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Change Management Issues: Recommendations for Governance CDM improvement work in NWT is based on five principles: • The design of the CDM strategy should build on both scientific and local evidence and best practices. • Design and implementation of CDM improvements should engage a wide range of stakeholders. • Design and implementation should take a participative bottom-up approach with top-down guidance. • Large scale improvements can be achieved through an incremental process. • Improvement is a collective learning process that builds on experimentation and the evaluation of potential solutions. The Department believes that the design and execution of the three pilot projects constitute significant steps towards CDM improvement in NWT. Project evaluation has, however, highlighted several factors that must be addressed to continue CDM improvement and sustain change that is underway. These factors relate to communication, program monitoring and evaluation, and the availability of resources. Communication Many project participants were unclear about roles, responsibilities, expectations, timelines and next steps. This lack of clarity stems from inadequate communication at multiple levels: between the Department and team leads, and between team leads and team members. It also reflects the complex matrix management nature of the NWT health and social services systems. Sustaining and expanded improvements rely on effective communication to convey not only high-level messages related to vision and strategy, but also vital project details on a day-to-day basis. It also relies on the capacity to absorb communications that are sent. The Department acknowledges the need to clearly articulate all messages related to CDM improvement and is committed to enhancing communication to inform stakeholders, build their communication capacity and gain their full support. Monitoring and evaluation Evidence from the literature and all three improvement projects indicates the importance of appropriate program monitoring and evaluation to assess future cost saving and improvements in quality of care. Some pilot projects created effective evaluation tools to monitor the work and establish baseline data (e.g., diabetes pre- and post-assessment tools). Others struggled to establish evaluative processes, resulting in a lack of evidence and an inability to share changes and outcomes. 21 Making the Case for Change
As a result, standardized evaluative tools and processes for CDM initiatives need to be established at the outset of work and carried out in a consistent manner throughout the project. 27 A continuous quality improvement loop enables practice teams to measure performance, identify gaps in care and make incremental, evidence-based practice adjustments. Resource availability The pilot projects were undertaken mostly by current staff who took on additional tasks and responsibilities with limited additional funding. Although the lack of financial resources, time and staff impeded pilot project implementation, these shortages may pose proportionately greater obstacles to the scale and spread of the improvement work. If improvement is indeed a priority, it should be reflected in resource allocation. Building leadership capacity Strong and committed leadership is essential to address challenges and carry out successful change. According to Kotter, 28 such leadership involves: • creating a climate for change by creating a vision, establishing a sense of urgency, and forming a powerful guiding coalition • enabling change by engaging stakeholders, communicating the vision, empowering change agents and creating short-term wins • consolidating incremental improvements to achieve greater change and institutionalize new approaches This evaluation shows NWT has the CDM vision, the engaged stakeholders and the short-term wins. Through its emerging integrated CDM strategy, the Department now looks to reaffirm the project’s sense of urgency, strengthen its guiding coalition, clearly communicate its vision, identify change agents and empower local champions by removing obstacles and allocating appropriate resources. Institutionalized change will be secured as improvements accrue and staff adopt new tools and approaches as standard components of patient care. Making the Case for Change 22
Page 1: Making the Case for Change Advancin
Page 4 and 5: Acknowledgments True collaboration
Page 6 and 7: Table of Contents 3 Executive Summa
Page 8 and 9: Executive Summary The Chronic Disea
Page 10 and 11: Introduction Forging an integrated
Page 12 and 13: INTRODUCTION Targeting improvement
Page 14 and 15: INTRODUCTION FIGURE 2 Expanded Chro
Page 16 and 17: Discussion and Recommendations This
Page 18 and 19: DISCUSSIONS & RECOMENDATIONS Table
Page 24 and 25: DISCUSSIONS & RECOMENDATIONS Summar
Page 28 and 29: Conclusion The aim of chronic disea
Page 30 and 31: Diabetes Self Management 25 Making
Page 32 and 33: The pilot phase began in June 2012
Page 34 and 35: DIABETES took place during June and
Page 36 and 37: DIABETES Figure 6 Pre- and Post-tra
Page 38 and 39: DIABETES Many patients appear to li
Page 40 and 41: Renal Disease Improved Coordination
Page 42 and 43: RENAL Clinical practice guidelines
Page 44 and 45: RENAL Forging alliances for better
Page 46 and 47: Creating new collaborative tools Th
Page 48 and 49: RENAL The experience of Hay River s
Page 50 and 51: Mental Health Standardized Processe
Page 52 and 53: Staff feedback was essential to rev
Page 54 and 55: MENTAL HEALTH Improving inter-branc
Page 56 and 57: In addition, interdepartmental lack
Page 58 and 59: Appendices To access appendices lis
Page 60 and 61: REFERENCES 35 Northwest Territories
Page 62 and 63: REFERENCES 94 Northwest Territories

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