A Simple Change

By Noriza Ab Ghani Matric number : 770114035684001

What is Change ?
Making something different from what it is ( Sullivan & Decker,1997) In many instances
The outcome remains the same But The processes change

Three types of change

Personal change
Professional change Organization change

Five steps of change

Assessment
Planning Implementation Evaluation Stabilization

Assessment
Identifying the problem or opportunity that necessitates change Done by collecting and analyzing data

Data can come from

the process or outcome of the process or both

Planning
Establishing the who, how, what and when of change.
Important for a change to be successful Expected outcomes must be identified at this stage

Implementation of change strategies

3 strategies
Power coercive approach Normative-reductive approach Rational-empirical approach

Evaluation
Assess the effectiveness of the changes Identify the time interval for evaluation Determine effectiveness of change and change implementation Decide on acceptance or any modifications required in the change

Stabilization of change
Sustain the objective outcomes over a period of time
May need another evaluation to know if change was sustained

Plastic Surgery Clinic Schedule

Day Sunday Operation Dressing, Wound Inspection, Removal of sutures Monday Clinic for new cases, referral cases and cleft surgery cases Dressing, Wound Inspection, Removal of sutures Morning Afternoon Operation

Tuesday

Operation
Dressing, Wound Inspection, Removal of sutures

Operation

Wednesday

Minor Surgery Dressing, Wound Inspection, Removal of sutures

Clinic for keloid case

Thursday

Clinic for Burns cases, operations for burns

Dressing, Wound Inspection, Removal of sutures

Clinic Set-up
Plastic clinic has two examination rooms
One is manned by the Surgeon The other by the Medical Officers

Assisted by
MAs, Nurses, Attendant, Assistant Nurse

Assessment

Attendance for minor procedures

Removal of Sutures Wound dressing 4-5 patients /day 4-5 patients/day

Monday, Wednesday and Thursday MORNING

Waiting time is longer as Nurses are also assisting the doctor in running the follow-up clinic sessions.

Planning
Solution
Re-schedule patient requiring removal of suture, dressing and wound inspection to non-clinic hours

Monday, Wednesday & Thursday AFTERNOON

Clinic Schedule When Change Implemented

Day Sunday Operation Dressing, Wound Inspection, Removal of sutures Monday Clinic for new cases, referral cases and cleft surgery cases Dressing, Wound Inspection, Removal of sutures Morning Afternoon Operation

Tuesday

Operation
Dressing, Wound Inspection, Removal of sutures

Operation

Wednesday Minor Surgery

Clinic for keloid case Dressing, Wound Inspection, Removal of sutures

Thursday

Clinic for Burns cases, operations for burns

Dressing, Wound Inspection, Removal of sutures

Evaluation of changes
Determine waiting time for
Patients seeing the doctor and Patients requiring the minor procedures

Assess staff number May encounter some problems when new arrangement is introduced

Stabilization
Especially when new process yields positive outcomes The new work process for removal of sutures, dressing and wound inspection

Discussion
Change has not been implemented

In planning, must discuss with dept. staff

Once agreeable, the whole department will be involved

Will pilot for a few weeks

High possibility of acceptance of proposal The new process does not involve additional budget, staff or place

Conclusion
Delay during clinic day with current system

Pt to be given an appointment on clinic day afternoon

Result: pt do not need to wait for a long time

Staff may find it hard to accept this change

With proper planning, discussion and evaluation the change in this work process should be successful.

Any questions?

Thank you