To Make Change, Consider Context

Change doesn’t come out of nowhere

Authors: Meagan Elam, Mackenzie Stratton, Francine Maloney

A lot goes into getting people the health care they need. There are the people providing care, the processes they follow, the physical spaces they work in, the digital tools they use, and more. This web of people, things, and systems creates context.

At Ariadne Labs, it’s our job to think about context. We work to improve the health care system by helping health care organizations make practical, positive changes. To do this, we help organizations understand their unique context, which includes factors like:

• How well different team members work together
• How committed and motivated staff and leaders are to making change
• How supplies, equipment, and data are integrated into the process of providing care
• Whether change is possible with current staff conditions

Imagine you work at a hospital. You read about the U.S. maternal mortality crisis, and you want to start a program to make childbirth safe, respectful, and empowering. It will involve new tools and procedure changes to give the patient more of a voice in their care. The program has a lot of potential to make a positive impact, but context will influence whether it reaches that potential.

• Do people think there’s a problem that requires change?
• Do people think the program is a helpful way to address the problem?
• Is the program something people can adapt into their day-to-day work?
• Does the hospital’s culture make it safe for everyone to speak up?
• Is the hospital committed to supporting the program long-term? (yes, this means money)

Asking all these questions — and they’re hard questions — will help you make a game plan. You might need data to make the case that there is a problem. You might need to adjust hiring and schedules so people have the capacity to make changes. Then, as you start the program, you can keep asking these questions to figure out how things are working.

By considering the whole system and its context, you can figure out how to introduce the right change at the right time in the right way.

Meagan Elam, DrPH, MS, Senior Clinical Implementation Specialist and Francine Maloney, MPH co-lead the Atlas Initiative at Ariadne Labs. The Atlas Initiative uses context assessment to help health care facilities of all types implement successful quality improvement projects.

Interested in bringing context assessment to your health facility? The Atlas Toolkit can help.