Introduction
The modern rapidly changing world provides healthcare with the opportunity for positive change, but as the years pass, this opportunity becomes a necessity and a challenge. The present paper is devoted to the concepts of quality management and improvement and discusses them from the point of view of the existing frameworks and policies. The notions are defined and discussed; the frameworks are described in short to demonstrate the key tendencies in their development. The examples of policies are taken from the Australian Commission on Safety and Quality in Health Care and Department of Health and Human Services of State Government of Victoria. These policies are described in brief and discussed in order to get an insight into the notion of quality improvement and the way it is used nationwide.
The Concept of Quality Management
Clinical governance can be regarded as a mechanism of maintaining and improving quality; in short, it is a mechanism of managing quality in healthcare (Tuan, 2014). The tools of clinical governance include quality standards as well as quality improvement (QI) frameworks and strategies that are supposed to be integrated into everyday practice in healthcare. Other tools include specific structures that are created to ensure that health services are maintaining their high-quality standards, remain responsible and accountable for them, and proceed to work towards QI. Finally, clinical governance uses data and knowledge sharing, clinical communication, and funding (Tuan, 2014, p. 216).
QI is a crucial part of clinical governance, which can be described as its ultimate aim. QI can be defined as “the combined and unceasing efforts of everyone—healthcare professionals, patients and their families, researchers, payers, planners and educators—to make the changes that will lead to better patient outcomes (health), better system performance (care) and better professional development” (Batalden & Davidoff, 2007, p. 2). In other words, QI is comprehensive in nature (Walker, 2012). Apart from that, QI is related to change, but there is no standard that would allow measuring the success of this change, and not every change tends to lead to QI (Morganti, Lovejoy, Haviland, Haas, & Farley, 2012). Similarly, although the frameworks for QI are numerous, there is still no unified approach that would guarantee successful QI (Liberatore, 2013).
For example, the Six Sigma methodology, which was first developed in the 1980s by Motorola, is meant for QI in standardised processes, which makes it applicable to a vast number of medical procedures (Goffnett, Lepisto, & Hayes, 2016, p. 82). It includes the DMAIC method that is aimed at defining, measuring and analysing defects, improving the situation to eliminate them, and controlling processes in the future to avoid recurring issues. Apart from DMAIC, Six Sigma utilises a vast number of tools with the eventual goal of “3.4 part per million error rate,” and improvement in this direction regarded as a partial success (Liberatore, 2013, p. 602). Liberatore (2013) shows that the method can lead to partial success in healthcare, but apparently not every of the hospitals from the sample reported any meaningful changes (p. 607). Similarly, the study by Ali (2013) is devoted to the barriers to total quality management (TQM) framework that reduce the effectiveness of its implementation.
TQM has been among the most popular strategies since the 1990s, but the research in the area is experiencing a decline nowadays (Sun et al., 2013). TQM embraces two elements: “values concepts and principles” and “techniques and tools,” of which the former are customisable, and the latter are universal (Ali, 2013, p. 148). Ali (2013) demonstrates that not the implementation, but the successful implementation of TQM results in QI, but this aim is more difficult to achieve since there is no universal framework for TQM implementation that could guarantee positive outcomes. Similarly, “the quality improvement collaborative (QIC) methodology of the Institute for Healthcare Improvement” has been applied to primary care in Australia since 2004 (Knight, Caesar, Ford, Coughlin, & Frick, 2012, p. 948). QIC involved numerous problem-oriented strategies of intervention (for instance, for diabetes prevention, diabetes risk assessment was completed for 50% of eligible population). Knight et al. (2012) note that QIC has led to the improvement of primary care data management and clinical care, but still insist that the success was inconsistent (p. 948). In other words, these examples show that there is no universal recipe of QI (Gardner et al., 2011).
The methodologies themselves can sometimes be subjected to improvement. In particular, they may be blended with each other; for instance, Motorola’s Six Sigma is often combined with lean (wasteless, cost-efficient, scientific method-guided) management developed by Toyota (Goffnett et. al., 2016). Lean QI (or quality management) can be implemented in health care on its own as well (Mannon, 2014). Other popular QI methodologies include, for example, the continuous quality improvement (CQI) approach that employs cyclic models of change and focuses on data use (Brennan, Bosch, Buchan, & Green, 2012; Gardner et al., 2011). PDSA (Plan-Do-Study-Act) is a “cyclical model,” which is also aimed at continuous QI, presupposes implementing a planned solution, analysing its effectiveness and then deciding to either standardise it or remove (Christina, Kinney, & Mattachione, 2015, p. 361).
It can be concluded that the research in the field of quality improvement has produced numerous options that can be used by modern healthcare. It is noteworthy that they do not have to be used in their initial form; they may be modified to suit a particular set of needs, and they are more likely to be successful in such a case (Gardner et al., 2011).
Importance of Quality Improvement in Health Care
The importance of QI for healthcare is a fact that is accepted in most countries (Sun et al., 2013) and is defined by a number of factors (Walker, 2012). Improved patient outcomes are the most obvious reason, but not the only one (Mannon, 2014). With the rising costs and the always restricted funding, the need for efficient healthcare has always been a must while also remaining a challenge (Liberatore, 2013). QI is aimed at dealing with this challenge while also improving the managerial and clinical processes and reducing the possibility of errors and failures (U. S. Department of Health and Human Services Health Resources and Services Administration, 2011). The institution and the healthcare system that are aimed at QI become more stable as the errors and issues are being eliminated in continuously. Also, QI is directly related to competitiveness and patient and family satisfaction; it tends to raise the reputation of an institution, which leads to better funding and improved relationships with the government and community (Goffnett et. al., 2016). QI is connected to the adoption of technically advanced healthcare approaches and tools as well (Sutherland, 2013). In other words, QI in healthcare is significant from the point of view of all the stakeholders, and apart from ensuring a high quality of service, it improves the corporate success of healthcare institutions.
Given the significance of QI for healthcare and the number of the existing frameworks, it is not surprising that national health care is being managed by specifically created bodies that work towards popularising and standardising QI nationwide. These bodies include the Australian Commission on Safety and Quality in Health Care.
The Roles of the Australian Commission on Safety and Quality in Health Care
The Australian Commission on Safety and Quality in Health Care (ACSQHC) exists to introduce and coordinate “improvements in a number of areas relating to safety and quality in health care across Australia” (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2016e, para. 1). The role that ACSQHC plays in Australian healthcare QI is, apparently, immense, and it can be discussed from several points of view that are presented below.
Accreditation and the NSQHS Standards
Australian Commission on Safety and Quality in Health Care [ACSQHC] (2016a; 2016d) has developed the National Safety and Quality Health Service Standards and national accreditation scheme in order to promote QI in Australian healthcare. There exist 10 Standards that include safety and quality governance, consumer partnership, the prevention and control of falls, infections that are associated with healthcare and pressure injuries as well as medication safety, “patient identification and procedure matching, clinical handover,” blood management, and clinical deterioration recognition and response in acute health care (ACSQHC, 2016d, p. 1). According to ACSQHC (2016d), these standards have been chosen since they tend to affect the greatest number of patients, and their outcomes can be improved. As for the accreditation to the Standards, ACSQHC (2016a) does not require it from every service, but hospitals and day procedure services in every state and territory are expected to be accredited beginning with January 2013. The Standards and accreditation appear to be the key tools for quality management that have been set for Australian healthcare.
National Priorities
The national priorities that are supported by the Australian Commission on Safety and Quality in Health Care [ACSQHC] (2016c) include healthcare rights, the development of frameworks and goals for safety and quality, the collaboration with the Independent Hospital Pricing Authority and a number of specific areas: antimicrobial use and resistance, blood management, and reduction in CT-scans radiation exposure (among children and youth). All these priorities are supported by projects that can be viewed at the Commission’s website. An example is the Australian Safety and Quality Framework for Health Care that appears to be of particular importance due to its universal nature. It is a visionary document that provides advice for QI strategies and involves three core principles: care must be consumer-centred, information-driven, and “organised for safety” (Australian Commission on Safety and Quality in Health Care [ACSQHC], 2010a, pp. 1-2). These priorities provide further direction for QI in Australian healthcare; the related projects can be regarded as tools for QI integration.
Supporting Quality Practice
ACSQHC (2016e) supports quality practice through a number of initiatives aimed at particular areas of care (falls prevention, medication safety, healthcare-associated infection, e-health safety), organisational aspects of health care (clinical communications, disclosure, information strategy), professional-related ones (credentialing for health professionals), some healthcare principles (consumer-centred care, patient safety), and so on. The initiatives aimed at the support of quality and safe practice are numerous, and they target specific areas (for example, mental health) or more general aspects (for example, shared decision-making promotion). By supporting quality practice, ACSQHC ensures that the standards are met, maintained, and QI has the chance to occur.
Indicators, Datasets, and Registries
Some of the Australian Commission on Safety and Quality in Health Care [ACSQHC] (2016b) projects are aimed at monitoring the quality of Australian healthcare. The Commission’s National Indicators Project is directed at moving QI in the focus of the national healthcare and improving the transparency and accountability of institutions in this respect. The result is the indicators that are supposed to be used for reporting and creating databases on the quality and safety performance of Australian healthcare. The core indicators are hospital-based; apart from that, there exist practice-level ones that can be used for guidance and may be included in QI strategy voluntarily. They have been created through extensive research and with the help of consultations of professionals. Also, new standards are being developed, including the current project that is based on patient experience survey (ACSQHC, 2016b)
Australian Commission on Safety and Quality in Health Care [ACSQHC] (2014) clinical quality registries are the bodies (organisations) that are created to monitor the performance of Australian healthcare. Guided by the standards and indicators, they generate datasets and reports that summarise the information gained and provide an overview of the quality of healthcare within the area of their activities. The data can be used by “jurisdictions, healthcare providers, funders, clinical colleges and researchers” (ACSQHC, 2014, p. 7). Also, it is used to define national and regional benchmarks. Thus, ACSQHC monitors the QI performance of Australian healthcare.
Consumers
ACSQHC (2010a) promotes a consumer-oriented kind of healthcare, which is reflected in its goals, frameworks, and the website itself. In particular, ACSQHC (2016e) website contains a specific section that provides the information meant specifically for patients. Similarly, ACSQHC (2016b) plans to use patient and consumer satisfaction survey for the development of new core indicators. It can be claimed that ACSQHC’s agenda for QI is consistently consumer-oriented.
Publications
The publications that are accessible with the help of Australian Commission on Safety and Quality in Health Care [ACSQHC] (2016f) include the annual reports of the Commission and those on the state of safety in Australian healthcare. Also, ACSQHC (2016f) suggests implementation plans, advisory papers, literature reviews, articles, and other resources that are aimed at improving healthcare stakeholders’ awareness of QI. When developing the materials for the recommendations, ACSQHC (2016f) takes into account the information gained from patients and carers.
Conclusion
ACSQHC provides concrete, comprehensive, and consistent guidelines for QI, including the standards that must be adhered to and those that can be used for maximum effect. These guidelines are made easily accessible by the Commission along with other vital information, which means that ACSQHC disseminates knowledge. Finally, ACSQHC monitors the adherence to the standards and produces reports that allow setting national benchmarks for QI and assessing the situation. To conclude, ACSQHC is aimed at providing comprehensive healthcare quality management, but it also offers some freedom in defining the specifics of QI frameworks that can be used by the states, territories, and individual institutions.
The Roles of the Department of Health and Human Services of State Government of Victoria
The Department of Health and Human Services of State Government of Victoria (DHHS) is also involved in quality improvement, but its area of activities is more limited when compared to ACSQHC. As a result, its role primarily consists in assisting ACSQHC. The quality, safety and service improvement is one of the aims of the Department of Health and Human Services [DHHS] (2015d). According to DHHS (2015d), it intends to spread the idea of continual improvement, which appears to be familiar to CQI. To assist this agenda, the Victorian Government has created “the Better Care Victoria Innovation Fund,” which is aimed at innovation and QI in Victorian healthcare (Department of Health and Human Services, 2015a).
The Department of Health and Human Services [DHHS] (2015b) provides general QI information (through reports, fact sheets, research and news articles) and that related to policies and QI guidelines; also, various forms and templates for reporting and some patient-oriented data can be found on its website. The accreditation that DHHS (2015b) promotes is naturally that of ACSQHC (2016a) since it is universal for Australia. The Department of Health and Human Services (2015c) provides all the relevant information and recent updates, offers online accreditation resources and an interpretation of the standards. DHHS (2015d) emphasises the importance of the areas that ACSQHC highlights (clinical risk, medicine use, infection prevention), provides the standards and the guidelines for their QI and offers reviews of the safety and quality of care in Victoria. Also, the Department of Health and Human Services (2015e) reports on local projects, for example, the redesign programs that have been implemented by 19 health services in Victoria since 2013. These projects were carried out in line with the Redesigning Hospital Care Program and became a part of the National Health Service Productive Series program that was built on lean management ideas and was first developed in 2008 by the UK National Health Service (Department of Health and Human Services, 2015f).
To sum up, the key role of DHHS is that of information disseminator; apart from that, it supports ACSQHC initiatives and promotes the QI agenda that is defined by ACSQHC.
Conclusion
In this paper, QI has been defined as the continuous, comprehensive, complex effort of collaborating healthcare actors aimed at the improvement of the quality of their service. The analysis of the activities of the two bodies (ACSQHC and DHHS) demonstrated a high level of cooperation that allows the unification and standardisation of healthcare QI in Australia. Given the numerous variants of QI frameworks, standardisation appears to be important. Also, it should be noted that while DHHS (a local body) apparently devotes itself to the popularisation of the ideas promoted by ACSQHC (the national body), the latter tends to base its standards on the consultations and feedback gained from stakeholders from all over Australia. This fact suggests that DHHS must have influenced the decisions of ACSQHC and demonstrates that collaboration between the bodies is reciprocal.
It can be concluded that ACSQHC and DHHS unite their efforts to develop the policies, standards, and frameworks for QI that are based on research, evidence, and existing frameworks (such as lean management and CQI). As a result, Australian healthcare proceeds to evolve, which means that it can enjoy all the benefits of QI, including better patient outcomes, more efficient management, and greater corporate success.
Change management has always been a challenge, and change management in healthcare is not an exception. The present paper is devoted to the exploration of organisational change theories and models and their application to the analysis of the OSSIE Guide to Clinical Handover Improvement created by the Australian Commission on Safety and Quality in Health Care (ACSQHC). To this end, the notions of organisational change and organisational change management are considered, and three related models are discussed. Also, the paper dwells on clinical communication and handover since the latter is the topic of the analysed Guide. These aspects provide the ground for the analysis of the Guide from the point of view of its change management organisation.
Clinical Communication
Clinical communication can be defined as the communication that occurs to transfer healthcare-related information (Wouda & van de Wiel, 2013). Effective clinical communication “is relevant to virtually every aspect of health care and patient well-being,” which emphasises the significance of communication skills for healthcare employees (Baker & Watson, 2015, p. 599). Moreover, the recent changes in healthcare (for example, the advances in treatment or the “expanding role of care providers”), make these skills even more commonly used and, therefore, significant (Baker & Watson, 2015, p. 600).
An example of clinical communication challenge is handover, the quality of which is affected by communication training and skills of the participants and the context (for example, documentation standards) (Baker & Watson, 2015, p. 599; Pascoe, Gill, Hughes, & McCall-White, 2014). Handover is a “high-risk activity” that endangers patient safety. However, it is becoming increasingly common in Australia due to the need to comply with safe working hours requirements (Pascoe et al., 2014). As a result, handover became a high-priority aspect of healthcare for the Australian Commission on Safety and Quality in Health Care [ACSQHC] (2010b), which resulted in the OSSIE Guide to Clinical Handover Improvement and the National Clinical Handover Initiative.
The OSSIE Guide to Clinical Handover Improvement
Clinical handover can be defined as the “the transfer of professional responsibility and accountability for some or all aspects of care for a patient, or group of patients, to another person or professional group on a temporary or permanent basis” (ACSQHC, 2010, p. 4). The danger of communication errors makes this process risky; in particular, it can cause “discontinuity of care, adverse events and legal claims of malpractice” (ACSQHC, 2010b, p. 6). However, effective communication is capable of reducing these risks. Therefore, the development of the OSSIE Guide to Clinical Handover Improvement is a tool that has the potential of empowering employees to reduce handover-related risks. The Guide was developed with the help of the results of 14 projects led by ACSQHC (2010b) and the seminal work at the “the University of Tasmania, the Royal Hobart Hospital, the Western Australia Country Health Service and Royal Perth Hospital” (p. 2). It is apparently evidence-based and takes into account the implications discovered during healthcare practice. However, ACSQHC (2010b) admits a number of specific issues are not covered by the Guide that is aimed at the sustainable improvement of the general practice of handovers in Australian healthcare. To this end, the Guide presents an organisational change management framework that should “support implementation of standardised clinical handover” (ACSQHC, 2010b, p. 6). The Guide comes with tools (diagrams, work plans) that can be used by employees and managers.
Since the Guide is going to be regarded from the point of view of the proposed change management framework, the notion of change in management needs to be considered.
Organisational Change
Organisational change is not a rare occurrence in healthcare. Typically, the need for change is the result of the need for improvement or the elimination of a flaw (Liberatore, 2013; Mannon, 2014; Sutherland, 2013). An example of a necessary improvement is the adoption of modern equipment that typically requires specific skills and management (Sutherland, 2013). The handover that the OSSIE Guide describes can be regarded as an example of a flawed process. In particular, ACSQHC (2010b) discovered that up to 95% of doctors suppose that no formal handover procedures exist; the number of negative consequences of ineffective handover cases can amount to 15%, and up to 20% of negative events are related to handover (p. 5).
The issue of handover apparently requires organisational change. However, this process has always been challenging, and the barriers to it include the lack of cooperation, communication errors, lack of funding, and various goal-specific and institution-specific issues (Queensland Government Chief Information Office, n.d.; Sutherland, 2013). To assist organisational change, researchers in the area have created a number of models, frameworks, and tools.
Change Management Theory
Organisational change is not supposed to happen chaotically; if it does, there is a large chance of unwanted results and failures. I was involved in change twice, and both times it was evident that the process could benefit from enhanced management and more extensive communication. Moreover, change is challenging, but modern researchers work to find suitable solutions to common issues, and the investigation has yielded results in the forms of change models and tips (Sutherland, 2013). Here, two noticeably distinct theories are considered, and a more practically oriented model is discussed.
Kurt Lewin Theory
Kurt Lewin’s theory of change involves three stages: unfreezing, moving, and refreezing. The first one presupposes the preparation for the change, which includes defining the reason for the change, examining the organisation, determining the underpinning elements that require modification, and communicating the need to stakeholders. The barriers are supposed to be found, and strategies for their overcoming should be developed. The stage is called “unfreezing” because it involves destabilising the stable (and flawed or no longer adequate) values, principles, processes, behaviours, and other foundations of the changing element. This definition allows grasping the stressfulness of change that requires controlled destruction of the previous order of things.
The next stage involves the change itself. Having “unfreezed” and “melted” the situation, the change manager is supposed to provide it with the expected shape. This stage includes all the steps of planning, implementation, monitoring and management, and working with the employees to ensure their motivation. Indeed, communication needs to be maintained during this stage and the following one. The final stage “freezes,” solidifies the change to achieve the pre-change stability. Also, this step includes the evaluation of the change process, which can become a source of information for the organisation and may be used in future changes (Sutherland, 2013, pp. 4-5).
Kotter’s Eight Steps
The model of change management by Kotter is more detailed than that by Lewin, although it follows a similar pattern. It includes eight stages: the first one presupposes the creation of a sense of urgency, that is, the process of alerting the staff and communicating the fact of the need for change to them. Thus, the first stage is concerned with bringing down the possible barriers of resistance and fear of change. Then, the guiding coalition is created of the people who are willing to foster change. The third stage involves planning, developing the vision and the strategy, and this part of the process should be concerned with making the change possible, achievable, and measurable. The fourth stage communicates the plans to the employees who are already willing to participate as the result of the first stage. Then, the manager is supposed to empower the employees for change, that is, provide them with the required information (training) and tools and reduce the obstacles that they might encounter. The sixth stage involves the production of “short-term wins,” tangible results that can be consolidated during the seventh stage to produce more change. The final stage presupposes, once again, refreezing: solidifying the change and making it a part of the organisation’s culture (Mbamalu & Whiteman, 2014).
The Change Management Process Presented by Queensland Government Chief Information Office
The Queensland Government Chief Information Office [QGCIO] (n.d.) offers a Change Management Plan Workbook and Template that among other things include a model of change management. It consists of three stages, and the final output is not the change but the change management plan. However, the model involves the strategies for implementation and results assessment and review. The stages include the “details of the change,” which includes the necessary investigations into the situation and the required change, the implementation of the change, which involves planning for it, and the review of change, which allows appraising the results and improving them (QGCIO, n.d., p. 3). The output that must be produced includes the activities schedule, action, communication, and training plans, plan for the resistance to change, and employee change readiness plan, the combination of which will result in the change management plan. Other specifics of this model include the attention to the resistance, the distinction between process and people change, the work to motivate all types of stakeholders, and the general orientation to the practical applicability, which results in additional materials and change management tools attached to the framework (for example, the organisation change readiness checklist).
Conclusion
To summarise, all the three change management models demonstrate that the change begins with analysis and planning, proceeds through implementation, and ends with reviewing. The first two models also highlight the need for destabilisation of the existing situation and the stabilisation of the changed state of events. The third one does not emphasise these processes, but some of its provisions are aimed at destabilisation (in particular, resistance assessment and reduction). The number of details is different for models; Lewin’s theory and QGCIO (n.d.) model are simplified and allow more freedom in choosing the specifics of the stages. Kotter’s model is much more detailed, which restricts the freedom of the potential user. The proposed order of events can be regarded as logical, but it can be challenged, which OSSIE Guide demonstrates. The QGCIO (n.d.) model is a part of a workbook, which is why it is supplied with various practical tools. In the end, it appears that the three models regard the process of change in a similar way, but their differences illustrate the fact that frameworks are created to fit the needs of their developers. This fact implies that none of the models must be reproduced word-to-word in practice. Rather, every particular situation might require a specific or modified existing model.
OSSIE Guide Analysis
The letters in “OSSIE” stand for the elements of the Guide’s change framework which includes the following stages: “Organisational leadership, Simple solution development, Stakeholder engagement, Implementation, Evaluation and maintenance” (ACSQHC, 2010b, p. 4). The guide discusses them from the point of view of resources required (which shows that the process is going to be time- and effort-consuming), suggests the team structure, and then proceeds to develop the stages as separate topics. It includes various tools for change planning, which makes it similar to the QGCIO (n.d.) model.
The first stage presupposes the prioritisation of handover (preferably within the organisation’s strategy), the examination of the existing handover processes from the point of view of clinicians, the determination of barriers to change and its potential facilitators (motivators), and providing employees with the leadership that ensures the communication of the need for change and the empowerment to achieve it. In other words, this stage results in the creation of the sense of urgency of the problem just like the first step in Kotter’s model. In general, the examination of the situation is typical for all the models.
The next stage includes only one objective, the development of the solution. It needs to fulfil the following requirements: be simple, patient-centred, and practice-centred. This stage appears to correspond to the third stage of Kotter’s model, but it is noteworthy that of the models considered, the OSSIE Guide is the only one to detach solution from planning and require for it to be simple.
The third phase of the Guide needs to be carried out throughout the process of implementation, and it consists in the engagement of all the relevant stakeholders. The need for continuous engagement is explained by the need for sustainable change; in other words, the commitment and interest of stakeholders should be maintained, which corresponds to the QGCIO (n.d.) model’s emphasis on stakeholders and Lewin’s idea of ensuring communication throughout the change. The Guide suggests that the important aspects of this phase include sharing of the information, ensuring that the objectives and roles are understood by the stakeholders, and empowering and motivating them. Empowerment holds an important place in the Guide, but it is primarily regarded as the confidence-related empowerment (ACSQHC, 2010b, p. 4).
In other words, it involves the destruction of psychological barriers rather than the development of the opportunity for the implementation of change. However, outside of the idea of empowerment, ACSQHC (2010b) mentions, for example, that the stakeholders might require the necessary training, which can be regarded as the Kotter-type enabling empowerment. Indeed, the third phase is similar to Kotter’s fifth empowerment stage, but they are not identical. The Guide’s stage is continuous; it provides the project with the team, information, and resources. Also, this stage presupposes the exchange of data, which offers a channel for dissemination of the vision- and strategy-related information. In other words, the Guide chooses to unite all the interactions with stakeholders into one stage, which appears to be justified by the fact that the communication with them does not have to be limited by phases. The need for extensive and intensive communication is proved by the described models and my personal experience.
The implementation stage of the OSSIE Guide includes the planning, education, and training, launching the pilot handover process, revising it (if necessary), spreading and establishing it as a part of the organisation’s practices and strategy. The Guide apparently chooses to avoid the detailed nature of Kotter’s model, probably, because the process of solution implementation is regarded holistically. In this respect, the Guide embraces the simplicity of Lewin’s theory the QGCIO (n.d.) model. For this stage, the Guide provides advice on managing the change effectively and mentions the following barriers: the lack of resources, communication issues, and the possible problem with the staff (conflicts of interests, unavailability, training). Apparently, the process of bringing the barriers down is reserved for this stage, but the psychological barriers have been opposed throughout the process (during the third continuous phase).
The final phase (that is similar to those of all the mentioned models) requires the creation of customised evaluation plan, framework, and tools that could measure the improvement of handover in the organisation and the strategies for the maintenance of the results. The evaluation is expected to provide the opportunity for learning. None of the tools of the Guide are required for use; in effect, the Guide invites users to develop and customise tools to their own advantage. Basically, the Guide is positioned as the direction for improvement; the specifics are to be added by the user (ACSQHC, 2010b, p. 6). Also, the Guide insists that the project remains continuous, but since the fifth stage, it is supposed to consist of the maintenance of the achieved results, their updating, and possible improvement.
To sum up, the framework that is proposed by the Guide generally follows the same pattern as the models considered in the theoretical part of this paper but does not mimic either of them. It is noteworthy that the final stage (refreezing and integrating the results) appears to be more or less the same for all the models, even though it may be argued that the steps by Lewin and from the Guide are more comprehensive while Kotter chooses to make more detailed stages from the same processes, and the QGCIO (n.d.) model appears to neglect the integration element. Also, the Guide introduces the concept of a “stage,” the length of which is roughly equal to that of the project. In general, the scheme of the project presupposes that its phases may overlap (ACSQHC, 2010b, p. 13). As a result, while including fewer stages than the Kotter’s model, the Guide provides a rather complicated framework that implies the possibility of a continuous and smoothly developing sequence of interwoven steps.
Conclusion
Clinical communication is connected to the transfer of crucial and often literally vital information, which explains the importance of the development of communication skills and processes in healthcare. Clinical handover has proved to be an immensely high-risk but rather unregulated area of communication. The OSSIE Guide provides a change framework that should help with the implementation of a customised simple patient-oriented solution to the problem of inefficient handover.
The analysis of the Guide with relation to other frameworks of change management suggests the following conclusions. First of all, the Guide does not mimic any of the models, but the general direction and most of its specific elements are more or less similar for all of them. Second, all the models follow a similar pattern and place a particular emphasis on the final stage of the project, which is logical, since it ensures sustainable improvement. Third, the Guide heavily relies on the involvement of stakeholders (which is in line with other models) and makes the stakeholder-related stage continuous (which is a specific feature of this framework). Similarly, the Guide chooses to make the borderlines between the stages blurry and generally emphasises the need for the customisation of the change management process. The resulting framework is clear and consistent; its specifics are guided by the needs of the developers and users and are aimed at the creation of a sustainable, continuous, process- and stakeholder-oriented improvement. Therefore, the Guide provides a customised framework that is aligned with the modern understanding of change.
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