project team concluded that a ‘no fill’ policy was required to reach 100 per cent compliance with the requirement to use the dose designation units. They also concluded that the education and peer comparison feedback process was a valuable strategy to increase compliance with the expected practice standard. A sequential approach to implementation was chosen for other areas using a similar education and peer feedback process, with priority for implementation given to those areas where use of U was common.
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U for Units: Implementation Strategy

The project team concluded that a ‘no fill’ policy was required to reach 100 per cent compliance with the requirement to use the dose designation units. They also concluded that the education and peer comparison feedback process was a valuable strategy to increase compliance with the expected practice standard. No additional implementation strategy was needed because the practice of all prescribers and those who transcribe orders had been addressed during the test and refine stage.

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