LEADING CHANGE Nursing 408Debbie-Jo Bubela, Chona Dick & Lora-Lee Pacheco
Introduction Evidence based practice is the way of nursing, in order to keep up with advancing healthcare and healthcare issues nurses and organizations seem to be in a continuous state of change. For this reason, and the effects of nursing shortage, change is often the last thing an individual or organization feels ready to tackle.
Leading Change Change of any type may be met with resistance if not approached correctly
Weber outlines 8 key elements to successful organizational change in the article “Effecting and Leading Change in Healthcare Organizations” (2000). These elements are summarized in eight crucial strategies or principles.
8 Key Elements of Change1.) Develop a vision for change2.) Focus on the change process3.) Analyze which individuals in the organization must respond to the proposed change and what barriers exist4.) Build partnerships between physicians and the administration5.) Create a culture of continuous commitment to change6.) Ensure that change begins with leadership7.) Ensure that change is well communicated8.) Build in accountability for change. (Weber, 2000) 528/02/2012
1. Develop A Vision For Change Absolute identity with ones cause is the first and great condition of successful leadership. -Woodrow Wilson-
• The vision should be easily understood• Able to be quickly communicated• Consistent with accepted organizational values• Intellectually solid• Understood by All within the organization
2. Focus on the change process Great changes may not happen right away, but with effort even the difficult may become easy. -Bill Blackman-
• Evidence based research shows effectiveness in healthcare. • Why have we not been able to translate all those robust findings into action? • Leaders and policy makers in the healthcare system generally haven’t been very good at creating and managing change. McIntyre 201028/02/2012 9
Working Toward Change Acceptance of ChangeOverall Performance Introducing Change Time Spent Retrieved from http://www.mybusinessprocess.net/change-process/
Cycle of ChangeChange Analysis Vision Continuous Improvement An ongoing process Design Implementation
3. Analyze which individuals inthe organization must respondto the proposed change andwhat barriers exist Some change their ways when they see the light, others when they feel the heat. -Caroline Schoeder-
Barriers to change include:• Those who resist change – People resist change if they are not prepared for it, informed of it, or have not had time to understand it• Nursing shortage – Nurses are fatigued from overtime shifts and do not have the energy to think about change http://freepdfhosting.com/4c7b0a4fc3.pdf 13 28/02/2012
“People often resist change for reasons thatmake good sense to them, even if thosereasons dont correspond to organizationalgoals. So it is crucial to recognize, reward, andcelebrate accomplishments.” -Rosabeth Moss Kanter
To some change is more of a difficult transition and in fact an actual grieving processHTTP://WWW.YOUTUBE.COM/WATCH?V=UD95SNWCAKS
4. Build partnerships betweenPhysicians and the administration ALONE WE CAN DO SO LITTLE; TOGETHER WE CAN DO SO MUCH. -HELEN KELLER-
• For a true partnership to develop and last between hospital administrators and physicians , they need to have open and honest dialogue— listening to and addressing each other’s concerns.• Through programs such as MoreOB, the whole hierarchy concept is eliminated and nurses and physicians work on the same levels.• This concept can be attempted for all levels of hierarchy in the healthcare system.28/02/2012 18
5. Create a culture of continuous commitment to change NOT EVERYTHING THAT IS FACED CAN BE CHANGED. BUT NOTHING CAN BE CHANGED UNTIL IT IS FACED. - JAMES BALDWIN-
• To have the commitment to change, employees need to be provided the tools to perform their jobs. • EMRs • Telehealth • Nurse Practitioners • Education28/02/2012 20
EducationOngoing education is necessary to both implement and support change.
Nurse PractitionersA Nurse Practitioner (NP) “is an advanced practicenurse whose practice is focused on providingservices to manage the healthcare needs ofindividuals, families, and communities. The NProle is grounded in the nursing profession’svalues, knowledge, theories, and practice and is arole that complements rather than replaces otherhealthcare providers. NPs have the potential tocontribute significantly to new models ofhealthcare based on the principles of primaryhealthcare” (p. 177). McIntyre and McDonald (2010)
Telehealthhttp://www.nursingchannel.ca/programs/daniels_story/index.html(This link is also available on the mainBlog page)
"Commitment is what transforms a promiseinto reality. It is the words that speak boldlyof your intentions. And the actions whichspeak louder than the words. It is making thetime when there is none. Coming throughtime after time after time, year after yearafter year. Commitment is the stuff characteris made of: the power to change the face ofthings. It is the daily triumph of integrity overscepticism." Shearson Lehman
6. Ensure that change begins with leadershipA GOOD OBJECTIVE OF LEADERSHIP IS TO HELP THOSE WHO ARE DOING POORLY TO DO WELL AND TO HELP THOSE WHO ARE DOING WELL TO DO EVEN BETTER. -JIM ROHN-
Nurse Leaders "It may seem a strange principle to enunciate as the very first requirement in a Hospital that it should do the sick no harm." - Florence Nightengale-• Dr. Moyra Allen http://freepdfhosting.com/241d42bfce.pdf• Mary Breckinridge http://freepdfhosting.com/6d8a164da9.pdf• Ethel Johns http://freepdfhosting.com/a78649c1a0.pdf 2728/02/2012
7. Ensure that change is well communicated THE ART OF COMMUNICATION IS THE LANGUAGE OF LEADERSHIP. -JAMES HUMES-
• EMR’s• CAIS• Communication systems• Gallup poll Reference28/02/2012 29
8. Build in accountability for change Coming together is a beginning; keeping together is progress; working together is success. -Henry Ford-
SummaryIn todays world we are inconstant change.Implementing long termchange is neither swift noreasy. It requirespatience, persistence, andsometimes a little creativity.The way these change effortsare introduced will directlyeffect the end result of eithersuccess or failure. Leadershipplays a key role in ensuringthis success. As cited inMcIntyre andMcDonald, “each of us as aprofessional nurse has thepotential and perhaps theresponsibility to provideleadership” (p.57).
References• Effecting and leading change in health care organizations. Jt Comm J Qual Improv. 2000 Jul ;26(7):388-99• -Forbes.com (2012). How to Create a Powerful Vision for Change. Retrieved on February 25, 2012 fromhttp://www.forbes.com/sites/johnkotter/2011/06/07/how-to- create-a-powerful-vision-for-change/• -McGrath, K (2008). The Medical Journal of Australia. Implementing and Sustaining Transformational Change in Healthcare. Retrieved fromhttp://www.mja.com.au/public/issues/188_06_170308/mcg11043_ fm.html• -McIntyre, M, & McDonald, C. (2008). Realities of Canadian nursing: Professional, practice, and power issues (3rd ed). Philadelphia: Lippincott.• -
QUESTIONS?1. Is Telehealth available in your community and if so to what extent?2. Have you ever played a role in initiating change inyour place of work?3. What has your experience with Nursing leadershipbeen through a change process?
Doing Your Best Work • Working from home • Working offsite • Technology requirements