How to Establish a Change Team

It is possible for a single person to execute a project, but most often it works better to include a team of people.

1. Define a Change Project
2. Appoint a Change Leader
3. Appoint a Change Team
4. Common Change Team Pitfalls

Define a Change Project

The Executive Sponsor defines the Change Project. Each project is defined by:

• One aim
• One level of care
• One facility location (if there is more than one)
• One targeted population (e.g., all clients, all clients referred from detox, or clients referred by criminal justice, etc.)

Each of the four NIATx aims can be applied to outpatient and residential care, for a targeted population at each facility location. This offers you a wide range of options for selecting process improvement projects. For example, typical projects might include:

• Reduce waiting to treatment + at the outpatient clinic + for clients transferred from residential treatment + at our downtown facility.
• Increase admissions that improve payer mix + at the outpatient clinic + for clients referred by parole officers + at our downtown facility.
• Increase continuation + at the residential facility + for all clients + at our suburban facility.

At one end of the spectrum, you can select a project aim simply by choosing something that keeps you awake at night—typically a process that has a direct impact on your organization’s financial health.

NIATx member organizations have shown how a Change Project targeting one of the four aims often provides a business case for process improvement.

Appoint a Change Leader

The Executive Sponsor appoints an influential Change Leader.

Qualifications of a Change Leader

Before appointing the Change Team, select the Change Leader—the person who will lead the Change Team. This person needs to have the ability (and leverage) to interact with all levels of the organization. She/he also needs to have the time commitment required to get things done. She/he also should be a good team leader, communicator, and delegator, have good organizational skills, and experience with making changes.

Who makes a good Change Leader?

Ninety-nine NIATx Change Leaders and Executive Sponsors who were surveyed identified the top leadership qualities of an effective Change Leader as:

• Challenges the status quo
• Gets results verified by data
• Persistence
• Respected throughout the organization
• Focuses team on the Change Project objectives

We would add to that list:

• Someone who reports to you, the Executive Sponsor
• Someone who is comfortable providing day-to-day leadership, energy, enthusiasm, and coordination
• Has the power and prestige to influence all levels of the organization
• Instills optimism
• Uses mandates (with time deadlines)
• Is goal-oriented
• Is systematic
• Would make Sherlock Holmes proud

Once you have selected the Change Leader, you might want to ask him or her to help you identify and appoint the rest of the Change Team.

Appoint a Change Team

The Executive Sponsor appoints the Change Team.

Who should be on the Change Team?

The Change Team should consist of no more than seven people. Once you have selected the Change Leader, you might want to ask him or her to help you identify and appoint the rest of the Change Team. Use the walk-through to identify people to appoint to the team.

1. The team should include members from all areas critical to the functioning of the system that is the focus of improvement activities. For example, a Change Team working on access issues would include a person who handles calls from potential clients requesting treatment services as well as a counselor. This may include:
   • Workers and supervisors in the unit (e.g., parts of the organization) where the changes will be implemented
   • Others who are affected by the change (e.g., other departmental staff if the change crosses departments, patients, etc.)
   • People with special knowledge about a specific change (e.g., patients, information technology staff, etc.)
2. Have diverse talents represented. For example, it helps to have people who are creative and insightful and people who can carry ideas through to completion.
3. Include outside perspectives (customers or someone who doesn’t work in the area).
4. Keep the size small, no more than seven people—-with more that, the team gets too unwieldy and makes slow progress at best.

Send Written Invitation

When the team is selected, send a formal letter inviting each person to work on the project(s) selected. This assignment is a temporary, additional job for the person.

Common Change Team Pitfalls

As Change Teams begin their work within the organization, it is common to encounter barriers to change. It is important for the Executive Sponsor and Change Leader to learn to recognize these barriers and common pitfalls when implementing PDSA change cycles, and strive to overcome them.

Examples of how to overcome these common pitfalls include:

1. Empower the Change Leader and team to move quickly avoid delays, lost momentum, waning enthusiasm (e.g., promote participation in the change process)
2. Communicate constantly to all stake holders insure better access to resources, maintain enthusiasm throughout the organization, enhance sustainability
3. Understand your customers' needs
4. Gather data quickly (weekly), often by hand, to insure immediate feedback and study by the Change Team
5. Break projects into manageable chunks
6. Look for some easy early successes (don't tackle the hardest jobs first)
7. Stick with one aim and do several cycles on it before moving to a different aim
8. Be bold! This is an experiment, not a permanent change.

Of these eight examples, communication is the key.

With an effective communication plan, the Executive Sponsor and Change Leader should:

• Involve staff in every step of the process
• Get input on how things are going and why
• Be willing to adapt to changing conditions
• Have clear goals and communicate them often to everyone in the organization.