Laying the Groundwork

[Not] starting slow to go fast is where we often fall down in our quality projects.

– Chief Medical Officer

When working toward such an ambitious goal, just figuring out where to start can feel overwhelming. Before diving into training curricula or working out lab logistics, it’s important to take a step back and survey the overall organizational environment. Organizational change cannot be accomplished without establishing some key, high-level pillars to support the massive effort.

Harmonize with Agency Goals

Aligned incentives are a magic dust on these sorts of projects.

– Chief of Psychiatry and former Medical Director, Brookwood site

At Santa Rosa Community Health, our HIV testing project benefited from an overall organizational goal of increasing the use of quality metrics. In turn, subsequent screening efforts have grown from the example we set through this project.
Think about how this project fits in with all the other priorities and projects at your organization. Take one more step back and think about how it aligns with your overall mission. Projects that don’t align with organizational goals and compete with other priorities will struggle. Here are a few things to think about:

Projects that align with mission, goals, and other projects are primed for success. It just takes communicating with everyone, from leadership to front-line staff, exactly how the project fits in.

Obtain Leadership Buy-In

It’s very relational.

– Chief Medical Officer

At Santa Rosa Community Health, achieving higher HIV screening rates resulted from healthy support and participation from clinic leaders. The many systemic changes we made would not have been possible without that support, achieved through significant early reconnaissance and communication. Here are a few things to try when garnering leadership buy-in:

Projects that align with mission, goals, and other projects are primed for success. It just takes communicating with everyone, from leadership to front-line staff, exactly how the project fits in.

Identify a Project Champion

As a new person, [our project champion] struggled at first to have credibility with staff but eventually won them over through persistence, many in-person appearances, a non-judgmental attitude, and incentives.

– Senior Nurse Manager

An ambitious project that spans the organization needs buy-in from leadership, but it also requires an individual, small group or committee to champion it, to oversee its progress and take the lead on problem-solving when barriers are encountered.

At Santa Rosa Community Health, the grant we received enabled us to hire an HIV Testing Training Specialist who spent 100% of her time leading the project. She attended leadership meetings, trained staff, facilitated the creation and distribution of data reports, and helped modify workflows and customize EHR settings. In addition, she was accessible to everyone; posters and fliers contained her contact information, and staff could reach her with a quick phone call.

Not every organization will be lucky enough to have a full-time champion, but change is still possible if at least one person takes the lead on knowing what’s happening and communicating it across the organization. In these situations, the higher the champion sits on the organizational chart, the greater the likelihood for success. But regardless of their position, keeping the project on everyone’s collective radar may be enough to generate forward progress.

Plan to Change the Culture

You can get tripped up on assumptions. You need to look at the assets and liabilities of each individual site. The culture is different in each one. The microenvironment matters. It adds complexity. We did HIV testing in a standardized way across all the sites but the microclimate still made a difference.

– Chief Medical Officer

Attend meetings to communicate with others but also to understand competing priorities
. For example, at Santa Rosa Community Health, the project champion attended regular cross-operations leadership meetings, and joined the Communications Committee, a cross-functional agency-wide committee formed to create more effective communication strategies. Attendance at these meetings gave her insights into organizational priorities, helping her to frame the HIV testing project in alignment with those competing priorities.Accomplishing opt-out HIV testing across all areas of an organization requires a cultural shift in how staff and patients think about HIV and what they understand about testing, prevention, and treatment. Cultural change requires planning and persistence, and wherever possible, work to embed the project into existing culture and systems. Here are a few strategies for taking it on: