---
title: "Implementing Changes"
---

::: {.callout-note appearance="minimal"}
"How will we implement changes throughout our system?"
:::

Let's recap. You've:

1.  [Chosen something you want to improve](choosing-what-to-improve.qmd).
2.  [Designed and tested changes](designing-and-testing-changes.qmd) that you're ready to introduce to your entire agency.
3.  [Created measures](creating-measures.qmd) to track progress.

## Create a Path to Change

Implementing changes takes:

-   **Leadership Commitment:** Agency leaders set the tone for adopting the changes.

-   **Understanding Why:** Tell people why you're making the changes. Explain the evidence or research. Help them understand how the change will make things better. Don't leave anyone out---leadership, providers, support staff, and people outside your agency who are involved or affected.

-   **Technical and Personal:** Changes have a technical aspect (specific steps of a process that will change), and they also have a personal side (how people will be affected). Attend to both aspects. Make sure people understand the steps of a change, and also pay attention to how they feel about it.

-   **Individual Differences:** Individual people have different ways of adapting to change. Some may be eager "early adopters," while others may take a "wait and see" approach. You can help people adapt by acknowledging and respecting their approaches.

## Culture Change

::: {.callout-note appearance="minimal"}
Culture eats strategy for breakfast.
:::

Implementing change means moving your agency from its *current* state to a desired *future* state. It means changing the *culture* in your agency. One way to think about culture change is that it involves three phases [@lewin1947]:

```{mermaid}
flowchart LR
  A(<img src="site_libs/bootstrap/images/i-unfreeze.svg"/> Unfreeze) --> B(<img src="site_libs/bootstrap/images/i-change.svg"/> &nbsp;Change&nbsp;)
  B --> C(<img src="site_libs/bootstrap/images/i-freeze.svg"/> Freeze)
```

<ul>

<li class="icon unfreeze">

**Unfreeze:** Get your agency ready for change. Explain why change is needed. Address fears.

</li>

<li class="icon change">

**Change:** Make the shift. Provide support. Encourage feedback. Keep people motivated through the discomfort of change.

</li>

<li class="icon freeze">

**Freeze:** Make the change stick. Make it the "new normal." Celebrate the wins. Use your data to show how the change made a difference.

</li>

</ul>

## Communication

Good communication is essential to the change process. Aim for communication that is:

-   Complete

-   Clear

-   Brief

-   Timely

-   Authentic

Communicate to address people's **knowledge**, **skills**, and **feelings**; or in other words, their **head**, **hands**, and **heart**.

::: {.callout-tip appearance="simple"}
The **SBAR** pattern can help you include the important stuff in your communication:

1.  **Situation:** What's the issue?

2.  **Background:** What's the relevant history?

3.  **Assessment:** What do you think is going on?

4.  **Recommendation:** What should happen next?
:::

**Close the loop** on your communications. Follow up to learn whether the messages you communicated were received and understood in the way you intended. Then you can adjust or clarify.

::: callout-tip
Create an **elevator pitch**---a persuasive summary of the change you're making, including why it's important, what you're doing, and what you expect to achieve. Keep it under a minute.
:::

::: {.callout-tip collapse="true"}
## Example: Airway Management Elevator Pitch

:::: {.clearfix}
![Example: Elevator Pitch](images/example-elevator-pitch.jpg){.example}Trent's agency wants to improve outcomes for patients with airway problems. Here's his **elevator pitch**:
::::

> "We're improving our care of patients with airway problems. The longer a patient goes without being able to breathe, the worse they do in the long run. One way we help patients breathe again is by inserting airway devices. It's important to get it right the first time, and quickly. Research has shown that we will be able to improve our airway first-pass success rate by adding video laryngoscopy to our kits. Video laryngoscopy will make it easier for us to insert airways and be sure that they were placed correctly. We hope to increase our first-pass success rate from 75% to 95% within a year."
:::

## Celebrate Improvement

Don't hide your data (even if it's not showing the improvement you hoped for). Share the measures that you're tracking. Thank people for their contributions. When you see good improvement, highlight it.

## Partners

Even when you're involving everyone in your agency in performance improvement, there are lots of situations where meaningful improvement can only be made by reaching outside of your agency and collaborating with partners. Consider how you can involve these partners in your efforts and keep them in the loop:

<ul>

<li class="icon medical-director">

Medical director

</li>

<li class="icon agency">

Other agencies---neighboring, mutual aid, transport, non-transport, air, ground---and others in your Ambulance Service Area

</li>

<li class="icon biller">

Biller

</li>

<li class="icon vendor">

Vendors (ePCR software, medical devices, and others)

</li>

<li class="icon hospital">

Hospitals

</li>

<li class="icon college">

Colleges

</li>

<li class="icon state-ems">

State EMS office and other state offices/programs

</li>

</ul>
