CPOM Module 9, Section 5: Sustaining Change Through Continuous Reinforcement
MODULE 9: CHANGE MANAGEMENT & CONFLICT RESOLUTION

Section 9.5: Sustaining Change Through Continuous Reinforcement

Learn why most change initiatives fail: a lack of follow-through. This section provides strategies for embedding the change into your culture through recognition, measurement, and feedback loops to ensure it sticks.

SECTION 9.5

Sustaining Change Through Continuous Reinforcement

From Launch to Legacy: Hardwiring New Behaviors into Your Pharmacy’s DNA.

9.5.1 The “Why”: The Physics of Organizational Inertia and Entropy

You have done everything right. You identified a compelling need for change. You built a powerful guiding coalition. You crafted a clear vision and communicated it relentlessly. You managed resistance with the skill of a clinician. Your new workflow, technology, or service has been successfully launched. The project is “done.” This is the single most dangerous moment in any change initiative. It is the moment when most leaders take a victory lap, disband the project team, and move on to the next fire. And it is the moment when the powerful forces of organizational physics begin to reclaim their territory.

Think of your pharmacy’s established culture and workflows as a massive object at rest—it possesses immense inertia. It took a tremendous, focused application of energy (your change initiative) to set it in motion in a new direction. The moment you remove that energy, the natural tendency is for the object to slow down and eventually revert to its original state of rest. Furthermore, any complex system, including your pharmacy, is subject to entropy. Without a continuous input of energy to maintain order, it will naturally drift toward a state of disorder and chaos. Old habits will creep back in. Workarounds will emerge. The “new way” will be forgotten.

The “Why” of this section is to instill one of the most critical lessons of leadership: the project is not done when you go live; it is done when the change is irreversible. This requires a final, deliberate, and sustained application of energy. This is Reinforcement, the fifth and final block of the ADKAR model. Reinforcement is the set of actions that ensures the new behaviors, skills, and processes are locked in, celebrated, and become “the way we do things around here.” It is the process of building a new inertia. Without a deliberate reinforcement strategy, you have not created change; you have created a temporary deviation that will inevitably snap back to the mean. This section provides the practical tools to fight organizational entropy and ensure that your hard-won progress becomes a lasting legacy.

Retail Pharmacist Analogy: The Adherence Follow-Up Call

You have just completed a highly effective initial counseling session with a patient starting a new, complex medication regimen for heart failure—an ACE inhibitor, a beta-blocker, and a diuretic. You explained the “why” for each drug, created a simplified schedule, and provided memory aids. The patient leaves your pharmacy feeling knowledgeable and motivated. This is your successful “go-live.”

The “Launch and Forget” Approach: You check the box for “counseling provided” and don’t think about the patient again until their refill is due. When they return a month later, you discover they stopped the beta-blocker because it made them feel tired and they are taking the diuretic at bedtime, causing them to be up all night. The therapeutic “change” has failed due to a lack of follow-up.

The CPOM’s Clinical Reinforcement Strategy: Your work isn’t done at the end of the consultation; that’s when the reinforcement phase begins.

  1. Proactive Follow-Up (Reinforcement): You don’t wait for problems. You schedule a follow-up call with the patient for three days later. “Hi Mrs. Smith, this is your pharmacist, just calling as promised to see how you’re settling in with the new heart medications.”
  2. Measure & Gather Data: You ask targeted questions: “How has your blood pressure been?” “Have you noticed any side effects we discussed, like dizziness or fatigue?” You are collecting data on the implementation.
  3. Provide Corrective Coaching & Support: The patient mentions the fatigue. You explain, “That’s very common in the first week as your body adjusts. It’s a sign the medicine is working to protect your heart. It’s really important to stick with it, as that feeling almost always improves.” You discover they are taking the diuretic at night and you immediately correct the process: “Let’s switch that to the morning so it doesn’t disturb your sleep.”
  4. Recognize & Celebrate Success: You end the call with positive reinforcement. “You are doing an excellent job managing a complex regimen. Asking these questions and sticking with the plan is the best thing you can do for your heart. Keep up the great work.”
  5. Embed the System: You document the call in the patient’s profile and set a reminder to check in again at the one-month mark. This becomes part of your standard workflow for all new heart failure patients.

You have actively managed the post-launch phase. By measuring, coaching, and providing positive reinforcement, you have fought the inertia of the patient’s old habits and the entropy of confusion. You have ensured the change sticks. Sustaining organizational change requires this exact same level of deliberate, proactive follow-up.

9.5.2 The Reinforcement Toolkit: Making the New Way the Easy Way

Effective reinforcement is not about a single action, but a system of mutually reinforcing structures that collectively signal to the team: “This is important. This is permanent. This is how we succeed now.” Your goal as a leader is to create an environment where it is easier and more rewarding for an employee to follow the new process than to revert to the old one. This toolkit is divided into three core categories: Measurement & Transparency, Recognition & Rewards, and Feedback & Coaching.

Strategy 1: Measurement & Data Transparency

You cannot reinforce what you cannot see. The single most powerful way to signal that a new process is important is to measure it. The act of measurement itself focuses attention and communicates priorities. When you begin publishing metrics on a new workflow, you are making an explicit statement that this workflow matters. Making that data transparent and visible to the entire team creates a powerful feedback loop and sense of shared accountability.

The Peril of Measuring the Wrong Thing

Be extremely careful about what you choose to measure. People will naturally work to optimize the metrics you make public. If you implement a new safety-focused verification process but only measure “prescriptions verified per hour,” you are implicitly rewarding speed over safety. Your team will find ways to bypass the safety checks to keep the number high. Your metrics must be directly aligned with the intended goals of the change. A good metric should measure the desired outcome (e.g., reduction in verification errors) or the key behavior that drives that outcome (e.g., rate of barcode scanning compliance).

Masterclass Table: Designing Reinforcement Metrics
Change Initiative A Poor Metric (And Why) A Strong Behavioral Metric (Leading Indicator) A Strong Outcome Metric (Lagging Indicator)
New Inventory Management System
(Goal: Reduce carrying costs & stock-outs)		 Number of inventory reports run.
(Why: This measures activity, not results. Someone can run 100 reports without taking any meaningful action.)		 Percentage of items with correctly set PAR levels.
(Why: This measures a key behavior that directly leads to the desired outcome.)		 Monthly inventory carrying cost AND stock-out rate.
(Why: These directly measure the ultimate business goals of the change.)
New Technician-led Med History Program
(Goal: Improve accuracy & free up pharmacist time)		 Number of histories completed by technicians.
(Why: This doesn’t account for quality. A tech could rush through 20 incomplete histories.)		 Rate of utilization of secondary sources (e.g., retail pharmacy call rate).
(Why: This is a key behavior that leads to higher quality histories.)		 Discrepancy rate found by pharmacist review AND pharmacist time saved per admission.
(Why: This measures both quality and the operational goal of the change.)
New Sterile Compounding Workflow
(Goal: Improve USP <797> compliance and safety)		 Number of IVs compounded.
(Why: This is a productivity metric that is completely disconnected from the goals of safety and compliance.)		 First-pass quality rate on required documentation (e.g., cleaning logs).
(Why: This measures a critical compliance behavior.)		 Number of documented deviations from USP <797> standards per month.
(Why: This is a direct measure of the primary goal of the change.)
Making Data Visible: The Power of a Visual Management Board

Do not hide your metrics in a spreadsheet on a shared drive. The most effective way to reinforce progress is to make it public and impossible to ignore. A simple visual management board—a physical whiteboard or a large monitor in a prominent location—is a powerful tool.

Key elements of an effective board:

  • Keep it Simple: Display no more than 3-5 key metrics.
  • Use Visuals: Use color-coding (green for meeting goal, red for missing) and simple run charts to show trends over time.
  • Update it Consistently: The board must be updated on a predictable cadence (daily or weekly). An out-of-date board is worse than no board at all.
  • Make it the Focus of Huddles: Conduct your daily or weekly team huddles in front of the board. This makes the data the centerpiece of the conversation about performance.

Strategy 2: Recognition & Rewards

Measurement tells people what is important, but recognition and rewards make them *feel* that their efforts are valued. When an employee goes the extra mile to adopt a new process, and that effort is met with silence, the message they receive is that their hard work doesn’t matter. This extinguishes motivation. A timely, meaningful reward system is the fuel that keeps the engine of change running during the difficult post-launch period.

Masterclass Table: A Spectrum of Rewards
Reward Type Description Pharmacy Examples When to Use It
Social Recognition (Public) Praise and acknowledgment delivered in front of peers. Highly motivating for many people.
  • A shout-out in the daily team huddle: “I want to recognize Sarah for being the first person to become a certified super-user on the new system.”
  • An “Adoption All-Star” section in the weekly pharmacy newsletter.
 Frequently and immediately. This should be your most-used reinforcement tool. Use it to celebrate specific behaviors and small wins.
Social Recognition (Private) Direct, one-on-one praise from a leader. Can be even more powerful than public praise for introverted team members.
  • A handwritten thank-you note left on a technician’s workstation.
  • Pulling a pharmacist aside: “Hey, I saw how you patiently coached John through that new workflow. That was great leadership. Thank you.”
 Also should be used frequently. Essential for building personal relationships and showing you are paying attention to individual effort.
Tangible, Non-Monetary Rewards Small, symbolic rewards that show appreciation.
  • A coveted parking spot for the “Champion of the Month.”
  • A team lunch or pizza party to celebrate hitting a key project milestone.
  • A $10 gift card for coffee for someone who stays late to help a struggling colleague.
 Periodically, to celebrate team milestones or recognize significant individual effort that goes above and beyond.
Monetary Rewards Direct financial incentives like bonuses or raises.
  • Incorporating a skill-based pay differential for technicians who achieve a special certification related to the new technology.
  • A spot bonus for the team that designs a creative solution to a major implementation problem.
  • Including “adoption of new processes” as a key factor in annual performance reviews that determine raises.
 Sparingly and strategically. Must be clearly tied to objective, measurable outcomes to avoid perceptions of favoritism. Most effective when used to reward significant, sustained results, not just initial effort.

Strategy 3: Feedback & Coaching Loops

Reinforcement is not just about celebrating what’s going right; it’s also about correcting what’s going wrong. After a change is implemented, you will invariably find that some individuals are struggling, some are developing unsafe workarounds, and some are still clinging to old habits. A robust feedback and coaching system allows you to identify and address these issues before they become ingrained. This is the “R” in ADKAR in its most active form.

The Reinforcement Script: A Coaching Conversation

Imagine you notice a pharmacist is still using the old, inefficient paper form for a task instead of the new required electronic process. Your coaching conversation should be supportive, not punitive.

  1. State the Observation (Data, not Judgment): “Hi Mark, I noticed you were using the paper form for the chemo order verification just now. Can you help me understand what’s happening there?”
  2. Listen with Curiosity (Diagnose): Mark might say, “I just can’t find the right screen in the new system, and the paper form is faster when I’m busy.” The root cause is a Knowledge/Ability gap, not defiance.
  3. Reiterate the “Why” (Reinforce the Goal): “I understand the time pressure. The reason we moved to the electronic form is to ensure all the safety checks are hardwired and documented automatically to protect our patients and meet our compliance goals.”
  4. Coach & Offer Support (Provide a Solution): “How about you and I spend 10 minutes right now, and I can show you a shortcut to get to that screen? I’ll also print out a new tip sheet for you to keep at your workstation.”
  5. Set an Expectation & Follow Up (Ensure Accountability): “Going forward, it’s really important that we use the electronic system for all verifications. I’ll check back in with you tomorrow to see if the tip sheet helped and if you have any other questions. I really appreciate your willingness to work on this.”

9.5.3 Hardwiring the Change: Aligning the Organizational DNA

Individual reinforcement is critical, but for a change to become truly permanent, it must be embedded into the formal and informal systems of the organization. If your official systems—like performance reviews, job descriptions, and standard operating procedures—still reflect the old way of doing things, you are sending a deeply conflicting message. System alignment is the process of methodically auditing and updating all of your pharmacy’s operational structures to support and require the new behaviors.

Masterclass Table: The System Alignment Checklist
Organizational System Key Question to Ask CPOM’s Alignment Actions
Standard Operating Procedures (SOPs) & Documentation Are our official policies and procedures updated to reflect the new process? Have we removed all old forms, templates, and job aids?
  • Conduct a full audit of the document control system.
  • Assign a project team member to update all relevant SOPs and work instructions.
  • Communicate the location of the new documents and formally decommission the old ones.
Hiring & Onboarding Are we hiring for the new skills required? Does our new employee orientation program train on the new process from Day 1?
  • Update job descriptions to include competencies related to the new technology or workflow.
  • Add behavioral interview questions to screen for adaptability and the new required skills.
  • Completely overhaul the onboarding and training checklist for new hires.
Performance Management Do our official performance review templates and goals reflect the new way of working? Are we formally evaluating employees on their adoption of the change?
  • Add a standard goal for all relevant team members related to proficiency in the new system or process.
  • Incorporate the metrics you are tracking for the change into the data used for annual reviews.
  • Train your managers to specifically coach and give feedback on the new behaviors during their one-on-ones.
IT Systems & Physical Layout Does our technology support the new workflow? Is the physical layout of the pharmacy optimized for the new process? Have we made the old way impossible?
  • After a transition period, formally decommission the old software or remove the old forms. Make it impossible to revert.
  • Re-arrange workstations, shelving, or equipment to make the new workflow the path of least resistance.