Five key principles guide the NIATx model. Research conducted in Europe, the United States, and Canada generated a list of 80 factors critical to fostering change (Gustafson and Hundt, 1995 ). Tests for statistical significance revealed that only five of these factors consistently influenced efforts to overcome barriers to process improvement.
This is by far the most important factor. Do not assume the customer’s needs are known or are being met. Actively involve the customer in the development of the improvement. Make sure the improvement is noticeable to the customer and that it will meet one of the customer’s key needs. Survey customers on a regular basis. Educate customers about new improvements.
At the state or payer level:
What is keeping the CEO awake at night? Our research indicates that it is crucial to select a project that addresses a key organizational goal. If the project can help CEOs sleep better, they will actively support the project and do everything in their power to make the project a success.
The SSA should undertake Change Projects that are most important to:
The SSA should ask each provider CEO to list the two state-level changes that the CEO would make should he or she become the SSA. The SSA should then use the NIATx model to address the priority state-level changes. If the changes cannot be done because of policy or legal reasons, the SSA must make sure that the providers are thoroughly convinced of the SSA’s helplessness in this regard. Projects undertaken to satisfy the SSA’s supervisor, major funders, and policy makers must also be related to one or more primary needs of the providers.
If you want to improve something, the person in charge of improving it must have power, prestige, and influence in the organization. They must also understand and respect the needs of the staff members (internal customers) who will be involved in the implementation process. Change Leaders with inadequate time dedicated to their role are not as effective.
There are additional areas that should be represented on the Change Team:
The SSA Change Team should be highly functioning and stress situational leadership.
This doesn’t mean that outsiders or experts have all the answers; rather, it draws attention to the importance of learning from others’ successes and failures. Looking outside the organization is an efficient way to find fresh ideas—the kinds of ideas that lay the foundation for a tailored and truly innovative improvement.
Pilot test all changes with clients to make sure they really are an improvement and that they make things better for the staff. Do not implement changes on a large scale until you have tested them on a small scale and know they work. This process often requires several tries or cycles before all the bugs or errors are resolved. This is common—rarely is a change perfect upon the first try.