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ESRA19-0096 Implementing a regional anaesthesia (RA) time-out procedure (TO) in our hospital: applying kotter’s ‘8 step change management’ (a management model)
  1. TK Tan,
  2. YM Gn and
  3. SY Goh
  1. Singapore General Hospital, Department of Anaesthesia, Singapore


Background and aims A series of ‘wrong site/side blocks’ (WSB) resulted in decision to implement RATO using guidelines by RA organisations. Implementing/transforming such change within our large department is difficult. We share our experience of using Kotter’s 8 Step Change Management, to implement RATO.

Methods Kotter’s 8 Step method was described to overcome organisational change failure.

  1. Establish sense of urgency: ‘What/Why/How to’ of RATO were explained to stakeholders, emphasising medico–legal impact of wrong–site blocks/urgency of preventing harm.

  2. Create guiding coalition: Like–minded/skilled colleagues (RA experts, Quality/Audit team, anaesthetic nurses championed this change, with senior leadership support.

  3. Developing vision and strategy: Our Vision was zero–tolerance for WSB, preventing this ‘never event’.

  4. Communicate this change vision: Various channels (morbidity/incident reporting meetings, email reminders) used to engage stakeholders, reiterating the RATO message.

  5. Empowering employees for broad based action: Staff empowered with requisite skills/tools/systems to enable this change e.g. authority to prohibit procedurist from proceeding before RATO.

  6. Generate short term wins: Transformation needs time. Short term wins help motivate staff, preventing momentum loss e.g. publicising near misses detected because of RATO.

  7. Consolidate gains and produce more change: To sustain this change, we created more change e.g. embedding RATO briefing during new nurses/doctors’ orientation.

  8. Reinforcing changes into our organisational culture: Implementing RATO changed our department’s ethos/culture towards procedural safety/TO diligence – all invasive procedures are now preceded by TO. Many consciously perform mental time–out when giving intravenous drugs.

Results Included with Methods

Abstract ESRA19-0096 Figure 1

Conclusions Using Kotter’s Change Management strategy, RATO total compliance was achieved within a month of implementation.

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