Myth buster: Change Takes Time. A Lot of Time.

May 16, 2016

Thomas F. Hilton, PhD

One process improvement myth that resurfaces regularly like a sighting of the Loch Ness monster is that change takes time. A lot of time. Because trying out new procedures takes so long, staff might be convinced that change is just not worth the effort. And they'll quietly go back to doing things the comfortable old way.

But I'm here today to bust the myth that change takes time.

There are two related issues here. The first is trial-and-error.  The second is tried-and-true.

An overly long period of trial-and-error drains momentum for change. That's why NIATx change teams using PDSA cycles as their structure for trial-and-error have the freedom to abandon a change after a short period of time, especially if the data show it just isn't working.  (More about data later.)

We've seen change teams revert to the tried-and-true practice when the trial-and-error phase drags on too long. The whole point of trial-and-error is to identify a "better" tried-and-true that everyone in the organization is happy to embrace.

Process improvement always involves trial-and-error. However, what gets tried should be guided by common sense and experience derived from living with the problem. In other words: NIATx Principle #1: Understand and Involve the Customer!

Another common mistake many organizations make is to tackle complex problems too soon. It's always a good strategy to take on a few simple changes first. An initial success can go a long way towards showing staff that change can happen quickly. Here's an example. Do a quick walk-through of the intake process at your agency. Go ahead and call your agency as if you were a client seeking services. Go on, dial the number. Did someone answer the phone after the first ring? Or did you have to listen to a long recorded spiel? How soon could you get in for an assessment?  One phone call to your agency might be all it takes for you to get ideas for a few things you could change quickly to improve your customers' experience.

Keep it simple.

By simple, I do not mean easy, but changes that everyone agrees should make things better and that you can try in-house. Does everyone in your agency dislike the current intake form because it's so lengthy? Does everyone want to reduce wait times? Try introducing a new intake form to see if it can shorten wait times. Give it a fair trial -- no more than a couple of weeks. Is the new form reducing waiting times? If not, adapt the form( don't throw it overboard just yet) and give it another trial.

What do the data show? 

What often sets the ship of change adrift in the Waitn'See is ambiguous data. Staff might expect the data to trend up or down, but it might instead be bobbing up and down after a couple of weeks. This can be a good indication that it's time to adapt the change and start a new change cycle. The data will help you determine if the problem is in the new practice itself or in its implementation.  Ask the following questions:
1. Is everyone on board? Is it possible that not everyone is capable and motivated to try the new way of working?
2. Is data being collected reliably?
3. Are you seeing all the data?
4. Are some staff seeing improvements, while others are not?
5. Are some staff returning to the old tried-and-true way now and then, because they have to?

If the answer to all question is NO, then the problem is probably not due to poor implementation.  What's more likely is that the new practice isn't working--the error part of trial-and-error. Altering course to try a new implementation altogether is the only sure way to sail out of the doldrums and get your process improvement back on course.

What is the quickest change your agency has been able to test and implement, using the NIATx approach?  Share your story in the comments section below. 

Looking for ideas for your next change project?  Check out the Promising Practices on the NIATx website.

Tom Hilton is a retired NIH science officer and NIDA program officer now in private practice. Tom has over 40 years of experience studying and conducting large-scale organizational change initiatives in publicly-traded corporations, DOD and other large federal agencies, as as general-medical and addiction health services organizations.

Read other posts by Tom Hilton:
Mythbusters: Staff don't want to help find solutions
Factors influencing organizations' use of NIATx

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