Using Kotter's 8 steps of change to tackle over‐fasting of children attending day surgery

Over‐fasting before surgery can lead to dehydration, irritability, lethargy, nausea, hypoglycemia, tricky intravenous cannulation, and decreased patient satisfaction (Newton et al., Pediatr Anesth, 2017, 27, 793). We used “Kotter's 8 steps for change” as an approach to tackling the problem of over‐fasting in our day surgery unit (Kotter, Leading Change, Harvard Business School Press, 1996). Using a video of a patient's experience with overfasting, we created a sense of urgency and need for change (Step1: create urgency). We formed a multi‐disciplinary fasting improvement team (FIT) (Step2: form a powerful coalition) and conducted a retrospective data analysis to establish a baseline. We then studied the system thoroughly using Ishikawa charts, process mapping, bench‐marking, user surveys, and Pareto charts. Using these findings, we created a vision for our change (Step3: create a vision for change). Within 6 months, we aimed for 90% of patients to have a fluid fasting time of