Changes in healthcare assessment tool (CHAT): developing a process for actuating changes in healthcare

Abstract

Background: The world is ageing and given that most health care costs occur in the last few years of life, the future demand for health services will outstrip supply if the current service models remain unchanged. Those services facing most pressure are the dedicated specialist services for older people, both mental and physical health. Literature highlights optimised models of care that have the potential to maximise outcomes in a cost efficient manner. However, implementing such initiatives is often problematic and requires careful and successful change management. Aim: This study sought to firstly identify and implement a process for engaging health care managers and workers in the delivery of change within Older Persons and Rehabilitation Services (OPRS) and Mental Health Services for Older People (MHSOP) in a large District Health Board. Secondly, the study aimed to develop and evaluate a method of assessing staff responses to change from two perspectives, the personal life response and the work life response, in order to understand how managers should engage with staff during a change process. Methods: In part one, two focus groups and four one-on-one interviews were held with senior health managers (n=2) and senior clinicians (n=2) from OPRS and MHSOP. Three change initiatives that had the potential to facilitate a more integrated response to the needs of older people were identified and prioritised for implementation. Focus groups and interviews were audio-recorded and transcribed verbatim to allow for the development of themes through general inductive enquiry. Themes were combined with key findings from the literature to develop a ‘change readiness’ questionnaire. In part two, the change readiness questionnaire was tested with 107 operational staff from the two services in order to assess sensitivity and internal validity. The three change initiatives were developed and implemented. Staff involved in the initiatives (n=11) were surveyed pre- and post-implementation using the change readiness questionnaire. Results: All three identified initiatives were implemented and staff from both OPRS and MHSOP worked collectively to support the change processes. The change readiness survey incorporated eight factors from both a personal and work perspective. There was a statistically significant correlation (p=<0.0001) between work life and personal life in relation to change (protection of self, r=0.6; resilience, r=0.4; personal attributes and emotional side of change, r=0.8; participation and involvement, r=0.6; resistance to change, r=0.6; support through change, r=0.6; change process, r=0.7; and communication and information, r=0.7). The questionnaire revealed little change pre- and post-implementation amongst the 11 staff involved in the initiatives, though there was variability between the change initiatives. Conclusion: Change in healthcare is a complex notion and the readiness or acceptability of staff towards change is an important consideration in maximising potential for success. This research identified that a change readiness questionnaire can be used to support managers in assessing potential problems and further a stratified approach, whereby senior managers and clinicians are seen to lead change can positively impact final outcomes.