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5. What factors should I consider before implementing a change?
5. What factors should I consider before implementing a change?
Read on for additional considerations on how you might approach implementing changes to your team’s clinical practice.
Any changes, however small, can have a large impact; this may impact on you individually but also at the level of the practice. It is impossible to anticipate all the potential effects of a change, but it is important to consider as much detail as you can prior to implementing any changes.
There are other factors you should take into account when considering implementing changes to your team’s clinical practice. It is possible that your colleagues may not agree with the changes that you are suggesting. Many barriers, for example time pressures, have been highlighted in the literature in relation to reasons why evidence is not applied into practice (Legare, 2009). Don’t let this stop you from making a change individually to the patients that are in your care. After discussion with your colleagues, perhaps at a practice meeting, or journal club, you might influence others to embrace changes too.
Research looking at the success of change implementation in the medical field (Haley et al., 2012) identified factors which facilitated and hindered proposed actions. We will explore each of these challenges in more detail:
Reflect on previous episodes of ‘change’ within your practice; who was for the change? who was against the change? what were the facilitators and barriers to change?
You have noticed that, on occasion, the equine vets in your practice approach lameness cases differently, leading to confusion amongst the support staff in your clinic as to what equipment and consumables they should be preparing. You are interested in developing an evidence-based standardised framework that the vets in your practice can follow for carrying out lameness work-ups. You expect this approach to lead to fewer misdiagnoses, and it should assist the support staff in their preparation.
You made an attempt at introducing a new framework a year or so ago, but as the junior vet, you got some resistance from the two senior vets in the practice.
Since the support staff are struggling with the preparation for these assessments, you decide to talk to one of them, Lizzie, who has worked in the practice for twenty years, to talk her through your suggestion. The senior vets seem more receptive to the idea when you bring it up again with Lizzie’s support.
Ensure that you have highlighted a specific time that can be used to make any changes; is it easy for other things to take priority in a busy practice.
Pick the most appropriate time to implement the changes. For example, if it requires others to help, make sure it isn’t during a busy period.
The senior vets agree to try the new framework. However, the initial timing for implementation was during a week when one of the vets was on holidays and the other was at a continuing education course, and you were busy with the additional work, so you abandoned your plans after the first day.
Thinking strategically about timing for the new framework, you know that in a month’s time, a new graduate is joining the practice and will be spending the first week with you on visits, getting to know the clients. The practice diary is being kept quiet to allow the new graduate more time on visits. You think this may be a good time to trial the framework as there will be less time pressure on you, and it will probably be of benefit for the new graduate also.
Ensure that you are clear as to what you are changing, and what actions are required. It is beneficial to make a note of any changes in order to compare the associated outcomes at a later stage, for example, what was done, the date, dose rates, approaches attempted. You may consider a more formalised framework, such as writing practice guidelines (see below).
Your aim is to get the vets to follow a lameness work-up framework, which will contain the steps they carry out anyway, but perhaps in a slightly different order to how they might have approached these cases previously, with slightly different equipment and consumables.
Communicate the specific details of the suggested changes with the vets and support staff in the practice to make sure everyone is clear about the changes you are suggesting. You could also run an initial pilot where you trial the framework first prior to getting the others involved.
If possible, plan to implement small incremental changes one at a time, particularly if the changes are required to a number of areas within the practice, to prevent staff feeling overwhelmed by too much change.
Make sure you have everything organised beforehand, for example, the necessary equipment, therapies, resources, people, to make the transition as seamless as possible.
You plan to trial the framework for forelimb lameness to start with. You ask the new graduate shadowing you to feedback on how well the framework works.
With positive feedback on the forelimb lameness framework, you may be in a good position to implement a hindlimb lameness framework in future.
As you consider all the factors which are involved in your strategy for change, it is useful to record any changes you are implementing. This can be done informally, or you may decide to adopt a more formal and evidence-based approach, through producing clinical guidelines. The final and important step in the EBVM cycle is to Assess these changes, covered in the next section.