About the Project
Physicians initiate projects because they notice that something can be done better. Dr. Daisy Dulay recognized an improvement opportunity for better patient care for Cardiac Cath and Cardiac Short Stay (CSS) patients. When pre-cardiac intervention instructions about medications are not clear or misunderstood, it can lead to cancellation of procedures. For patients who have traveled from mid- and north Island, this can be a frustrating and costly delay. Rescheduling puts pressure on the wait times for all procedures. Dr. Dulay proposed a project to better understand the experiences of patients and design appropriate remedial actions.
Despite initial enthusiasm among the CSS team for the project aims, the project ran into challenges. Staff and clinicians were busy, there were many competing priorities, and gradually, the energy for this project stalled. Rather than become disengaged, however, Dr. Dulay wrote a description of what had happened in her final project report. This enabled the MSA support team to follow up with her and develop strategies to better support projects in a similar situation.
Looking at this project through a Change Management lens may help to reveal why this project did not achieve its aims. Change Management is a structured approach to support people through organizational change. This human dimension involves building awareness of the need for a change, motivating people to engage in the change, building knowledge and capacity to work in new ways, and sustaining changes over time.
A good way to think about a project is as a seed. This seed could produce delicious food that is nutritious and well-adapted to the climate. However, if this seed is planted in nutrient-scarce sand, no amount of watering or sun will make it grow. The pre-conditions have not been met. Like soil, there are several ingredients for a project (the seed) which need to be met before it can succeed. The key ingredients in the preconditions or soil of change include:
- An influential leader or leaders who is actively involved in the change by communicating, engaging in meaningful dialogue about the change
- A clear vision articulated, including why the change is necessary
- An understanding of all groups who will need to be involved through planning, consultation and implementation
- A solid plan to support groups and individuals through the change transition by addressing the ADKAR model (named after the 5 pre-conditions for successful change: Awareness, Desire, Knowledge, Ability and Reinforcement) with key change activities
- Early, frequent and ongoing, communication,
- A plan to involve impacted people and middle managers throughout the design, implementation and sustainment with 2-way communication mechanisms
As a result of these conversations with Dr. Dulay, three changes have been made to support future South Island MSA projects:
- The South Island MSA project intake form now asks applicants to identify “what they expect the greatest challenges to be in completing this project’. The hope is that people will flag a challenging area early on and can put some additional resources and effort in that direction.
- The project support team has drafted a short guide to Change Management approaches, which will be shared with any project that identifies ‘connecting with the right stakeholders’, ‘getting everyone on board with this project’, etc. in their application.
- The MSA support team has connected with the Enterprise Change Management Office in Island Health and asked about the process of connecting physicians to them for one-on-one consultation, should the need arise.
We thank Dr. Dulay for her transparent and honest feedback on the project process, and for helping the team make ongoing improvements.
 For more information about the ADKAR model, please explore: https://www.prosci.com/methodology/adkar or consider taking the Learning Hub module on Prosci Change Management eLearning: Introduction to ADKAR, available to all Island Health employees and staff through the Learning Hub site: https://learninghub.phsa.ca/Courses/23937/prosci-change-management-elearning-introduction-to-adkar#info