Select Figure 1.1 for steps you can take (13 KB).
Before introducing the Put Prevention Into Practice (PPIP) program for delivering clinical preventive services, it is important to assess physician and staff readiness for a systems change by assessing staff values and attitudes about prevention, determining how staff view their current practice, and establishing goals for the delivery of preventive care.
Include each staff member in the decisionmaking process about whether, when, and how PPIP should be implemented in your setting by soliciting, acknowledging, and considering staff input. Use the worksheets included in this chapter to compile staff suggestions. (Go to Appendix B for additional copies of these worksheets.)
Understanding the values, attitudes, and beliefs of the staff can contribute to establishing support for the program before implementation begins. Staff members are more likely to put energy into a program aligned with their values and one they helped to create than one that is imposed on them.
Acknowledging the value of staff members who openly resist change also is important. Often, those who resist see barriers to change that need to be addressed. If the opinions of all staff members are considered important, and if all staff members are enlisted to solve problems, then barriers to implementing PPIP can be overcome. Those who initially resist may become champions of change and innovators in implementing PPIP.
Eliciting patients' ideas about preventive care also is valuable. Listen to what is important to your patients and consider incorporating their suggestions as you begin to implement the PPIP program.
Before an organization-wide systems change can occur, the entire staff should agree:
One of the first steps in assessing staff readiness to change and, ultimately, in delivering clinical preventive services is to determine:
You can begin to make these determinations by administering a readiness survey and following with open discussions.
A readiness survey (PDF File, 15 KB; PDF Help) has been used in clinical settings (or go to Appendix B). It is designed to stimulate discussion about the readiness of a practice to change. Encourage staff members at all levels and from all departments to complete and submit this survey anonymously. Then, after analyzing the results both for variability and for salient issues, elicit staff members' help in assessing your organizational climate (use the Worksheet for Assessing Organizational Climate [PDF File, 10 KB; PDF Help] for guidance, and also in Appendix B).
Through group or individual discussions, use the results of the Readiness Survey to probe staff values and beliefs. These interactions can help staff members understand each others' viewpoints and can give them a basis for envisioning how best to implement PPIP. In such discussions, all staff should feel valued for their contributions so that information can flow freely. Because staff and practice situations change, this process should be revisited often.
A cohesive working team will begin to emerge from these discussions. Information gathered on the group process will be helpful when preventive services are delivered. Gather information relating to the following questions:
A worksheet for assessing organizational climate (PDF File, 10 KB; PDF Help) can help facilitate further group discussion (also in Appendix B). Having the staff discuss the questions in this worksheet and then debate, disagree and, finally, agree on an assessment of your organizational climate can be exciting. The processing, the final plan, and the changes that evolve will be as individual to your site as are your staff members.
Before incorporating preventive services into your clinical setting, consider patient perspectives about such services. You can elicit opinions from your patients in a variety of ways, including customer satisfaction surveys, brief interviews, suggestion boxes, and focus groups.
By this stage, you have taken two pivotal steps toward implementing PPIP in your clinical setting:
The next step is to review your findings, introduce PPIP, and discuss whether to proceed with its implementation. Before an organization-wide systems change can occur, the staff must agree that prevention is important and that prevention is aligned with the clinical setting's values.
You may wish to use the sample agenda, below, at a staff meeting.
Team Presentation of Findings
Goals