Prepare a strategy for change

It is important to remember that making any changes, however small, can have a large impact, not only on your caseload but also at the level of the clinic/practice. It is impossible to anticipate all the potential effects of a change, but it is important to consider as much detail as you can prior to implementing any changes.

Changes can be initially made at the caseload level (e.g. you changing how you treat cases), or potentially, after some discussion with your colleagues, at the practice level. Research has been carried out previously looking at the success of change implementation, specifically at the factors that facilitated and hindered proposed actions in the medical field (Haley et al. 2012). These included:

Who

Reflect on previous episodes of ‘change’ within the clinic/practice and what the facilitators and barriers to it were – factor these into your strategy.

You are interested in developing a framework that the vets in your practice can follow when doing lameness work-ups in horses. You have noticed that, on occasion, different vets approach these cases differently, which leads to confusion amongst the staff in your clinic as to what equipment and consumables they should be preparing prior to the assessment. You did attempt using a new framework a year or so ago, but it was a week when one of the vets was on holidays and the other was at a continuing education course, and you were busy with the additional work, so you abandoned your plans after the first day.

When

Ensure that you have highlighted a specific time that can be used to make any changes; is it easy for other things to take priority in a busy clinic/practice.

Pick the most appropriate time to implement the changes. For example, if it requires others to help, make sure it isn’t during a busy period so that people will have the time to help you.

You know that in a month’s time, a new graduate is joining the practice and will be spending the first two days of the week shadowing you. You also know that these days are deliberately being kept quiet so that the new graduate can get to grips with the clinic/practice. You think this may be a good time to trial the framework as there will be less time pressure on you, and it will probably be of benefit for the new graduate also.

What

Ensure that you are clear as to what you are actually changing, and what actions are required. It may be beneficial to make a note of any changes in order to compare the associated outcomes at a later stage (e.g. what was done, the date, dose rates, approaches attempted).

Your aim is to get the vets to follow a lameness work-up framework, which will probably contain the steps they carry out anyway, but perhaps in a slightly different order to how they might have approached these cases previously. You may want to discuss the suggested changes with the other vets in the practice/clinic to make sure everyone is clear about the changes you are suggesting. You could also run an initial pilot where you trial the framework first prior to getting the other vets involved.

How

If possible, plan to implement small changes one at a time if they require alteration to normal protocols in a number of areas within the clinic/practice.

This step may help you and the other vets to not feel overwhelmed by what may be required in order to make the changes.

You plan to trial the framework during the two days that the new graduate is shadowing you as a starting point. This will allow you to get feedback from the new graduate to add into your review of how well the framework worked at the end of the two days. Depending on the confidence of the new graduate, you may be able to get them to trial aspects of the framework.

Make sure you have everything you think you might need beforehand (e.g. all necessary equipment, therapies, resources, people) to make the transition as seamless as possible.

You might ask the receptionist to potentially book more (or less, dependent on how much you are wanting to change) lameness work-ups for you on the days you want to trial the framework. If there are other staff that usually help with activities such as lunging, or preparations for nerve or joint blocks, it may be useful to have a short discussion with them to explain what you are attempting to do, and what additional equipment or resources you may need that might be different to what is usually prepared.

It is important to have a periodic systematic assessment of any changes implemented to ensure that they have had the desired effect on patient outcomes. Techniques for doing this can be found in the next stage of the EBVM cycle under ASSESS.