We find the major issue in implementing CAPA is managing change. We know that change is most likely when the present is seen as unbearable, there is a clear vision of change and the first steps are seen as manageable. Change is most likely to succeed if everyone in the team has a shared view of what is unbearable and the vision, and can agree the first steps. Aarons (2004) found that clinicians working in services with low levels of bureaucracy, who considered that the change had intuitive appeal, felt open to change and perceived the changed be necessary were more likely to be try new practices and organisational requirements.
Many studies have found that leadership support, key stakeholder involvement, practice changes, communication, resources, staff education, out- come evaluation and consumer involvement are key in delivering adoption of new practices (see for example Henderson et al, 2006).
So you, as the change-leader, have to deliver a range of processes which:
- Deliver KNOWLEDGE: How much does the team know about CAPA? How are you going to get them up to speed? Reading the book? Looking at the website? Watching some of our PowerPoint presentations together?
- Allow you to address team ANXIETIES and create an ownership culture: this needs to be continuous. Staff anxieties may change as CAPA gets more understood and after it begins!
- Changes CULTURE: for some staff working in a CAPA model can be quite different. How are you going to help the team really get to grips with the ideas (partly connected to knowledge) and to think about them enough to both actually work that way and do it reasonably consistently across the team? Team away days or really regular discussion in the team meeting can help with this.
- Plans all the PRACTICALITIES including getting on with job planning cycle.
- Sets and MONITORS the plan with dates (including a full CAPA START DATE) to stop drift and…
- Allow time! In our experience with teams anything from 6 months to 2 years is common from the first thoughts of starting to being up and running.
The Leadership Team
The first step is to form a leadership team. This could consist of the manager of the team, a clinical leader (or someone representing the team if you have no designated clinical lead) and an admin lead. If you have someone who is really enthusiastic about CAPA then having them on the leadership team whatever their role and seniority can be helpful.
Set regular meeting times to plan all the other steps and review the process. Inform the team regularly about your discussions (circulated minutes, regular feedback slot in business meeting etc.).
Ensure the wider team can input into your discussions. Model collaborative, participatory practice and shared decision making as facilitators with expertise!!
There, that’s the first of the 11 components done!
Allow time to address anxieties
As any change involves losses and gains it is worth exploring these in the team. How can people express anxieties? These are some ideas:
- Weekly discussion of issues in the team meeting. (We know that lots of time in many, many team meetings is helpful – it was in Steve’s team who implemented wholesale)
- Regular discussion in individual supervision
- Mechanisms for anonymous feedback with reflection in the team
- Slots for this in the team calendar or at team away days.
Gathering anxieties can be done in many ways and each team will find a way that suits them. We find using small discussion groups that then feed- back, talking in the large group, using anonymous post-it notes to collect issues can help. Be realistic, not over optimistic, about the impact of the changes and give people as much control as possible. It may be that the fundamental change is not negotiable (e.g. to start CAPA) but the process is.