“I am frequently asked ‘But how do I get people to change? to listen to me?’ and the answer is ‘slowly and by being persistent’. But of course it is more than that. It takes a plan, a vision, and tools to make changes to complex systems. Infants and families are systems. NICUs are systems, Early intervention services are provided within systems. Clinics are systems.” Dr. Ross
Change never happens overnight. The first step in change may be “where are we and where do we want to go”. But the very next step is “how do we get there.” As soon as you consider a change in a process, you must begin to think about the system. Systems thinking assesses the parts to the whole, and the way each is related to the other. And feeding and eating are perfect examples of how the parts relate to the whole. Success in eating relies on a successful integration of breathing, sucking, swallowing, digesting, and alerting. At a minimum. Eating relies on an integration of organ systems, motor and behavioral state systems, sensory systems, learning, environment, and development. But there is even more… Infants rely on adults – parents and other family members, nurses, therapists, physicians, dietitians, lactation consultants… all of whom may have differing opinions of what needs to be done. And the infant and family, as well as the professionals, are functioning within a system of care. This environmental system of care is further influenced by professionals looking at the budget, personnel, and equipment necessary to accomplish the tasks. Each and every one of these components influence each other – in one way or another.
“We had no idea how hard this would be. Where do we even start?”
First, teams must decide that they are in the same boat, in the same ocean. The vision of care and the values of the people need to be shared. This is where mission and visions are helpful – not just for the bigger company but for the smaller environment of care. Does your NICU have its own mission? How about your early intervention setting? Have you considered your culture, environment and practice? What about the infrastructure? And how will you know when you arrive? What outcomes can you identify to know you are moving in the right direction as a unit? There are many tools to help with the process of system’s change. And it helps to have a mentor to guide you… which is why we have expanded to offering trainings to systems of care.
How do you move a mountain? One rock at a time…
Old Chinese Proverb