The document outlines 8 key elements to leading successful organizational change in healthcare. The elements are: 1) developing a vision for change, 2) focusing on the change process, 3) analyzing who needs to respond to change and what barriers exist, 4) building partnerships between physicians and administration, 5) creating a culture of continuous commitment to change, 6) ensuring change begins with leadership, 7) ensuring change is well communicated, and 8) building in accountability for change. Barriers to change include resistance from those unprepared for or unaware of changes, as well as nursing shortages that leave nurses without energy to consider changes. Partnerships, education, tools like EMRs and telehealth, and nurse practitioners can help create commitment

1. LEADING CHANGE
Nursing 408
Debbie-Jo Bubela, Chona Dick & Lora-Lee Pacheco

2. 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.

3. Leading Change
Change of any
type may be met
with resistance if
not approached
correctly

4. 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.

5. 8 Key Elements of Change
1.) Develop a vision for change
2.) Focus on the change process
3.) Analyze which individuals in the organization must
respond to the proposed change and what barriers
exist
4.) Build partnerships between physicians and the
administration
5.) Create a culture of continuous commitment to
change
6.) Ensure that change begins with leadership
7.) Ensure that change is well communicated
8.) Build in accountability for change. (Weber, 2000)
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6. 1. Develop A Vision For Change
Absolute identity with one's cause is the first and
great condition of successful leadership.
-Woodrow Wilson-

7. • The vision should be easily understood
• Able to be quickly communicated
• Consistent with accepted organizational
values
• Intellectually solid
• Understood by All within the
organization

8. 2. Focus on the change process
Great changes may not happen right away, but with
effort even the difficult may become easy.
-Bill Blackman-

9. • 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 2010
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10. Working Toward Change
Acceptance
of Change
Overall Performance
Introducing
Change
Time Spent
Retrieved from http://www.mybusinessprocess.net/change-process/

11. Cycle of Change
Change
Analysis
Vision
Continuous
Improvement An ongoing
process
Design
Implementation

12. 3. Analyze which individuals in
the organization must respond
to the proposed change and
what barriers exist
Some change their ways when they see the light,
others when they feel the heat.
-Caroline Schoeder-

13. 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
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14. “People often resist change for reasons that
make good sense to them, even if those
reasons don't correspond to organizational
goals. So it is crucial to recognize, reward, and
celebrate accomplishments.”
-Rosabeth Moss Kanter

15. To some change is more of a difficult
transition and in fact an actual grieving
process
HTTP://WWW.YOUTUBE.COM/WATCH?V=UD95SNWCAKS

16. The Process of Transition
This can
What work
Denial
impact will and be
Can I At Last this have? Change? good
cope ? something’s How will it What Change?
going to affect me?
change !
I can see
This is bigger myself
than I Disillusionment in the
thought! I’m off!! future
… this
isn’t for
me! Moving
Did I
Forward
really do
that
Who am
I?
Happiness
Anxiety
Gradual
Acceptance
Fear
I’ll make
this work
Threat Guilt Depression if it kills
Hostility me!!
© 2000-3 J M Fisher. Not to be sold or published. Sole risk with user. A free resource from www.businessballs.com.

17. 4. Build partnerships between
Physicians and the administration
ALONE WE CAN DO SO LITTLE; TOGETHER WE CAN DO SO MUCH.
-HELEN KELLER-

18. • 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.
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19. 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-

20. • To have the commitment to
change, employees need to be provided
the tools to perform their jobs.
• EMRs
• Telehealth
• Nurse Practitioners
• Education
28/02/2012 20

21. EMRs (electronic
medical records)
www.youtube.com/watch?v=Uhb1SeBL00s

22. Education
Ongoing education is necessary to both implement and support change.

23. Nurse Practitioners
A Nurse Practitioner (NP) “is an advanced practice
nurse whose practice is focused on providing
services to manage the healthcare needs of
individuals, families, and communities. The NP
role is grounded in the nursing profession’s
values, knowledge, theories, and practice and is a
role that complements rather than replaces other
healthcare providers. NPs have the potential to
contribute significantly to new models of
healthcare based on the principles of primary
healthcare” (p. 177).
McIntyre and McDonald (2010)

24. Telehealth
http://www.nursingchann
el.ca/programs/daniels_st
ory/index.html
(This link is also available on the main
Blog page)

25. "Commitment is what transforms a promise
into reality. It is the words that speak boldly
of your intentions. And the actions which
speak louder than the words. It is making the
time when there is none. Coming through
time after time after time, year after year
after year. Commitment is the stuff character
is made of: the power to change the face of
things. It is the daily triumph of integrity over
scepticism."
Shearson Lehman

26. 6. Ensure that change begins
with leadership
A 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-

27. 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
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28. 7. Ensure that change is well
communicated
THE ART OF COMMUNICATION IS THE LANGUAGE OF LEADERSHIP.
-JAMES HUMES-

29. • EMR’s
• CAIS
• Communication systems
• Gallup poll
Reference
28/02/2012 29

30. 8. Build in accountability for change
Coming together is a beginning; keeping together is progress; working
together is success.
-Henry Ford-

31. Summary
In today's world we are in
constant change.
Implementing long term
change is neither swift nor
easy. It requires
patience, persistence, and
sometimes a little creativity.
The way these change efforts
are introduced will directly
effect the end result of either
success or failure. Leadership
plays a key role in ensuring
this success. As cited in
McIntyre and
McDonald, “each of us as a
professional nurse has the
potential and perhaps the
responsibility to provide
leadership” (p.57).

32. 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.
• -

33. QUESTIONS?
1. Is Telehealth available in your community and if so
to what extent?
2. Have you ever played a role in initiating change in
your place of work?
3. What has your experience with Nursing leadership
been through a change process?

34. Doing Your Best Work
• Working from home
• Working offsite
• Technology
requirements