AHRQ Safety Program for Long-Term Care: HAIs/CAUTI
Purpose: To provide senior leaders with a deeper explanation of technical and adaptive solutions for change
Who should use this tool? Senior leaders (long-term care facility administrator, director of nursing, medical director, etc.)
How should you use this tool? Use the examples to better understand technical and adaptive solutions for change and to better utilize these types of solutions in your facility
Technical Solutions for Change
The technical work includes these characteristics:
- The problem's definition is clear and potential solutions are relatively straightforward, easy to put in place, and require minimal learning.
- Responsibility for implementing a solution is fairly apparent.
- Teams have the necessary resources.
- Technical solutions may require new procedures, training, or data collection; however, they need very little cultural or attitude change to be successful.
Examples of this type of work can include—
- Ensuring teams have the staffing, budget, space, supplies and authority to succeed.
- Providing adequate time and training to complete jobs successfully.
- Working with team members to create project goals and timelines.
- Removing any other barriers that hinder project success.
Examples of Technical Solutions for Change From the Field
- At a small rural facility, staff identified issues with recruiting nurse champions for their facility safety teams. Having already successfully recruited their senior leaders, the team needed to find nurses to join. Because of ties the senior leaders had with facility administration, the team was able to relay their concerns to administrators, who then looked into the matter. The administrators found that nurses were not receiving important communications about training and team-building events and also could not attend many of these events because they conflicted with work hours.
In a solution that paired technical problem solving with accountability, the facility established a single intranet site where nurses could find updates on essential meetings and events, including those addressing quality and patient safety initiatives. The senior leaders accepted responsibility for updating the site every 2 weeks. Nurses were held accountable for checking the calendar and were relieved of the worry of missing an important email or notice related to their participation. The intranet site allowed the senior leadership team members to solve a problem with a minimal amount of effort.
- Another example of a technical solution comes from a common safety issue many facilities encounter: a lack of supplies for inserting and maintaining catheters. To address this, one facility team used a cart to house all the necessary supplies for a clinician to safely insert a catheter into a resident. This line cart also contained a checklist requiring staff to verify the items were stocked in the cart. This technical solution—the line cart and supply checklist—increased staff accountability of necessary materials without requiring major changes at the facility.
Adaptive Solutions for Change
The senior leader must also understand and support adaptive work. Adaptive work is things like—
- Addressing problems that require a change in attitudes, beliefs, and behaviors.
- Clarifying decision-making, conflict management, and problem-solving processes.
- Encouraging an environment of mutual respect, and making the team feel safe to discuss their concerns.
- Helping the team use results of a safety culture survey to drive improvement.
Adaptive work requires facility wide cultural adjustments. Effective senior leaders help people successfully adapt to change by reinforcing attitudes, beliefs, and behaviors that facilitate the initiative.
Examples of Technical Solutions for Change From the Field
- As discussed earlier, the senior leaders of a small rural facility collaborated with front-line providers to create a technical solution, an intranet site, to engage nurses. In addition, the facility held a focus group on Saturday mornings to respond to the needs of the facility nurses. This resulted in the development of safety training and events the nurses felt would best address their concerns. There were a series of nurse-led quarterly gatherings attended by facility leaders, quality improvement staff, and patient safety staff. These are examples of adaptive solutions.
After putting these technical and adaptive solutions in place, the facility saw an improvement in nurse involvement in safety initiatives. The facility safety teams were able to support changes in the culture and engage a group of skilled staff in the project.
- Other adaptive solutions used by nursing home include-
- Implementing an evidence-based checklist for key procedures.
- Creating an action policy for when a protocol is breached.
- Holding individuals accountable for following new policies.
