As we were growing up, one of our favorite programs was Bewitched. For those of you who have never seen this program, it was about Samantha, a witch in the land of mortals who could twitch her nose to make things happen. Often, the things which were set in motion when she twitched her nose were typically not the things she wanted done, and the remainder of the episode was the undoing of that one twitch.

In healthcare, we see change constantly as new technology is developed, and funded research makes discoveries. How often does a hospital or clinic get new equipment? How often do healthcare personnel attend a symposium or industry conference and return home wanting to implement the latest and greatest? What might be the latest regulations or financial imperatives which shape how we do business in healthcare? What do we need to do to improve quality and patient safety outcomes?

Just as Samantha had done, we often wish we could twitch our way to implementing the numerous imperatives we as healthcare leaders juggle. The lesson to be learned from those early TV episodes is that getting the right things done to make effective and lasting change requires more than just doing it. But rather, successful change really boils down to four key things, and the leaders of change need to take time to:

1) understand the reason for change

2) engage those who will be asked to change in the planning

3) develop a good implementation plan

4) monitor for outcomes & resistance to the new process, and address roadblocks which prevent achievement of the expected outcome

Using these general concepts, we advise on an approach for Patient Flow improvement which has proven successful.

Reason for Change

First, we set the stage with senior leaders and their respective department leaders regarding patient flow inefficiencies within their organization. Using the “Voice of the Customer”, we seek feedback from key constituents within their organization to understand the strengths & weaknesses of their current patient flow approach. Connecting patient flow improvements to key strategic priorities can create the reason for change for senior leaders. Translating the reason for change into a vision which can be shared among all associates begins the process for needed change.

Using the vision to communicate what “good” looks like may jump-start thinking about what may need to change. But often, another level of granularity is required to get them fully engaged. It is the age-old adage of “what’s in it for me?” that can get them ready for change. Engaging the team early and thoroughly will help to make change happen

Team Engagement for Adoption

Patient flow is a team sport; it is not just a nursing or physician issue…or an ED or inpatient issue. We know that timely management of the patient’s episode of care is impacted by other clinicians, such as pharmacists, rehab therapists, & case management professionals to name a few.  We also know that preparing the bed for the next patient requires a hand-off of sorts from the clinician to the EVS (environmental services) associate.  Preparing the room for cleaning is very much a nursing function, and if left undone can cause unintended delays.

So, when devising processes which incorporate leading practices for patient flow, we strongly encourage interdisciplinary teams from clinicians to support department associates working together to eliminate the waste of current processes and create the new best way. Giving the folks who do the work every day the chance to improve that work will likely result in a process that works well for all members of the team.

It will also likely make the task of implementing the new process a bit easier. The process improvement team members can become ambassadors of the revised process and with their leadership, will share the reasons for the change. Understanding the why for doing something will increase the chances that a team member will adopt this new process. The “what’s in it for me” question can be answered by these ambassador leaders and can provide the ultimate reason for change.

Planning for Change

Implementation of a new process is hard, especially in healthcare where we staff people around the clock, 7 days a week. While we might have designed the best process in the world to address patient flow, it could be all for naught if the training approach goes “hay-wire”. Creating a standard work document which concisely & logically addresses the steps to a process can be a great support to achieving successful implementation. Not only does the teacher know exactly how to teach this highly reliable, standardized process, but it can be used as an aid for the learner until this new process is fully internalized. You will notice that in the example below, the overall purpose for this new standard process is highlighted which can address the reason for change. And the Key Point/Reason for a particular process step can be highlighted. All helpful in increasing adoption to the new process.

Education is only one of the steps in the implementation process, spending some time with the process design team to understand the barriers to implementation can be helpful.  Being sure to address these barriers in the implementation plan will also support effective change.  So, the implementation plan should include how to address the barriers identified.  Then a reality-based Go Live date with the new process can be set for implementation.

Monitor for Outcomes & Resistance and Address Roadblocks

Implementation day has finally come and gone.  Agreed upon metrics to measure success have been collected globally and at the unit level. It is important to measure progress at the unit level, to identify the people or process issues that may need adjustment.  Data is helpful but leaders walking the units where the work gets done is also helpful to see if there are unanticipated barriers that were not considered in the design process. One can also see if the process as designed is being followed. Attempts should always be to encourage associates to follow the planned process for a given time to achieve the expected results. We need to be able determine if the metrics are not achieved because the process is not being followed, or because the process failed to consider a barrier when designed.  In the case of the latter, gathering the design team members together to understand the root cause of the process failure will aid in refining the process for implementation again. And the loop will continue until outcomes as expected are achieved.

Certainly, the twitching method of change does seem easier.  However, remember the amount of time and effort that it takes to undo unintended consequences, taking the easy route, can be equal to a thorough and thoughtful change plan.  Let us help you develop that plan!

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About the Experts

Carole Miserendino

Carole Miserendino serves as a Managing Consultant with the TeleTracking advisory team. In her role, she supports organizations to optimally use TeleTracking solutions and influencing how they adopt the technology through change management and process redesign.

Carole joined TeleTracking after more than 35 years’ experience in the healthcare industry. Her expertise spans strategy development, nursing staff development and optimization, operational performance improvement, patient care and quality processes, labor productivity, Toyota Lean Management System, and clinical information system transformation.

Carole has held various leadership roles focusing on patient care, operations, and performance improvement. She has served as senior patient care executive for an academic medical center and large community teaching hospital within a large system. In that capacity, she collaborated on the local and system strategy development for the organization and led the patient care operations with a focus on operational performance improvement. In addition, she has served as a senior patient care consultant for healthcare institutions ranging in size and complexity from small rural community hospitals to large academic medical centers. She assisted nursing divisions to examine and improve operations in areas such as patient care processes and quality care outcomes, labor productivity and staffing processes using operations management methods and Big Data, and organizational effectiveness.

Carole has presented at numerous professional meetings including American Organization of Nurse Executives (AONE), Nursing Management and Association of Women’s Health, and Obstetric and Neonatal Nursing (AWHONN). She has also been an American Nursing Credentialing Center (ANCC) Magnet Hospital Appraiser.

Carole holds a doctor of public health degree in health policy and administration from the University of Illinois at Chicago – School of Public Health, a master’s degree in maternal child nursing from Loyola University of Chicago, and a BA in nursing from Augustana College in Sioux Falls, SD. She is a Fellow in the American College of Healthcare Executives.


Jodell Speckhart

Jodell Speckhart brings extensive experience in healthcare consulting, change management, and facilitation methodology to her role as a consultant for Teletracking. She is a certified Lean Six Sigma Green Belt, and maintains professional certifications as a Registered Health Information Technologist (RHIT) and as a Professional in Healthcare Quality (CPHQ).

Prior to joining TeleTracking, Jodell was a consultant with Joint Commission Resources (JCR), a not-for-profit affiliate of The Joint Commission. As a consultant for JCR, she facilitated and conducted gap analyses and performance improvement consulting for accreditation preparation for home care, hospital, and ambulatory settings, working with all levels of staff to ensure safe, quality and efficient care was provided.

Prior to her consulting position with JCR, Jodell served as Administrative Coordinator for the Blessing Health System in Quincy, Illinois, in a tenure that spanned 27 years, during which time she was responsible for quality, infection control, utilization management, and risk management. She is a former Baldrige Performance Excellence examiner as well as an Illinois Performance Excellence Lead Examiner.

Jodell holds a bachelor’s degree in healthcare management and is a registered health information technologist. She is also a Licensed Practical Nurse and a certified Professional in Healthcare Quality (CPHQ).

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, Patient Throughput, Patient Flow Experts
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Clinician, Operations

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