Using Kotter’s 8 steps of change to tackle over‐fasting of children attending day surgery

Ong, S. Y. and Walker, A. (2022) Using Kotter’s 8 steps of change to tackle over‐fasting of children attending day surgery. Paediatric Anaesthesia, 32(11), pp. 1238-1245. (doi: 10.1111/pan.14499) (PMID:35598179)

Abstract

Over-fasting before surgery can lead to dehydration, irritability, lethargy, nausea, hypoglycaemia, tricky intravenous cannulation and decreased patient satisfaction1. We used ‘Kotter’s 8 steps for change’ as an approach to tackling the problem of over-fasting in our day surgery unit2. Using a video of a patient’s experience with overfasting we created a sense of urgency and need for change (Step1: create urgency). We formed a multi-disciplinary Fasting Improvement Team (FIT) (Step2: form a powerful coalition) and conducted a retrospective data analysis to establish a baseline. We then studied the system thoroughly using Ishikawa charts, process mapping, bench-marking, user surveys and Pareto charts. Using these findings, we created a vision for our change (Step3: create a vision for change). Within six months we aimed for 90% of patients to have a fluid fasting time of less than two hours and for 90% of afternoon patients to have had breakfast. We communicated this vision to all staff involved in the day surgery (Step4: communicate the vision). Following, we empowered them (Step5: empower action) by asking for their opinions for changes and let them take over various tasks without micromanagement. The Institute for Healthcare Improvement (IHI) Psychology of Change Framework described a focus on the human side of change, to increase the likelihood that improvement efforts will succeed by activating people’s agency3. Our change ideas were divided into “quick wins”, “doable” and “challenging”. We focussed on creating short term wins (Step6: create quick wins) and celebrated successes along the way to create initial momentum. We did this in parallel with working on longer term changes. We continued to work on cementing these new ideas (Step7: build on the changes) so that transformation in the day surgery would persist before using the same system to spread the change to the rest of the hospital (Step8: making it stick).

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Walker, Dr Alyson
• Authors: Ong, S. Y., and Walker, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Paediatric Anaesthesia
• Publisher: Wiley
• ISSN: 1155-5645
• ISSN (Online): 1460-9592
• Published Online: 22 May 2022
• Copyright Holders: Copyright © 2022 John Wiley and Sons Ltd.
• First Published: First published in Paediatric Anaesthesia 32(11): 1238-1245
• Publisher Policy: Reproduced in accordance with the publisher copyright policy