Plagiarism check
References and citations should be given in APA 7th edition
Please follow the assignment instructions properly.
Your task is to develop for the Board of Directors at London Health Sciences Centre (LHSC), which is in Ontario, Canada a Strategic Communication plan. You are to use the modules from weeks 11 to 14 inclusive on change management, communication regarding the changes, the PDSA performance, and Quality safety outcomes for patients. Hence please show at least one reference to the PPT and one reference to one of the readings for module 11, 12, 13, and 14. This will show evidence that you learned concepts that are relevant to course vocational learning outcomes.
Remember you need to answer this creative assignment with purpose which is why you should not be using the internet. The exception for using the internet is if you want to bring context to your own country use INDIA or when you want to reference the new Bill 60, but very minimal as this is not the purpose of the assignment. Remember, you are addressing an environmental change in legislation (Bill 60) that has a direct impact on hospitals (operating budget, patient flow, patient health outcomes, health human resources, patient safety) and developing an effective strategic plan for the Board of LHSC. For this assignment AI/Chat GPT (including Grammarly is forbidden). Per the protocol, an automatic zero grade and an academic offence will be issued.
Please also structure your work. Provide a cover page, table of contents, introduction, key subheadings for the main strategic areas of focus: Professionalism and Change Management, Communication Tactics, PDSA Performance, and Quality and Patient Outcomes, and Conclusion.
Format:
▪ The assignment must be completed in WORD in the proper format. Font: Times New Roman Size: 12pt
▪ Single space and 6000 words in length (excluding cover and reference page).
▪ References following APA 7th edition must be provided at the end of the document.
Type
Written Assignment
INFO 6057 Health Systems Management
Assessment
Section 3 Independent Creative Assignment
Strategic Communication Plan
Weighted Evaluation
20%
Purpose of the Assessment:
You are near the end of the final semester of MGMT 6181course and there has been a lot you have been
taught on leadership and ethics (weeks 1-5), finance management and analysis (weeks 6-10), and now this
section of the assessment is evaluating your quality assurance and decision-making implementation skills
(weeks 11-14).
You are going to examine a decision recently made by our Provincial government to address the increase
wait time. Please review the Background on Bill 60 and the Appendix 1 (Article) on page 3 that highlights
the new Ontario legislation changes. As a future Health Information Manager (HIM), your task is to
critically examine this Provincial government decision and apply what you learned in the MGMT 6181
modules 11-14 inclusive to a decision support role you would have as a HIM working in a hospital setting.
Your task is to develop for the Board of Directors at London Health Sciences Centre (LHSC), a
Strategic Communication plan. You are to use the modules from weeks 11 to 14 inclusive on change
management, communication regarding the changes, the PDSA performance, and Quality safety
outcomes for patients. Hence please show at least one reference to the PPT and one reference to one
of the readings for module 11, 12, 13, and 14. This will show evidence that you learned concepts that
are relevant to course vocational learning outcomes.
Remember you need to answer this creative assignment with purpose which is why you should not be
using the internet. The exception for using the internet is if you want to bring context to your own country
or when you want to reference the new Bill 60, but very minimal as this is not the purpose of the
assignment. Remember, you are addressing an environmental change in legislation (Bill 60) that has a
direct impact on hospitals (operating budget, patient flow, patient health outcomes, health human
resources, patient safety) and developing an effective strategic plan for the Board of LHSC. For this
assignment AI/Chat GPT (including Grammarly is forbidden). Per the protocol, an automatic zero grade
and an academic offence will be issued.
You are being evaluated on vocational learning outcomes and essential educational skills required as a
health information manager providing decision report. Therefore, you are to review the lecture zoom
collaborative videos (PPTs), readings and practical tools taught from module 11-14 inclusive. Using
critical thinking, analysis, you are going to reflect on the situation that is real in the scenario that is
articled in Appendix 1. You will need to critically examine the context of the situation and how it currently
impacts London Health Sciences Centre surgical capacity issues, operating funding issues, health human
resources (both positively and negatively). It is important and critical that you compare/contrast the
information from the modules you learned and use your personal experience in the responses just like we
have been doing in our collaborative sessions. You must provide an in-text citation for all information
used from the modules 11-14 using APA 7th edition documentation.
Created and Written by Dr. S. MacLean, Nov 21, 2023
p. 1
MGMT 6181 Assessment
Please also structure your work. Provide a cover page, table of contents, introduction, key subheadings
for the main strategic areas of focus: Professionalism and Change Management, Communication Tactics,
PDSA Performance, and Quality and Patient Outcomes, and Conclusion.
Format:
▪
▪
▪
▪
The assignment must be completed in WORD in the proper format. Font: Times New Roman Size: 12pt
Single space and 6000 words in length (excluding cover and reference page).
References following APA 7th edition must be provided at the end of the document.
Your assignment will be saved with your: First name_Lastname_Assignment 3
Experiential Learning: Your role as a health information manager is to critically examine the situation
from diverse angles and highlight a strategic communication plan for the Board of London Health
Sciences Centre to communicate with the staff across the hospital organization. This Plan needs to
consider an effective change management plan, communication methods/tactics used, a PDSA analysis
you would recommend, and key measures and indicators to address quality improvement. Remember, you
are to use the module lecture recordings (PPT), FOL readings, and practical tools provided in weeks 1114 inclusive in your assignment.
Reminders: All Assignments must meet the due date in drop box and not accepted via email. In addition, the following
are the four (4) minimum standards for all written assignments:
1. Integrity: Ensure your assignment contains no plagiarized segments and is 100% paraphrased. Note: Quotations and
paraphrasing of any source without proper in-text citations and attached reference list is considered plagiarism. The turnit-in score must not exceed 15% and have more than one consecutive copied sentence from any source. Using
AI/ChatGPT is forbidden and considered plagiarism. If there is plagiarism, your assignment will be considered an
academic offence.
2. Purpose: Ensure that your assignment answers the key objectives of the assignment and achieves the primary purpose.
3. Readability: Ensure that your assignment is edited to account for the majority of grammar, punctuation, and spelling
errors. If it contains too many errors that create confusion of meaning and severely limits communication, then it will not
meet the minimum standards.
4. References: You must reference ALL sources from which you obtained information, and provide a citation for any
information using APA 7th edition format (see A136 Academic Integrity).
Read the Background (this background and
the article will give you context to the
“legislative change” that has a direct impact
on the hospital (in terms of funding, health
human resources, patient flow and
potentially patient quality/safety of care)
Use critical thinking. Think of questions that
the Board may have? Ask relevant questions
and carefully anlayze the matters with pro’s
and con’s. Use your own personal experience
from your home country to contrast and
compare but don’t lose sight on the purpose
of the assignment.
Created and Written by Dr. S. MacLean, Nov 21, 2023
p. 2
At the end, you require to develop a viable
and realistic communication plan where
LHSC is able to mitigate from overflow issues,
increased wait time, surgical back log issues,
operating budget increases, loss of human
resources, and patient safety.
MGMT 6181 Assessment
Background: This is an experiential learning exercise that is real and you are part of the solution:
The Ontario government has passed a bill allowing private clinics to conduct more OHIP-covered
surgeries as advocates warn of potential legal action. Bill 60, also known as the Your Health Act, was
passed by the Doug Ford government on Nov 1/23 and will go into effect once it receives Royal Assent.
Under the legal bill, both for-profit and not-for-profit clinics will be allowed to conduct cataract surgeries,
MRI and CT scans, minimally invasive gynecological surgeries and, eventually, knee and hip
replacements under the Ontario Health Insurance Plan. There is no doubt that Ontario’s health-care system
was hard hit by the COVID-19 pandemic. Emergency rooms and intensive care units were regularly over
capacity, and the constant spread of novel coronavirus meant staff had to struggle with their own numbers
to keep up. Physicians, who typically worked in the surgical wards, were re-routed to general or
emergency care. All non-urgent procedures were put on hold, creating an immense backlog of patients.
Some questions you should critically think before you tackle this assignment include: Although surgical
wait time back log is significant, are there factors to consider given private clinic surgeries don’t offer
overnight care? Hence, is this going to impact hospitals significantly and if so, how? What will be the
impact at the end when you mix public versus private health care in a publicly funded healthcare system
which already taxes Ontario citizens heavily? Think about our discussion we had regarding for-profit and
not-for-profit and the comparisons of your country where two-tier health care and caste systems exist?
What quality standards would exist for the for-profit private clinics when there is no legislation holding
them accountable? We know the rules which hospitals apply for patient surgeries, what are the rules for
the for profit, private clinics? Put your thinking caps on for this assignment. Remember, the government
pays the media to share information to the public, so the media are NOT a good source of ethical reasoning
nor are the media ever balanced (in other words paid by the government what to say which is not in the
benefit of society).
Created and Written by Dr. S. MacLean, Nov 21, 2023
p. 3
MGMT 6181 Assessment
Appendix 1: Examine article critically (Nov. 1, 2023 by Author Katherine DeClerq)
Expansion of private clinics likely to increase wait times in Ontario
Ontario’s plan to allow more for-profit clinics to conduct surgeries and diagnostic procedures is likely to
increase wait times rather than reduce them, a new report suggests.
The report, released Thursday by left-leaning think tank Canadian Centre for Policy Alternatives(opens
in a new tab), suggests that for-profit surgical and medical imaging was a half-billion-dollar industry in
Ontario between 2021-22 and that an expansion into this sector will only worsen the public health staffing
shortages.
“I’m very concerned to see the government moving in this direction when Ontario has actually been a
fairly well integrated and coordinated system, in large part because it hasn’t farmed out surgeries to a
cottage industry of for profit facilities,” Andrew Longhurst, health policy researcher at Simon Fraser
University and author of the report, told CTV News Toronto.
According to Longhurst’s report, Ontario had the best wait time performance for hip and knee replacement
surgeries in Canada last year. About 72 per cent of hip replacements and 68 per cent of knee replacements
were conducted within the national benchmark of 26 weeks.
“Ontario is actually one of the best performers among all the provinces for hip and knees and MRI and
CT scans,” Longhurst says. “And these are the four areas where we have heard the government is most
likely to expand for profit delivery.”
In May, the Ontario government passed Bill 60(opens in a new tab), which allowed private clinics, both
non-profit and for-profit, to conduct more surgeries covered under the Ontario Health Insurance Plan
(OHIP). The procedures covered include cataract surgeries, MRI and CT scans, minimally invasive
gynecological surgeries and, eventually, knee and hip replacements.
The government has stressed that these procedures will remain covered under OHIP. However, experts
and advocates have expressed concern about oversight, staffing and upselling—three of the most
significant issues outlined in Thursday’s report.
“Ontario does not lack the physical space and equipment to improve wait times for surgeries and medical
imaging; what is missing is the health-care workforce necessary to do the work,” the report notes. “When
surgeries and diagnostics are outsourced, the public and for-profit sectors compete for a limited pool of
specialized health-care professionals.”
“The private sector may offer incentives to attract health-care workers from the public system, such as
reduced workloads, less complex patients, and higher pay.”
In a statement provided to CTV News Toronto, Ontario’s Ministry of Health said there will “always be
those who are opposed to innovation,” in response to the report’s findings.
“But our government is not okay with the status quo. That’s why, as part of Your Health, we announced
in January that we are further leverage [sic] community surgical and diagnostic centres to deliver more
publicly funded surgeries and procedures to reduce the surgical backlog and overall wait times,” a
spokesperson for the ministry wrote.
Created and Written by Dr. S. MacLean, Nov 21, 2023
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MGMT 6181 Assessment
“Our plan has already reduced the surgical backlog to pre-pandemic level, adding 14,000 additional OHIP
covered cataract surgeries annually and 49,000 hours of MRI and CT scans, with 80% of all Ontarians
now receiving surgery within the target time,” the spokesperson added.
Between 2019-20 and 2020-21, operating rooms in Ontario lost 122 full-time equivalent staff, the report
notes. The loss of staff in the public sector places more burden on not just hospitals but the health-care
system as a whole, the report argues.
“If you don’t have enough patient flow happening through your hospitals, you can’t move people through
the hospital and you’re constrained in terms of the number of inpatient surgeries you can do,” Longhurst
said. Instead of focusing on for-profit care, the government should instead ensure that operating rooms
are able to work at full capacity, Longhurst says. According to the report, about 34 per cent of hospitals
had unused operating room capacity in 2019-20.
“Additional capacity can be created by extending OR hours, but a significantly expanded for-profit
surgical sector will be competing for the same skilled staff,” the report says.
PROTECTING PATIENTS FROM EXTRA-BILLING
Over last two decades, patients in Ontario have been reimbursed more than $3 million for unlawful extrabilling, the report suggests. In 2022, there were 43 complaints related to the Commitment to the Future of
Medicare Act. The report notes that 35 per cent were “verified contraventions.” The report does note that
the number of complaints and contraventions are at historic lows, however Longhurst says “it’s still an
issue.”
“I think we would be mistaken and I think government would be mistaken to say that extra billing and
two tier health care is not an issue in Ontario,” he said.
The report argues that a complaint-driven enforcement regime will result in a conservative estimate in the
number of unlawful extra-billing.
While Bill 60 specifies that a physician at a private clinic shall not turn a patient away for choosing to pay
with their OHIP card, it does not prevent upselling or self-referrals. The Canadian Centre of Policy
Alternatives is suggesting there should be measures outlined in legislation to protect patients.
While the government has promised to designate “expert organizations” to work with Ontario Health and
the Ministry of Health to ensure quality and safety standards are met, advocates argue its not enough to
combat instances of what they call “manipulative upselling.”
The Ontario Health Coalition, which advocates for publicly-funded health care while representing more
than 500 member organizations and individuals, previously shared testimonies (opens in a new tab)from
patients in which people paid out of pocket for procedures. In some instances, patients said they were
urged to get upgraded lenses, told they had to incur the costs of eye measurements, and invoiced for
contrast dye needed for imaging.
The costs, according to the coalition, were anywhere from a few hundred dollars to over $8,000.
“I think we need to be live to the reality that this activity will continue as you see and you grow this forprofit industry,” Longhurst said.//End of Article (Think: What questions do you have)?
Created and Written by Dr. S. MacLean, Nov 21, 2023
p. 5
MGMT 6181 Assessment
0 Not acceptable
3
1 Needs improvement
2 Competent
3 Good
Your written work will be evaluated by the criteria below in
order to give you specific feedback to help guide your
development as a writer. Communicating in writing is an
essential skill required in the 21st century.
Measurement Indicator
Quality (/5)
1. The purpose and focus are clear and consistent.
2. The communication plan is clear, significant, and
accurate. Includes all 4 subheadings and answers with purpose
3. F o r m a t is purposeful, effective, and appropriate.
4. Sentence form and word choice are varied and appropriate.
5. Punctuation, grammar, spelling, and mechanics are
appropriate. APA 7th edition documentation is followed.
Content (/5)
1. Information and evidence are accurate, appropriate, and
integrated effectively with purpose.
2. Claims and ideas are supported and elaborated.
3. Alternative perspectives are carefully considered and
represented.
4. Contains original ideas. Academic integrity is followed.
5. All ideas are clearly developed, organized logically, and
connected with effective transitions.
Analysis (/5)
1. Connections between and among ideas are made.
2. Analysis/synthesis/evaluation/interpretation are effective
and consistent.
3. Independent thinking is evident.
4. Creativity/originality is evident.
5. Effectively applied appropriate tools for decision support
Assignment Specific Criteria (/5)
1. Responds to all aspects of the assignment.
2. Documents evidence appropriately.
3. Considers the appropriate audience/implied reader.
4. All relevant module concepts are applied appropriately.
5. Structure and format enhances delivery of the
information.
4 Excellent
RUBRIC: This rubric is designed to make clear the
grading process for written communication by informing
you, the writer, what key elements are expected by the
College in a “good” piece of written analysis work.
Overall Evaluation: Scored out of 20 points
D
Excellent
D
Competent
Created and Written by Dr. S. MacLean, Nov 21, 2023
D
p. 6
Not Acceptable
MGMT 6181 Assessment
Organizational Decision Support
MGMT 6181
Week 11, Class 1
Professionalism and Change Management
Professor Dr. Silvie MacLean, EdD, CPA CMA, MHSc, HBA
Educate, Engage, Empower, Excite
Today’s Learning Objectives:
1. Identify the key features of change in a professional
environment.
2. Highlight the importance of behaviour with respect to the
culture of an organization.
3. Outline and discover new ways to support/encourage
change (consent/circle of care/important legislation).
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
2
Change:
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
3
Mento et al., 2002
Evaluates and
presents a mind
map of three
different models
of change
Kotter’s strategic
eight step model
(transitioning
organization)
Jick’s 10 step
model
(implementing
change)
General electric
7-step change
(accelerating
processes)
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
4
Mento et al., 2002 Stated the following:
Kotter’s strategic eight
step model
(transitioning
organization)
• Best used as a vision for the change process
• Each change process goes through a series of phases lasting a
considerable amount of time
• Devastating if a mistake occurs b/c breaks momentum for change
• More tactical
• Change is not a discrete process
Jick’s 10 step model
• Change is iterative process instead where change is continuous
(implementing change)
General electric 7-step
change (accelerating
processes)
• Follows Lewin (1947) notion of unfreezing, movement and freezing
• Focuses on the leaders role
• Seen more as a checklist for the leader to use
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
5
Mento et al. developed 12 step model (use story telling of
a mission boat voyage):
The idea its
context
Define the
change initiative
Evaluate the
climate for
change
Develop a
change plan
Develop and
choose a change
leader
Create the
cultural fit
Prepare your
target audience
Find and cultivate
a sponsor
Create small
wins for
motivation
Constantly and
strategically
communicate the
change
Measure
progress of the
change efforts
Integrate lesson
learned
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
6
Important lesson learned:
Those who forget the
past are condemned
to repeat it
12 steps are meant
to be integrated and
iterative
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
7
Change and Transition:
What’s the Difference?
Change is the event that
happens – the outward and
visible.
Transition is the internal process
that happens – emotional,
psychological, mental, and
spiritual responses to change –
the inward and spiritual.
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
8
Understanding the Theory of
Change and Transition:
Understanding the
difference between
change and transition
will help you:
• Look for God in your midst
• Understand your own role
and power – or lack of it!
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
9
Remember……Change and Transition:
Key difference
Change is
outward and
visible.
Transition is
the inward
and spiritual.
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
10
Change Is Like A Move to a New Location:
I. Begin Here
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
11
Transition Is More Like a Journey:
When Does the New Place Feel Like Home?
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
12
Transition Feels Like the Time
between Trapezes
▪ What is hard about letting
go of the trapeze bar?
▪ What is it like to be
between trapeze bars?
▪ What will it be like to grab
the next trapeze bar?
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
13
When Have You Experienced Transition?
A time of significant change – what was it?
What ended?
What helped get you through the transition?
What were the signs that things were going to be OK?
When did things seem “normal” again?
Looking back, where did you see God at work in the midst of your transition?
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
14
A Sense of Control Influences Transition:
I influence
I control
I have no control
or influence
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
15
One More Thing about Transition. . .
Transition time can be so
chaotic or painful that it is
tempting to go back to the old
status quo or engage in
uncharacteristic behaviors.
Trust us: Neither is very
helpful for long term stability!
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
16
Congregation in Transition:
What do people need to let go of?
Are there signs of wanting to return to the past or uncharacteristic
behaviors? What are they?
On a scale from 1 (letting go) to 10 (firmly into whatever is new),
where are you personally?
On a scale from 1 (letting go) to 10 (firmly into whatever is new),
where is the congregation as a whole?
What would ease the transition – for you? For the congregation?
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
17
Heath and Heath:
How do we achieve Change?
There are three main components to change:
• Emotional side
• Rational side
• Direction of change
From the book “Switch” by Heath and Heath (2011),
these components are viewed as a relationship
represented as:
• A Rider
• An Elephant
• A Path
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
19
Emotional Side
Emotional side Elephant
• Strengths: Strong, get
things done, energy
• Weaknesses: Lazy
skittish, looks for quick
solutions
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
20
Rationale Side:
Rationale Side: Ride
• Strengths: Long-term
solutions, planning
• Weaknesses: Overanalyze, spins wheels,
focus on problems not
bright spots
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
21
In reality:
Surprises about change:
• What looks like a people
problem is often a situation
problem
• What looks like laziness is
often exhaustion or lack of
project management
experience
• What looks like resistance is
often a lack of clarity
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
22
What are the results of these components?
1. Effective Change
2. Small change
snowballs into bigger
change
3. Culture change
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
23
What do we see when components are
not aligned?
Misalignment of components:
• Rider reached, but not the Elephant:
understanding without motivation
• Elephant reached but not the Rider:
passion without direction
• If the elephant and rider disagree
(functioning on willpower) the rider
gets exhausted
• A clear path is more powerful than
willpower
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
24
How do we achieve the change?
Direct the Rider
Motivate the Elephant
Clear the Path
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
25
Direct the rider:
Find the bright spots – Investigate what’s working and clone it
Script the moves – Don’t think big picture, think in terms of
specific behaviours
Point the destination – Change is easier when you know
where you are going and why it’s worth it
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
26
Shape the Path:
Tweak the environment – When the
situation changes, the behavior changes.
So change the situation.
Build habits – When behavior is habitual,
it’s free – it don’t tax the Rider. Look for
ways to encourage habits
Rally the Herd!
• Behaviour is contagious. Help it spread
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
27
Egan (2005) Resistance to Change:
Change is difficult and
resistance occurs
Usually people most
affected by change are
the ones that resist
The ones affected by the
change are the ones that
need to be convinced. Of
course, there are other
reasons that change is
resisted, which we will
now look at
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
28
Egan (2005) stated that Keen (2005) believed-
People need to rely on incremental,
facilitative approaches especially when
contemplating strategic change, which
requires coalition building and attention
to political mechanisms
In Keens’ work, he looked
specifically at resistance, (inertia),
as it related to information
systems. Keen identified four main
causes of inertia:
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
29
4 causes of Resistance which Egan referred to by Keen (2005):
1) Information is only a
small component of
organizational decision
processes;
(2) Human Informationprocessing is
experimental and relies
on simplification;
(3) Organizations are
complex and change is
incremental and
evolutionary; large steps
are avoided, even
resisted;
(4) Data are not merely
an intellectual
commodity but a political
resource, whose
distribution through new
information systems
affects the interests of
particular groups.
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
30
Three main reasons for resistance to change
(management of change):
People resist, because they
lack the skills to use and gain
benefits from the new
technologies.
There is resistance because
employees in the traditional
companies and industries do
not understand the ‘big picture’
and how the application of the
new technologies changes
how business is done and
processes executed.
Finally, resistance, especially
in middle and upper
management, comes from the
fact that new technologies and
their translation into new
business models redefine the
organizational structures and
the power bases
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
31
Bagranoff et al listed six reasons why people
fear change:
Leaving the
“comfort zone.”
Loss of
position.
New
responsibilities.
Higher
expectations.
Loss of power
and influence.
Past
experience.
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
32
Bagranoff et al listed 4 ways to address change:
1. Establish the need
for change
3. Get a quick win
2. Develop vision and a
business case
4. Align the
organizational structure
and
performance
measurement systems
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
33
Lesson Learn from diverse authors
writing about resistance to change:
As practitioners, this
is valuable; we have
a guide that we can
use.
We still need to keep
in touch with the
literature, but we
have a framework for
implementing
change.
A framework that
allows us to judge
future studies as we
implement change in
our organizations.
34
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
35
Circle of Care:
Circle of care:
• Ability of certain HI custodians to assume
an individual’s implied consent to collect,
use or disclose Personal HI for the purpose
of providing health care in circumstances
defined in PHIPA legislation
HI custodians can be:
• Physician
• Specialist
• Nurse
• PSW
• Case Manager
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
36
Principles of consent to treatment:
Professional care
Better communication
Respect the law/regulations
Legislation: to conclude a perfect decision
Individual’s right to access and obtain information
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
37
Remember legislations:
Personal Information Protection and Electronic Documentation
Act (now being replaced)
• Principles which define how patient personal information can be collected,
used, and distributed by healthcare custodians to ensure security/privacy
Personal Health Information Protection Act (PHIPA, 2014)
• Governs rules and regulations regarding collection, use, and disclosure of
PHI by health custodians
Freedom of Information and Protection of Privacy Act (FIPPA,
2012)
• Entitles individuals to request data to their own data or other organization’s
data if they are a public entity
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
38
Key Features of Maintaining Professionalism:
Communicate
effectively
Accountability
Reliability
Ethics/Trust
Competency
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
39
Summary:
Change means different things to different people and are
influenced by several factors
• Social, Economic, Technological, Legal, and Environmental
Transition is different than change given it is focussed on the
state of change or activity or condition to another
There are different perspectives on change that we need to be
able to address while being resilient and addressing the
emotional and rationale side of change:
• Start with understanding type of change before directing the path for change
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
40
Reflection:
Why is communication so important in healthcare?
What are the important aspects of change and transitioning?
What do you believe will be the most significant challenges to
address diverse change in our healthcare environment?
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
41
References:
Egan, R. W., & Fjermestad, J. (2005, January). Change and Resistance
help for the practitioner of change. In Proceedings of the 38th Annual
Hawaii International Conference on System Sciences (pp. 219c-219c).
Heath, C., & Heath, D. (2011). Switch. New York, NY:
Vintage Espanol.
Mento, A., Jones, R., & Dirndorfer, W. (2002). A change management
process: Grounded in both theory and practice. Journal of change
management, 3(1), 45-59.
Oakland, J. S. (n.d.). Total Quality Management and Operational
Excellence: Text with cases (4th Edition) [Texidium version]. Retrieved
from http://texidium.com
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
42
Questions:
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA, BA, p. 43
Let’s Discuss Creative Assignment 2
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA, BA, p. 44
TWO PARTS:
WORD
EXCEL
Next Class
Communications
and Practical Tools
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA
45
Organizational Decision Support
MGMT 6181
Week 13, Class 2
Practical Training
Understanding PDSA for Quality Improvement
Professor Dr. Silvie MacLean, EdD, CPA CMA, MHSc, HBA
Educate, Engage, Empower, Excite
Today’s Learning Objectives:
1. Establish a clear improvement goal for an improvement
project
2. Plan effective rapid cycle improvements using the PDSA
cycle model
3. Understand the importance of QI measurement and how
to select indicators
4. Appreciate the importance of good survey design, data
collection and the ethics of quality improvement
5. Incorporate change management skills in order to
enhance improvement projects
2
Pulse Check:
How many of you have had
some formal training in QI?
How many of you have
‘done’ QI?
How many have an
improvement project / goal
in mind this morning?
Theory and Science of Quality
Improvement:
Total Quality
Management
Lean / Six Sigma
TRIZ
The Model for
Improvement /
PDSA
Complex
Adaptive System
(Complexity
Theory)
CQI
Theory of
constraints
FOCUS
Knowledge
Translation /
Evidence Based
Medicine
Human Factors /
Systems
Thinking
SQUIRE
Common Themes:
Importance of planning and preparation
Stakeholder engagement
Understanding your environment/culture
Effective communication
Importance of measurement /evaluation
The Importance of Stakeholders:
Identification of internal, external and
key stakeholders is critical to
ensuring successful change
Stakeholders are your partners in
refining what improvements need to
happen
They will also determine how well
your improvement is sustained
Assessing your environmental readiness
Reference: RNAO Clinical Guideline Implementation Toolkit
Structure
Workplace culture
Communication systems
Leadership support
Knowledge, skills & attitudes
Resources
Interdisciplinary relationships
Model for Improvement & Rapid Cycle
Improvement
AIM
What are we trying to
accomplish?
Plan
MEASURES
CHANGES
How will we know a
change is an
improvement?
What changes can we
make that will result in
improvement?
The Model for Improvement
(Langley, Nolan, et al.
Improvement Guide, 1996)
Act
Do
Study
PDSA Cycles for rapid
testing & implementation of
changes
Model for Improvement:
AIM
What are we trying to
accomplish?
MEASURES
How will we know a change
is an improvement?
CHANGES
What changes can we make
that will result in
improvement?
The Model for Improvement (Langley, Nolan, et al. Improvement Guide, 1996)
Aim Statements:
A good Aim Statement will:
• Be clear, concise and specific
• Define WHAT we are accomplishing, not
HOW we will accomplish it
• Allow us to know when we have
accomplished the task
• Direct us on what we will need to measure
• Answer the question: what problem are you
trying to solve?
Aim Statement examples:
❑ Reduce the incidence of hospital-acquired
pressure ulcers to below the provincial
benchmark by March 31, 2023
❑ Eliminate opioid-related critical incidents by
end of FY2022/23
❑ Increase satisfaction with end of life care
(overall score) to above provincial ‘high
performer’ by December 2023
❑ Reduce wait time for palliative care beds to
below best quarter performance by April 2023
SMART Objectives:
SPECIFIC
MEASUREABLE
ACHIEVABLE
REALISTIC
TIMELY
Creating an Aim Statement:
Select one project and take 5 minutes to create
an Aim Statement
Remember: what problem are you trying to
solve?
Aim Statement: ________________________
_______________________________________
_______________________________________
_______________________________________
Model for Improvement:
AIM
What are we trying to
accomplish?
MEASURES
How will we know a change is
an improvement?
CHANGES
What changes can we make that
will result in improvement?
The Model for Improvement (Langley, Nolan, et al. Improvement Guide, 1996)
What do you measure?
Type of improvement measures (indicators):
Outcome measures are tracked over time to
monitor whether the goal / aim has been
achieved.
• Process measures are tracked to ensure changes to the
process/system are taking place.
Balancing measures are tracked to ensure other
parts of the process/system are not being
disrupted by the changes (adverse effects)
In other words….
Outcome
Measures
Process
Measures
Balancing
Measures
What’s the problem you’re trying to
fix?
What NEW behaviours or practices
are you trying to promote to fix that
problem?
What unintended / unforeseen
problems might we cause if we
make this change?
Example of indicators:
Aim: Improve satisfaction with end of life care (as measured by
the end of life survey tool) to greater than the provincial
highest performer by December 2014
Outcome
Measures
Percent positive score (8 – 10): “Overall
satisfaction with end of life care”
Process
Measures
▪ Percentage of patient receiving all comfort
measures (as defined by standard order set)
▪ Percentage of family members who received
the “What to expect…” support materials
▪ Percentage of patients/families with automatic
spiritual care and palliative care consult
Balancing
Measures
Workload
Selecting your indicators:
TAKE 5 MINUTES:
What would the ‘outcome measure’ be
for the initiative you are supporting?
What might a possible ‘process
measure’ be?
Exercise: The Standard Pig
❑ Your customer wants a drawing of a
pig
❑ Your supplies are a plain piece of
paper and a pen or pencil
❑ You have 40 seconds
Reference: Kaiser Permanente 2013: Center for Health System Performance (Lisa Schilling)
Define what you are collecting:
Clear definition of what you are
capturing and how you’re capturing it:
– Sample (all patients or subset?)
– Date / timeframe (per shift? per day?)
– Inclusions / exclusions (eligibility)
– Bundle or individual measures?
– Could someone take your data
collection tool or graph of your
data and collect EXACTLY the same
information?
Ethics of QI Data Collection:
Fair participant selection (surveys)
Positive benefit/risk ratio
Respect for participants
Privacy / confidentiality
Sharing of results (where possible)
Informed consent
Rule of rescue
Is consent required?
Initiatives that typically
require implied* or verbal
consent
Initiatives that typically
require written consent
Surveys
Research projects
Quality initiatives that require Focus Groups
direct patient contact to test a
new practice/idea that is not
Use of patient/family
yet evidence-based (not yet a images, videos or quotes
common standard of care)
Initiatives that do NOT
typically require
expressed (verbal or
written) consent
Auditing charts or using
data from electronic
patient records to monitor
compliance with a new
best practice
(i.e. practice audits)
*Implied consent = by choosing to participate they give their consent
“Ethical” survey design:
Is a survey the best tool to gather the required data?
Design based on “what problem are we trying to solve?”
Ask only what is required to answer the question
Anonymity of responses
Identification of patients for before / after projects (will they need to be
assigned a number?)
Follow-up process for any concerns arising
Plotting data – tell a simple story
Model for Improvement:
AIM
What are we trying to
accomplish?
MEASURES
How will we know a change
is an improvement?
CHANGES
What changes can we make
that will result in
improvement?
The Model for Improvement (Langley, Nolan, et al. Improvement Guide, 1996)
“If I had an hour to solve a problem
I’d spend 55 minutes thinking about
the problem and 5 minutes thinking
about solutions.”
– Albert Einstein
Diagnosing the problem:
Root causes & contributing factors:
Gather data to answer some questions:
What is the problem you’re seeing?
How bad/frequent is this problem?
Why is it happening?
What factors are contributing to the problem?
How often are these contributing factors occurring?
Is it happening broadly or in a subgroup?
Flow Chart Tool:
A FLOW CHART is a powerful tool
for understanding:
• How a system or process currently performs
• Where deviations exist (due to design or
error)
• Where the greatest complexity exists
• Where there are waits, delays, bottlenecks
• What areas might be targeted for
improvement
Basic Flowcharting Symbols
Flow Chart: visualizing your current state
The beginning or end of the
process
A step or task in the process
?
No
Yes
Decision or question leading to a ‘Yes’
or ‘No’ response
Root Cause Analysis:
Reference: Canadian Incident Analysis Framework 2012 (CPSI)
Root Cause Analysis Cont’d:
Reference: Canadian Incident Analysis Framework 2012 (CPSI)
Experience Based Design:
Important questions to answer:
• Do I understand the patient’s path?
• Do I understand their experience/feelings along the path
(‘touchpoints’)?
• Do I understand what triggered those feelings?
Work with patients, caregivers and frontline staff
to redesign these experiences rather than just
systems and processes.
Hierarchy of Effectiveness:
Forcing and constraining functions
Most
Automation and computerization
Simplification and standardization
Independent double check system/ other
redundancies
Policies and procedures
Training and education
Least
Based on a bulletin from ISMP. Medication error prevention tool box. ISMP Medication Safety Alert. 1999 (June).
Recap: Model of Improvement
Start with a clear aim statement
Understand how you’ll use data to guide you
in selecting & monitoring improvements
Choose changes wisely and with the right input
The PDSA Cycle:
Act
What changes
are to be made?
Next cycle?
Study
Plan
Objective
Questions and
predictions (why)
Plan to carry out
the cycle (who,
what, where, when)
Do
Complete the Carry out the plan
analysis of the data Document problems
and unexpected
Compare data to
observations
predictions
Summarize what Begin analysis
was learned
of the data
Key Principles of PDSA:
Iterative cycles
Initial small-scale testing
Prediction-based testing of change
Use of data over time
Documentation
Taylor MJ, et al. BMJ Qual Saf 2013; 23: 290 – 298
Why test using PDSA?
Increase the belief that the change will result in improvement
in your environment (with your team)
Predict how much improvement can be expected from the
change – learning in action
Learn how to adapt the change to different conditions and
settings (refine and moving forward)
Evaluate costs and side-effects of the change
Minimize resistance upon implementation
“What can we do by next Tuesday?”
PDSA Cycle Worksheet
Repeated Use of the Cycle
Changes That
Result in
Improvement
A P
S D
Increasing –complexity
number of people
different situations
A P
S D
Change ideas
to be tested
Time
Multiple tests of change:
Multiple root causes = multiple tests of change
http://www.youtube.com/watch?v=osUwukXSd0k
Tips for Successful PDSA Cycles:
Engage early adopters
Keep it small
Reflecting on what is learned with each test of change is the key to
improvement
If at first you don’t succeed, try something else*
Lack of success is not failure if, in doing so, you learn something
new
Improvement requires change
Remember: Tip for Assignment 3
You are developing 3
options
Remember each
option would need to
consider the PDSA
Therefore, think
critically and more
deeper whether your
option you
developed meets the
PDSA framework
Does the
recommendation you
are making to the
Deputy Minister have
key indicators to
address the
outcomes? If not, it is
not a good option!
444
4
Summary:
Establish a clear improvement goal for an improvement
project
Plan effective rapid cycle improvements using the
PDSA cycle model
Understand the importance of QI measurement and
how to select indicators
Appreciate the importance of good survey design, data
collection and the ethics of quality improvement
Incorporate change management skills in order to enhance
improvement projects
45
References:
Oakland, J. S. (n.d.). Total Quality Management
and Operational Excellence: Text with cases
(4th Edition) [Texidium version]. Retrieved from
HCVLN. (2011). Chapter 1: Thinking Lean at
ThedaCare: Strategy Deployment . Retrieved
July 17, 2019.
https://www.youtube.com/watch?v=CAMX9xfn4
vM&list=PLC1C3CD40865769C9&index=1
Questions:
Presented by Dr Silvie MacLean, EdD, CPA CMA, MHSc, HBA, BA, p. 47
Next Class:
Quality Improvement, Patient Safety &
Performance: Practical Applications
Educate, Engage, Empower, Excite
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