The role of innovation and change management in quality improvement

In many organisations, including in healthcare, there is an active and ongoing effort in the area of quality improvement (QI). QI looks at the healthcare environment and applies a systematic approach to improving the safety, effectiveness, and experience of care for patients. In private healthcare, factors like competitive advantage may be drivers for change, but generally, the focus is on improvement for patient populations, individual patients, or reducing healthcare costs. 

Change in itself is not a measure of improvement, so QI is built upon a foundation of goal setting and testing. Metrics are continuously monitored and assessed so improvement can be measured quantitatively or the process can be reviewed if targets are not being met. Because of the nature of quality improvement, Agile and Lean ways of working can be integral to putting improvements into action and taking a proactive stance.

What is change management?

Quality improvement involves change management, which some would refer to as the “people side” of innovation. Even with an innovation strategy that’s highly likely to bring wide-spread improvement, all stakeholders and team members need to be informed and involved in the project for it to be a success. This is known as change management. More specifically, in many cases, change management is a method for managing and reducing resistance to change.

Whereas QI offers a framework to systematically improve processes and systems, change management is not a process improvement system, it’s a standalone business process for improving organisational performance. There are three main stages in organisational change: initiation (preparing), implementation (managing), and continuation (reinforcing).

Skills for change management in healthcare include leadership, team building, understanding of culture and context, and patient and family engagement. There are many change management processes and business models to refer to, one of which is Kotter’s 8 Steps for Leading.

The eight components which should be considered when planning change according to Kotter are:

• Create a sense of urgency
• Create a guiding coalition
• Develop a vision and strategy
• Communicate the change vision
• Empower people for broad change
• Generate short-term wins
• Consolidate gains and produce more wins
• Anchor new approaches in culture

Change management requires buy-in from leadership teams; if the leadership is not invested in change, it will be very difficult to get teams across the organisation on board. Any change initiative – whether departmental or large-scale – requires a high level of employee engagement and involvement for it to achieve its objectives. Those involved in the project management relating to major changes may find stakeholder analysis helpful to identify major influencers within the organisation who can be advocates of change and support efforts.

How is innovation a challenge?

1. Warren McFarlan of Harvard Business School says that change management “…is a game of implementation. Only 15% of the job is figuring out what to do. Making it happen – that is where the action is.” An innovative organisation needs to:

• Provide the skill and structure required to identify problems and improvement opportunities
• Carry out implementation in a cost-effective and efficient manner
• Manage all aspects of implementation such as the human and cultural elements e.g. silo mentality, unwillingness to change the status quo
• Provide the organisational support, time, and resources needed for successful implementation

Innovation can be a challenge if the innovation itself is needed to help change the organisational culture. Organisational culture describes shared ways of thinking, feeling, and behaving within an organisation. Healthcare organisations often consist of multiple subcultures, which can help or hinder change, innovation, and quality improvement, especially if communications from the top are not clear. To drive innovation and change, management teams may require human resources and an internal communications team to support knowledge management across the organisation.

It’s always important to know why there is resistance to certain initiatives and this in itself requires a culture of trust. In some corporate cultures, there can be an attitude of “this is the way we’ve always done things around here, so why change it?” This would require innovation teams to demonstrate the benefits of change in a more human-centred and persuasive way. However, there may be genuine issues and valid points of concern which need addressing before implementation can happen. For this reason, organisations may contract a third-party consultancy agency which can act as an impartial advisor. For large, transformational change, innovation teams may be created within the organisation to ensure that implementation is carried out effectively and with the sustainability of the change in mind.

What is the function of innovation management?

It’s not enough to innovate for the sake of innovation. Innovation management is a key aspect of involving people in any change within an organisation. Taking an open innovation approach that looks outwardly as well as inwardly can help teams to be more collaborative and move away from a silo mentality. Open innovation promotes an information age mindset towards innovation, which is transparent and iterative with input from outside sources. Knowledge transfer partnerships (KTP) with a partner like a research institution are a good example of open innovation practises. Innovation management is a methodology that advocates cooperation and interaction between stakeholders to facilitate decision making that affects the whole organisation positively.

Simple exercises like process mapping with stakeholders can highlight barriers to improvement and stimulate debate on how they may be overcome. Getting all team members who are affected by change in one room and mapping processes in a hands-on way makes people feel seen and heard and offers full visibility of the road ahead. It’s important to remember that human beings are central to how an organisation operates – becoming fixated on the process can be detrimental and that’s where innovation can help. New technologies can be introduced as part of the process to streamline systems and processes with new ways of working contributing to a smoother transition.

What is the difference between change and innovation?

Change and innovation are often mentioned within the same breath but they are not synonymous. Innovation by its very nature requires change, however, change in an organisation doesn’t always equate with innovation. Innovation projects are increasingly seen as a cornerstone of the business process that helps catalyse change and stimulate continuous improvement.

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