Reducing Avoidable Readmissions: Measuring and Influencing Change

To wrap up the 2-day “Reducing Avoidable Readmissions Course” from the Institute for Healthcare Improvement, was a session on measuring results. The session, while helping to provide measures and objects was as focused on how to manage change in an organization, with the understanding that within healthcare organizations this can often be akin to turning a cruise ship.

One presenter, describing a successful partnership between a hospital and skilled nursing facility to improve transitions in care mentioned that it took over 3 years to implement the program. She expressed frustration that often people’s roles changed in this period but seemed to accept that this length of time was pretty typical, and considering it was an inter-organizational transformation that is probably true, and possibly fast.

When planning to make changes within your organization, here are some great ideas for influencing change and getting it to stick.

  • Set realistic goals. For example, when trying “Teach Back” ask physicians and nurses to try teach back with their last patient every day. This will give them the experience without unrealistic expectations and if the new method takes a bit longer at first doing it with the last patient will not disrupt the schedule.
  • Use the lean principles of the 5 Whys to get to the root of why something is broken.
  • Make sure that new processes do not increase workload and have perceived value, using the “highly adoptable” formula from Chris Hayes.
Source: Christ Hayes,

Source: Christ Hayes,

  • Involve frontline staff in process design. They will be the ones who need to implement it so make them part of the solution.
  • Determine what you will measure before implementing so you can gage success.
  • Test changes under a variety of conditions before trying to replicate across an organization. That way, you will be prepared for any potential adoption blockers.
  • Prepare for and manage relapses. People may revert to older processes if the new ones fail. Plan for this, and see it as a learning opportunity rather than a failure.
  • Make the change about improving patient care. Even though the goal may also include reducing readmissions, lowering costs, and increasing predictability, these are topics that are hard to rally people around. Remember why you and your colleagues entered healthcare: to help people. Appeal to the highest goal of improving patient’s experience and health.

Posted in: Behavior Change, Healthcare transformation, Outcomes

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