Doing things better without adding hours to the day

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By Emily Holton

Dr. Chris HayesDr. Chris Hayes is a staff physician in the MSICU as well as medical director of quality and performance. (Photo by Yuri Markarov)

Change is all around us! Thousands of passionate people at St. Michael’s Hospital are working right now on countless projects and initiatives to improve the way they do what they do, while at the same time actually doing their work.

“I see great enthusiasm for quality improvement in every corner of the hospital, and together we’ve achieved so much,” said Dr. Chris Hayes, medical director of quality and performance. “But I also see that this work can add extra time and effort, on top of the already busy work that we do to care for patients. It can lead to overburdening of providers and contribute to quality improvement – and other change initiatives – not being successful.”

Dr. Hayes took these concerns to the Institute for Healthcare Improvement in Boston where he spent a one-year Harkness Fellowship researching the best way to design and implement quality improvement projects.

“To succeed, the people who are implementing the changes need to be able to reliably do the new tasks and see value in what they are being asked to do,” said Dr. Hayes. “There needs to be the right balance between how valuable the outcome will be, and how much cognitive and physical work it will take to get there.”


Six questions to ask before planning and implementing a change

1) Are the end users involved in designing, testing, revising and implementing the change?

2) Does the change initiative align with the organization’s and/or team’s values and goals and has the rollout been planned effectively?

3) Are the required resources (training, equipment, time, personnel) for making the change known and will they be made available?

4) How much workload (cognitive, physical, time) is associated with the initiative?

5) How complex is the initiative?

6) What degree of evidence and belief is there that this initiative will lead to the intended outcome?

It’s not a complicated recipe, but Dr. Hayes said people tend to go through a lot of trial and error – and exhaustion – trying to get it right.

Dr. Hayes conducted a literature review, site visits, expert interviews and focus groups. He distilled what he learned into six main questions to ask, including one about extra workload, before planning and implementing a change. He developed the Highly Adoptable Improvement model and tool to help determine exactly how likely a change initiative is to succeed, or if further thought is needed.

“I piloted the assessment tool with 16 improvement advisers from the Institute for Healthcare Improvement,” said Dr. Hayes. “They all took it back to their institutions, and tried it out on their quality projects. They said the model was intuitive, clear and useful, and it opened their eyes to why some projects just weren’t getting anywhere. They all said they’d keep using the tool.”

Learn more and download the tool at

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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