Implementation Approaches to Avoid

Implementation approaches to be avoided include: across-the-board train ing, big teams, too many tea ms,
delegated implementation responsibility, and starting a project at the wrong time (Goetsch and Davis,
2010, 774-776). Across-the-board training has been used to demonstrate that all employees were trained,
wit h bu reaucrats duly documenting com pletion of the train ing. The first problem with such an approach
is that the one-si ze-fits-all approach seldom adequately addresses t he informational needs of dispa rate
groups of employees, and the very attempt to t rain different employees at the same time often creates
problems. Physicians do not want to be trained with nurses or other healt h care workers, and the
divergence in status at these educational meetings may inhibit lower-level employees from voicing their
concerns and opinions. The second problem is that introducing infor mation in adva nce of need often
results in rapid loss of information ."Use it or lose it" applies: infor mation should be delivered when
employees need it to ensu re that desired procedu ral changes are immediately practiced . The problem
wit h providing treat ment plans for infrequent events is physicia ns may not read or remember the in
formation when a case arises.

The problem with big teams is that opti mal group size has been dem onstrated to be five or seven people.
Small groups ease communication and reduce the probability of coalition building, and groups of odd nu
mbers cannot deadlock . Orga nizations must also avoid implementing a shotgun approach, in wh ich
multiple initiatives are simultaneously pu rsued . The problem with too many groups and too many
projects is that energy dis sipates and priorities become u nclear when multiple qua lity improvement
initiatives are operating a t the same time. If employees do not believe that management is comm itted to
change, t he probability of successful action is greatly reduced.
Another factor that reflects the commitment of management and that decreases the likeli hood of success
is when top management delegates responsibility for implementation downward . Ifquality improvement
is not important enough to upper management to be actively engaged, employees will not commit
themselves .

Premat ure start of a quality initiative occurs when the need for change has not been created among staff,
the appropriate people are not enlisted in the effort, baseline and comparative data have not been
collected, potential solutions are not identified , and so on. If the organ ization culture is not prepared for
change, if new procedures are introduced prior to t heir need, or if the chosen solution is inappropriate,
the chance of successful imple mentation is mi nimal. Organizations may fi nd thei r employees refuse to
perform the new procedures or have forgotten t heir instruction . On the other hand, implementation
cannot be delinquent; if an organization waits too long, the sense of u rgency may be Jost and employee
enthusiasm and com mitment will wane.