Table 2.

Change Management Stages, Actions and Pitfalls.²⁵

Stage	Examples from our experience with integrating tablets into palliative care
Establish a sense of urgency	Sense of urgency ensured by pandemic, and acknowledged need to prioritize telehealth for clinical care across the healthcare system
Form a powerful guiding coalition	Collaboration with Acute Care Committee and building on long-standing relationships and alliances with medical ward leadership
Create a vision	Need identified from initial review of literature, social media, etc. Brainstorming on uses of tablets, not only for outpatient and home care but also for inpatients and family visitation
Communicate the vision	Stakeholder buy-in elicited in committee meetings and individual outreach
Empower others to act on the vision	Identified a common goal that motivated participants to persevere. Leveraged climate of “get things done quickly” during pandemic, and loosening of restrictions on use of communications platforms such as FaceTime for duration of crisis
Plan for and create short-term wins	Completed successful test calls and encounters with patient-owned devices; completed an encounter with team tablet after SOP approval
Consolidate improvements and produce more change	Create and update a step-by-step guide for video chats; incorporate telehealth encounters as part of provider pay for performance and PCT SMART Goal for FY 2020
Institutionalize new approaches	SOP is on the facility SharePoint website; PCT members and trainees being trained to do telehealth visits Front-line staff being trained how to access tablets and virtual palliative care services

Abbreviations:

SMART – specific, measurable, attainable, relevant, time-bound.

SOP – standard operating procedure.

PCT – palliative care team.

FY – fiscal year.