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So now we're ready to jump into the adaptive work that went so
far in helping us with our implementation of CLA-BSI.
I want to say that the adaptive work can be challenging, but
it can also be sort of fun because it allows you to think outside the box.
And often we would brainstorm, and we would say if no idea was silly,
how can we get people to do what we need them to do?
So it was actually a great opportunity.
And I'm going to show you how getting the right mix of adaptive and technical work
really does impact your project rather than just saying we're going to do this.
A top-down approach is less likely to be effective.
In fact, people really don't sustain top-down approaches
nearly as much as when they're involved then again as a stakeholder.
So we visit the TRIP model again, and
we're back to that part of walking the process.
So again,
this is how do we know what we need to change before we begin to implement?
And so this is really the second stage.
And we get them to make recommendations.
The other thing that we say, because we are looking at culture change over time,
is that we want you to value the dissenter.
Now that was hard for me to buy,
but there's always somebody that you work with that knows everything all the time.
Those are the people that would say this isn't going to work,
this isn't going to work, it's going to fail.
Those are the people you want to hear from.
You want them to legitimize their feelings.
You want them to tell you why it's going to fail.
And you want to take that into an account and
make changes based on what the dissenter says.
This is the same way as your pilot team.
So if you send a doctor and
a nurse out to implement this, what do they say would make it better?
Or what do they need that's different and
unique to their unit compared to what we've done for them.
And I think that's really important
as we get down closer to the implementation phase.
So identifying the local barriers, as I said, really, really important.
Because if you don't address the barriers, you will never have success.
So what we found is when we didn't hand hold,
educate, train them, show them fast fact sheets,
and all of that, we didn't have the buy-in that we needed.
But when we treated this from an implementation science
perspective where we were not only an interdisciplinary team but
we were a transdisciplinary team, meaning that instead of just a doctor and
a nurse working together, we were looking across disciplines.
So what did the physician say?
What did the nurse say?
What do our human factors engineers say would help with compliance?
What did our organizational psychologist say would help with compliance?
What did people like me who are a health outcomes researcher say the importance
of process measures?
So how often?
And we needed to let them know that after we addressed these barriers,
they would be held accountable to make sure that we could actually implement in
the time frame that we wanted and have the results that we needed to see.
So there's a wonderful thing called change management.
I’m very familiar with it and I’ve read lots of books on it.
And one of the things that I think really helped with us was a book,