Respond +summaryDuring Phase V, I touched on the fact that my project initially failed to be successful.  The reasons for this failure was related to poor nurse-patient communication with the implementation of a fast-track and poor compliance to change on night shift after most all leadership left the building.  The communication component was easily fixed with providing a script to support nursing.  Unfortunately, ensuring compliance to change required holding the staff accountable.  It was not a lack of education or the staff not having the tools to ensure change was successful, it was merely staff reverting to what they knew and were comfortable with.  It was also a behavioral issue because the staff knew compliance to change was an absolute must.With all that being said, sustaining change until the process becomes hardwired might be a challenge.  Removing this barrier to change deeply depends on two factors.  First, it is crucial that from the beginning all staff are engaged and own this project.  Sustaining change will not be successful if a change is implemented without staff buy-in, engagement, and ownership, regardless of the level accountability utilized.  Therefore, I began with the 3-day break-out session.  This session was designed to have the project team realize the problem and develop their own solution to fix it.  I, as the PM, was the facilitator, but I also steered the ship moving the team toward the agreed upon terms established by the stakeholders and me.Accountability is the second most important factor in sustaining change.  There will always be those few souls that refuse change and need to be held accountable.  If those certain individuals hold key roles that influence the team, they need to be removed from their roles and perhaps worked out of the emergency department (ED) all together.   So, if I kicked this project off correctly and engaged the staff to own this project and if ED leadership maintains monitoring and accountability, I firmly believe that I can return in a year and find this implemented project is actually performing better than I left it.

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