Change Concepts

All improvement requires change, but not every change is an improvement. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (Langley GJ, et al., Jossey-Bass, 2009) is an excellent resource on how to enhance the performance of any organization.  One of the ideas that the authors of the book develop is, what kinds of changes will lead to improvement? 

The authors argue that people have a tendency to resort to common and often ineffective ways of developing change, such as adding more resources (money, time, people), adding more inspection or oversight/control, adding more procedures or defining them more rigorously, or adding more restrictions.  They note another pitfall is that people seek perfection when they are developing a change and never get around to implementing anything because they are too absorbed in building the perfect solution (also known as “letting the perfect be the enemy of the good”).

Based on the authors’ work as improvement advisors to many types of organizations and industries, they note that one effective strategy for developing change is to use generic ideas for change, what they call change concepts.   These are general approaches that have been found to be useful in developing specific ideas for change when they are adapted to specific situations. 

The book’s appendix, “A Resource Guide to Change Concepts”, contains a list of 72 generic change concepts that is a valuable source of ideas of how to change any process. The changes can be grouped in categories of changes to meet a certain objective, such as: eliminate waste, improve work flow, eliminate mistakes, change the work environment, address customer needs, and manage variation.  The following table provides examples of the change concepts discussed in more detail in the book.



Examples of change concepts

Eliminate waste

Evaluate the purpose of every step and eliminate those that don’t add value; eliminate inputs that are not essential; eliminate multiple entry (e.g., recording the same information); reduce overkill; recycle or reuse; remove intermediaries

Improve work flow

Minimize handoffs; do tasks in parallel; move steps in a process closer together; use a coordinator/triage manager; change the order of steps; adjust to peak demand

Eliminate mistakes

Use reminders; standardize procedures; put in place constraints (things that prevent mistakes) and/or affordances (things that lead you to do the right thing); color code or mark similar things to differentiate them

Change the work environment

Give people access to information; reduce demotivating aspects of the work; provide training; emphasize natural consequences; develop alliances and cooperative relationships

Address customer needs and problems

Listen to customers; reduce waiting time; reach agreement on expectations; offer services whenever clients want them; offer services wherever clients want them

Manage variation

Standardize (create a formal process); develop contingency plans; adjust to peak demand; match the amount to the need


When to Use Change Concepts


Sometimes, changes that can improve health care services or outcomes are obvious.  Many times, however, a change that will result in improvement is not obvious.  In place of the common tendency to simply do more or add resources, consider making changes in the actual process of delivering care. Generic change concepts can provoke new thinking about how to improve a specific process and suggest changes that otherwise might not have been considered.


How to Use Change Concepts

Step 1. Choose a category of change concept from the table above at random and discuss with the improvement team how generic concepts in the category could be applied to the health care process the team wants to improve.  Change concepts can also be selected based on criteria such as “this change concept has never been considered before” or “this change concept has been used successfully in a similar setting.”

Step 2. Use brainstorming or another discussion technique to generate ideas of how to apply each change concept to the process of interest.

Step 3. After the generation of ideas is complete, evaluate or critique each idea using voting or another method to rank the ideas in order of preference for testing.

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