Break through the resistance to change
Sigmund Freud believed there was such a thing in animal life as a "death instinct" -- an impulse in an organism to resist evolution and move backward toward stasis and inert matter. The same may be said in organizational life with regard to improvements. Staff members have an instinct to resist change and even to drift backwards into old, comfortable habits, toward an outdated status quo that might well spell out the death of reform, if not of the institution itself.
The way around this impulse is through implementing "breakthrough," rather than incremental, improvements, says Ellen Gaucher, MSN, MPH, senior associate director of the University of Michigan Hospitals in Ann Arbor, who conducts a workshop on the subject. It's a question of first-order vs. second-order change, she says.
"With first-order change, there are incremental changes, but they are within already accepted frameworks," says Gaucher. "You see minor improvements, not major system improvements. Most of the projects are reversible. You could slip back to doing things the old way and nobody would even notice. When you're talking about second-order change, the whole system changes."
As an example of breakthrough in quality improvement projects, she cites her hospital's revision of admissions policy. When they first began looking at the admitting process in the late 1980s, they considered reducing the wait in the admissions lounge by 50%. They moved to breakthrough -- major, nonreversible change -- when they decided to have patients bypass the admissions lounge altogether.
"They went right to the bed like you do in a hotel," Gaucher says. Now at University of Michigan Hospitals, about 99% of the patients are registered by phone. When they arrive at the hospital, they merely have to stop briefly at the front desk before being escorted to their rooms. "The goal is to have everyone met at the door, but we haven't achieved it yet," says Gaucher. *
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