Improvements that last

Some people believe that once a decision has been made, a change has been implemented. But change has not actually occurred until all employees are working in a new way. The simplest issues are those that can be decided on the unit level. If there are many organizational levels a change must pass through, it can take a long time to implement.

Many people have at some point decided to quit smoking, lose weight, start exercising or make another lifestyle change. This does not mean they have quit smoking, lost weight, or exercise regularly. Often, these promises to ourselves become something we try to suppress until the next time we make the same promise to ourselves.

In the workplace, change initiatives are sometimes launched that don't lead to real change. Sometimes, those who want to change encounter resistance. Change work takes time because new habits and routines need to feel natural. A permissive and forgiving climate where it is allowed to try things out is a success factor. An operation driven by fear of making mistakes is an insecure environment. There are tricks to increase the chances of succeeding with change in both personal life and at the workplace.

In a nursing home, there are often many roles with some form of responsibility. Licensed personnel have responsibilities within their professional areas, nursing assistants may have responsibilities as hygiene officers, meal officers or fire safety officers. Anyone wanting to work with change always needs to anchor it with the manager.

Improvement work in healthcare - work step by step

1. Think about what you want to achieve and why. What is the most important change you want to achieve right now? It may be useful to start from a specific event, perhaps deviations or complaints. Perform an event analysis, what possible factors may contribute to things not working as desired? If you have several ideas for development areas, it may be good to let the employees prioritize what to implement first.
2. Set a goal that is clear and measurable, so you know when you have reached the goal,
3. Be receptive to questions from others. What are they worried about, what difficulties do they see? Perform a risk analysis together over what risks and benefits exist with the change. Make sure not to spend too much time on the opponents. Those who are for the change are given encouragement and support.
4. Make a plan for how you will implement the change. Are there any simple measures you can start with? Think about where you start and then take one step at a time. It doesn't pay off to start at the end. If you don't have a good foundation to stand on, the change will not last.
5. Participation is necessary to achieve lasting changes. Think about how you get your employees or colleagues on board. How do you best communicate the message? Communicate what you want to achieve with the change. Be clear with the goal and why you want to achieve it. Make sure to involve colleagues and employees in planning how the change will take place. Perhaps residents and relatives also need to be involved.
6. Communicate recurrently during the change process. Change work can often cause disorder and confusion initially. Clear communication about what will happen creates security and reduced confusion.
7. By having an open process where everyone can participate and influence with ideas and suggestions and where all are invited to the risk analysis work and where all documents are available increases participation and security. Highlight good suggestions even if they cannot be implemented for the moment.
8. Change work is often a type of project. Make milestones in the change work. Small concrete sub-goals that you want to achieve and which you have documented and follow up. Celebrate when you have reached a sub-goal and the final goal. Adjust the plan if obstacles arise. Pick the low hanging fruits first. Think about which steps are easiest to take in the change work and take one step at a time.
9. Evaluate the change work continuously. Adjust the process if there is something you missed or something that doesn't work.
10. Don't forget to follow up so that the operation does not fall back into old tracks. This can happen a few times during the half-year after the change work ended.
11. Continue to develop: Improvements are an ongoing process and it's important to keep developing the workplace over time. Continue to listen to the employees' feedback and identify new opportunities for improvements.

By following these steps, you can start a process to implement improvements in the workplace. Remember to involve the employees and communicate clearly throughout the process to increase the success factor.

Reflection - structure and culture
Care Staff
• Do you see any improvement work you would like to implement?
• Do you have a good culture for working with continuous improvements?
• Do you work according to the written routines?

Manager, Nurse, Occupational Therapist and Physiotherapist:
• What management risks exist in the operation?
• Do you have a good climate for change work?
• Which routines are most important to improve at the moment?

Residents and Relatives
• Is improvement work ongoing in the unit?
• Do the employees appreciate if you point out opportunities for changes?
• Do you receive information about development work that is ongoing?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day