![\"Saru\"](\"https:\/\/blogs.bmj.com\/quality\/files\/2016\/02\/Saru.jpg\")
<\/p>\n<\/p>\n
Saru Bhartia has completed the Improvement Advisor Program at the Institute for Healthcare Improvement and Advanced Lean Training at Virginia Mason Institute. She leads a portfolio of quality improvement projects spanning clinical and non-clinical services at Sitaram Bhartia.<\/span><\/em><\/p>\n Meta-Description: <\/b>Initiating quality improvement at Sitaram Bhartia\u2019s telephone exchange brought us better-than-expected results and gave insights on leading change.<\/span><\/p>\n Keywords: <\/b>Quality improvement, Quality improvement in healthcare, Sitaram Bhartia, India<\/span><\/p>\n Change is always hard and most of the times we hate to change. Often, attempts to change or improve in an organization are met with resistance, making failure and frustration the common outcomes of change initiatives.<\/span><\/p>\n In the summer of 2012, I was two years into my new position as Quality Manager at our family-founded nonprofit hospital. \u00a0I had earlier completed the ten-month Improvement Advisor Professional Development Program of the Institute for Healthcare Improvement and become one of earliest professionals with such a certification in India. \u00a0<\/span><\/p>\n Yet my two projects attempting to improve cleanliness of public toilets and availability of quality linen had failed. \u00a0I was beginning to question the applicability of the methods I had learnt in the Indian setting.<\/span><\/p>\n Triggering Incident: <\/b>Changing the status quo can sometimes \u00a0begin with the most unassuming catalyst. And that\u2019s exactly what propelled our third major improvement project at Sitaram Bhartia.<\/span><\/p>\n One of our consultants complained to our medical director about her patients not being able to reach her through the telephone exchange, moving us towards addressing this issue. This time, we succeeded and managed to reduce missed calls to the hospital telephone exchange from about 26% to 8%. Clearly, something was different that led to success, but what? <\/span><\/p>\n The Story of Our Change: Engaging Frontline Staff<\/b><\/p>\n As I\u2019d mentioned earlier, success had evaded us with earlier improvement projects. However, this time, we had two major differentiating factors on our side:<\/span><\/p>\n So how did we make it happen?<\/span><\/p>\n While still in the US, I spoke to my project team and requested them to ask the telephone exchange staff to help reduce the missed calls. Irina called for a meeting of all telephone exchange staff without a specific agenda. <\/span><\/p>\n Mid-Journey Roadblocks<\/b> We were disappointed with the initial failure but we brainstormed again and set up another meeting \u2013 this time for generating ideas for reducing missed calls at night. The project team had already come up with a list of change ideas for reducing missed calls during the day and believed that they had covered everything; moreover, they felt the frontline staff would not be able to add anything further. <\/span><\/p>\n Simple Fixes for Large Obstacles: A Snorkel in Action<\/b> Though the meeting had been called to get ideas to reduce missed calls at night, the staff became so engaged, they also offered ideas to reduce missed calls during the day with solutions that hadn\u2019t occurred to anyone in the project team. At this point <\/span>I realized the power of the frontline staff – they bring insights that nobody else can. <\/i><\/b><\/p>\n With the help of the frontline staff, we regenerated a list of change ideas. Some of the changes were implemented immediately \u2013 these were the \u201cjust do it\u201d sort of ideas that required little effort and seemed like \u201cno-brainers\u201d. For some of the other change ideas we decided to run Plan-Do-Study-Act (PDSA) to test if the change would lead to an improvement. <\/span>\n
\n
\n<\/span><\/b><\/li>\n<\/ul>\n\n
\n<\/span><\/li>\n<\/ul>\n\n
\n<\/span>
\n<\/span>As was typical for our organization at the time, most discussions happened in a room away from where all the action was \u2013 between the department manager and the quality manager supported by a quality officer; an experienced telephone exchange officer was brought in occasionally. <\/span>
\n<\/span>
\n<\/span>We changed that.\u00a0<\/span><\/li>\n<\/ul>\n\n
\n<\/span>
\n<\/span>They suggested that I re-think how the front-line staff was being involved in the project and pointed me to \u201c<\/span>Transforming Care at the Bedside How-to Guide: Engaging Front-Line Staff in Innovation and Quality Improvement<\/span><\/a>\u201d. <\/span>
\n<\/span>
\n<\/span>This is how I got introduced to the <\/span>Snorkel<\/span><\/a>: a valuable process, not only for generating new ideas for testing, but also as a powerful way to engage the hearts and minds of frontline staff.<\/span><\/li>\n<\/ol>\n
\n<\/span>The meeting was held in a typically formal manner with the manager doing most of the talking. \u00a0It failed as the staff did not participate in the discussion. This was the first time the management was asking the staff for their opinion and the staff was a bit suspicious.<\/span><\/p>\n
\n<\/span>For the next meeting, we created an informal round table set up with the manager, a quality officer, and our telephone exchange staff. <\/span>
\n<\/span>
\n<\/span>The manager started the meeting by sharing what was working well in the telephone exchange and acknowledged the defects in the present system. She <\/span>assured <\/span><\/i>the staff that the idea of the meeting was not to point fingers but to understand system-related issues. Tea was served. The manager acted as a facilitator and the quality officer, Zorba Bahlvi, took notes. A change in the meeting format led to the staff feeling relaxed. Once the first staff member started talking, others joined in.<\/span><\/p>\n
\n<\/span>
\n<\/span>Did we face any resistance this time? Unequivocally, no. <\/span>Because the frontline was engaged in coming up with the list of change ideas there was no resistance in testing or implementing these new ideas.<\/i><\/b><\/p>\n
![\"B](\"https:\/\/blogs.bmj.com\/quality\/files\/2016\/02\/B-1.jpg\")
![\"B](\"https:\/\/blogs.bmj.com\/quality\/files\/2016\/02\/B-2.jpg\")
<\/p>\n","protected":false},"excerpt":{"rendered":"