Chapter012

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 12
Creating a Vision and Motivating
a Change to Evidence-Based
Practice in Individuals, Teams,
and Organizations

Implementing EBP
• Numerous factors make it challenging to implement EBP
in the clinical setting, including
− Short staffing
− Cost reductions
− Heavy patient loads
• Skill and commitment are necessary to bring about
genuine change

Elements of Successful Organizational
Change: Vision and Goals
• Big dreams; clear vision
• Think success at the outset
• Establishing an exciting shared vision with the team of
individuals who will lead organizational change is
important for buy-in and success
• Goals established should be SMART (i.e., specific,
measurable, attainable, relevant, and time bound)

Change: Belief
• Belief in one’s ability to accomplish the vision is a key
element for behavior change and success
• Cognitive behavior theory (CBT) is a useful framework to
guide individual behavioral change
− Beliefs affect emotions as well as behaviors, including
the ability to successfully function or attain goals

Change: Strategic Planning
• Carefully outline implementation strategies in writing
• Perform a SCOT analysis
− Identify the current strengths in the system that will
facilitate the success of a new project.
− Identify the challenges in the system that may
hinder the initiative.
− Outline the opportunities for success.
− Delineate the threats or barriers to the project’s
completion, with strategies to overcome them.

Question
• Tell whether the following statement is true or false.
• A SCOT analysis helps clarify the goals and beliefs that
underlie a proposed change to EBP.

Answer
• False
• Rationale: A SCOT analysis aids in the strategic planning
for the execution of proposed change. Identification of
the goals and beliefs that inform the change should take
place prior to formal strategic planning.

Change: Action, Persistence, Patience
• No matter how outstanding a strategic plan is
conceptualized and written, action, persistence, and
patience are key elements for success in accomplishing
any new initiative

Organizational Change Models: The
Change Curve Model
• Provides basic assumptions for change in an organization
• Stages
− I: Stagnation
− II: Preparation
− III: Implementation
− IV: Determination
− V: Fruition

Organizational Change Models: Kotter
and Cohen’s Model of Change
• Proposes that the key to change is appealing to emotion
− Step 1: Increase a sense of urgency
− Step 2: Build the guiding team
− Step 3: Get the vision right
− Step 4: Communicate for “buy-in”
− Step 5: Empower action and remove barriers
− Step 6: Create short-term wins
− Step 7: Don’t let up
− Step 8: Make the change stick

Organizational Change Models: Diffusion
of Innovations
• See Figure 12.1.

Organizational Change Models: The
Transtheoretical Model of Health
Behavior Change
• Conceptualized to explain patients’ change, but also
applicable to organizational change
• Stages:
− Precontemplation
− Contemplation
− Preparation
− Action
− Maintenance
• The goal is to help individuals move along the continuum

Question
• What model of organizational change would be most
likely to prioritize changing nurses’ feelings over
presenting them with new information?
a. The Transtheoretical Model of Health Behavior Change
b. Kotter and Cohen’s Model of Change
c. The Change Curve Model
d. Diffusion of Innovations Model

Answer
• b. Kotter and Cohen’s Model of Change
• Rationale: Kotter and Cohen proposed that the key to
organizational change lies in helping people to feel
differently (i.e., appealing to their emotions). They assert
that individuals change their behavior less when they are
given facts or analyses that change their thinking than
when they are shown truths that influence their feelings.

Overcoming Skepticism and
Misperceptions About EBP
• Allow individuals to express their skepticism, fears, and
anxieties about the change
• Clarify any misperceptions that they may have about EBP
• Educate in a way that appeals to emotions

Personality Styles
• Any time that change is introduced in a system, it is
important to be sensitive to the personality styles of
individuals
• Rohm’s taxonomy (the DISC Model)
− D Personality Styles: Drivers
− I Personality Styles: Inspired
− S Personality Styles: Supportive and Steady
− C Personality Styles: Contemplators

Question
• Individuals with which of the following personality styles
are most likely to be comfortable in a leadership role?
a. D
b. I
c. S
d. C

Answer
• a. D
• Individuals with “D” (Driver)personality styles like to take
charge of projects and are highly task oriented, making
them well-suited to positions of leadership.

Overcoming Barriers
• Teamwork
• Resources and administrative support
• Addressing and overcoming resistance
• Engaging the organizational culture
• Mentorship
• Preventing fatigue

Chapter012

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