Launching IBRs: what makes a good alpha unit

Introduction

Implementing new Programs or innovations that are not home grown can be daunting to hospital leaders and frontline staff. For hospital leaders, they want to pick a solid foundation on which to build future success. For frontline staff, there is always a level of uncertainty and hesitance of wanting to see how it goes … on a different unit first. So, how can hospital leaders identify the solid foundations for success and engage frontline staff to try yet another change.

What makes a good alpha unit?

From our experience with most of our customers, the right starting point may appear obvious: the unit most in need or the unit most eager to take on the challenge. But these units might not be the best fit or have the right ingredients for success.

When launching a unit as an Accountable Care Unit (ACU® care model), one of the first things we explore is the variety of innovations, improvements and changes that are already occurring in the hospital, e.g. is there a new EMR/EPR coming soon, is there a big change in staffing coming?

The Unit and the Unit Leadership

Next we look to the units that meet the basic criteria: for a unit wanting to implement Structured Interdisciplinary Bedside Rounds (SIBR® rounds) that effectively means geographic colocation of the Attending physicians and their patients leaders. We don’t need that to be 100% colocation, with 80%+ being very acceptable or slightly lower depending on the size of the unit.

Then we explore the unit leader(s): have they seen the need for the change and are they ready to do the work needed; have they a history of successful innovation or are they carrying any potentially negative baggage around past innovations that may or may not have worked out; are they fed up of being the ‘test’ unit for everything?

Where possible select units that are clearly enthusiastic and ready: a strong grass-roots led implementation will have a much greater chance of success than a diktat coming from hospital leadership.

The Physician Team

Next for interdisciplinary rounds, we explore the physician roster and their enthusiasm for the new process. In terms of SIBR, you only need a selection of willing physicians to get the process rolling – you do not need to have all physicians onboard initially. In fact, some physicians may take several rotations through the unit and experience with the new process to fully see the benefits and become valuable proponents of the model.

Ideally launch on two units

With over 10 years of IBR implementations under our belts, we have learned the hard way that where possible you should launch on two units within a few weeks of each other. Why not just one unit, I mean it’s our company name after all?

In short, protect your efforts from bad-actors. We have realized that despite the best due diligence in unit selection and preparation, there are just too many idiosyncratic and strong personalities in the workforce. If these personalities take a disliking to the new process, for whatever reason, they can severely undermine what would otherwise be a highly successful implementation. Unfortunately, these saboteurs can cause significant  difficulties at such an early and critical stage that they can be detrimental to the work. Often, these personalities may not appear to be obviously trying to hamper progress but they slow progress, focus on the challenges and barriers, and create discontent. Bad-actors will be more apparent if a second unit is striding forward successfully.

Book a call with us if you would like to hear more detail about some of our more challenging experiences.

Two units give you the opportunity to compare performance early on, explore common barriers and challenges, share successes and create synergistic opportunities to problem-solve with the view to subsequent implementations. In our experience, it also creates a competitive environment that can be leaned into if beneficial, where one unit does not want to be less impressive than the other.

Summary

With 10+ years of IBR implementations in 100+ units, we’ve learned some hard lessons. But, now we have a reliable process to support units achieve success with minimal effort. Avoid the scorched earth of failed attempts where possible, do your due diligence on your unit selection and try to implement as a grass-roots effort rather than a top-down diktat.

A final piece of advice for your implementation: DO NOT call it a 'PILOT'. A 'pilot' implies something time limited that the hospital are not committed to and so unit staff will consider transient and likely to end once the pilot period is over. You need everyone on the unit to fully commit to know that the process does not work, otherwise they will just prove that a half-hearted attempt can be unsuccessful.