• As you think through a change process that you are currently going through or have recently been through, can you identify any of Kotter’s 8 steps for leading change? If so tell us about it.
I look forward to some great discussion this week!
Identify different modes of organizing nursing care and describe the importance of implementing a nursing delivery model that meets the goals of the patient, unit, and organization. (PO 2, 7)
Identify the importance of delegation and describe ways in which the registered nurse can utilize delegation skills to optimize team functioning and patient care. (PO 3, 6)
Identify various team strategies for problem solving that enhance patient-centeredness and value-aIDed care. (PO 8, 9)
What was the impetus for a recent change that occurred in a healthcare organization that you are familiar with? What was the role of the leader; of the staff? How did this change improve the unit or department? What contribution did this change make to the organization?
The Art of Change Effectiveness
Mastering the art of effective change is perhaps the most important leadership skill that can be attained, with the one exception of effective communication. It is through the change process that leaders improve the workflow and workload for staff as well as the attitudes and behaviors of staff, and establish a professional caring environment in which the spirit of inquiry and best practices lead to exceptional patient care. Most nurses have learned about the history of change and are familiar with Kurt Lewin as one of the first researchers to propose that there was a process for effecting change (Roussel, 2013). Over the years, there have been many models of change. Many change models were developed based on the needs of specific work groups, such as auto makers, bakers, police officers, and business workers.
Nursing leadership has integrated the Kotter (2012) model of change with many aspects of emotional intelligence to ensure a step-by-step process that guides leaders to consider multiple aspects associated with change. Kotter appreciated the importance of the human factor in change and focused on facilitation of the change process and change of behavior to overcome objections and resistance. Leaders must use a strategy like the Kotter model of change for every change that is to be undertaken, from moving the blanket warmer to adjusting nursing shift times to making the holiday nursing schedule.
The Change Model for the 21st Century
The Kotter model of change (Kotter, 2012) appreciates that, while facts and data are clearly important, these are not the motivators that create acceptance or demand for change. An example of attempting change with many facts and data can be seen in the many no-smoking campaigns. There are few smokers who cannot recite the risks, dangers, and nearly assured development of lung disease related to smoking, yet these same individuals do not change their behaviors even when advised that ill health and death are imminent. The Kotter model of change demonstrates through its eight, sequential change steps that constructing a situation in which feelings are impacted leads to changes in behavior.
The eight steps in this change process are (1) creating a sense of urgency; (2) building a guiding coalition or team; (3) creating a shared vision; (4) gaining buy-in; (5) empowerment and barrier removal; (6) providing intermittent rewards; (7) maintaining the push; and (8) hard wiring the change.
Click on the “Change Model” link below to learn more about this change process.
Thus, for the leader as a change agent to be effective, the vision must be shared or jointly created with those affected by the change. Full and frequent communication of the vision and the steps of implementation with opportunities for discussion must occur often. And, most importantly, the message must be carried from the perspective of emotional intelligence so that the staff appreciates why the change is occurring and how it will affect them. The feelings most often conveyed in this change model include passion, urgency, and hope, and the behaviors expected relate to being able to see and feel the change (Kotter, 2012).
Nursing leaders have special expertise that is often tapped by project management teams in which nurse leaders are asked to participate in the project planning. Project planning has several phases: (a) initiation, (b) planning, (c) implementation, and (d) finalization (Van den Broucke, 2011). The types of projects can range from capital-equipment purchase, building and construction, project implementation, maintenance, and supplies inventory. Regardless of the type of project, nurse leaders must be prepared to work collaboratively with professionals outside of healthcare who have a healthcare focus to ensure project success. Some of the professionals that will be engaged in project planning can be architects, lawyers, construction supervisor, financial analysts, HVAC (heating, ventilation, and air conditioning) specialists, and others. Although each of these groups will be working on the project, each has its unique focus and interests that must be satisfied for a consensus to be reached.
Capital-equipment planning requires determining the current and future needs of the organization. These needs must be in alignment with the organizational vision. Planning includes both the short term and the long term, where organizational decision makers, such as the chief financial officer and chief executive, will have influential views. AIDitionally, there needs to be a process for evaluation and selection that will have components from each of those that are a part of the project team. Nurses aIDress the issue of ease of use and changes in patient flow or census that may occur with new equipment acquisition. An example would be an operating-room leader who is working to secure a robotic device for use in surgery.
Building-and-construction planning requires appreciation of the amount of space available and whether this is new construction or a renovation. Nurses are key contributors because they share the workflow and the space necessary to ensure safety and quality of patient care. An example would be the placement of a new cardiac-catheterization angiography table with consideration of how to move a stretcher in and out of the room.
Project implementation is the consideration of the phases over which the equipment or construction will occur. Nurses will have a unique perspective on coordination of the new with the current equipment or how to continue care while under construction in a renovation situation. AIDitionally, with new equipment comes the need for staff training, which will need to be considered and budgeted for during this phase.
Maintenance, either through in-house technologists or external contract, requires nurses to ask important questions. Some of the questions may include: Will there be 24 hour service? Can I get a technician in at 3 a.m.? Is there loaner equipment that can be used while repairs are made? The answers to these questions are important to patient flow, length of stay, and overall cost related to the use of the equipment or repair to patient diagnostics and treatment.
Supplies are an important aspect because with some high-end or new devices, there is just one manufacturer. How many supplies are needed? How many procedures will be done? What is the timeframe if we run out of supplies for the next delivery? Supply inventory is important to ensure that the supply will be immediately available when a patient needs it.
Project planning as a part of overall organizational asset management is the second highest organizational cost, topped only by the cost of labor. Nurses are instrumental in collaborating with others to ensure that the costs are reasonable, the product will meet expectations, and the staff can manage the use of the equipment. Nurse leaders are often the professionals who will measure and evaluate the effectiveness of the implemented plans. Some of the challenges to project planning include (a) choosing the wrong project that is not of the highest priority or best aligned for the organization; (b) making a poor choice for the intervention, such as selecting a product that will not meet all of the basic needs; (c) failure to plan the implementation, missing adequate resources, or an unrealistic timeline; and (d) failure to establish the metrics to measure effectiveness, plan for analysis of the measurement data, and determination of evaluation with an action plan for correction (Van den Broucke, 2011). Nurse leaders should seek out project-planning opportunities to gain foundational knowledge to be able to know what is expected of the nursing profession in project planning and to better appreciate organizational asset management daily as well as yearly.
Nurse leaders are those who understand change in a social context and can bring innovation and implementation to nursing practice and patient care. Nurse leaders work collaboratively with others to achieve the high-end results demanded by the organization and the high quality demanded by the patients. Leading others requires many skills that can be selected for use depending on the situation that presents within the unit, division, or organization.
Marquis, B. L. & Huston, C. J. (2014). Leadership roles and management functions in nursing: Theory and application (8th ed.).Philadelphia, PA: Lippincott, Williams & Wilkins.
• Chapter 7: Strategic and Operational Planning
• Chapter 8: Planned Change
• Chapter 9: Time Management
Ajmal, S., Farooq, M. Z., Sajid, N., & Awan, S. (2013). Role of leadership in change management process. Abasyn Journal of Social Sciences, 5(2), 111–124. link to article
Small, A., Gist, D., Souza, D., Dalton, J., Magny-Normilus, C., & David, D. (2016). Using Kotter’s Change Model for Implementing Bedside Handoff. Journal Of Nursing Care Quality, 31(4), 304. link to article
Who moved my cheese? The movie. (2013). link to video
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Van den Broucke, S. (2011). Essentials of project management [PPT]. Paper presented at the EA HC Workshop on Joint Actions, Luxembourg. Retrieved from https://ec.europa.eu/eahc/documents/health/Workshop_JA_2011/10_VanDenBroucke_190111.pdf
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