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.

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8 Key Elements of Change 1.) 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 exist

4.) Build partnerships between physicians and the administration

5.) Create a culture of continuous commitment to change

6.) Ensure that change begins with leadership7.) Ensure that change is well communicated8.) Build in accountability for change. (Weber, 2000)

1. Develop A Vision For Change

Absolute identity with one's 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-

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• 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

Time Spent

Ove

rall

Perf

orm

ance

Introducing Change

Acceptance of Change

Working Toward Change

Retrieved from http://www.mybusinessprocess.net/change-process/

Cycle of Change

Continuous Improvement

AnalysisVision

Design

Implementation

An ongoing process

Change

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-

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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

“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

HTTP://WWW.YOUTUBE.COM/WATCH?V=UD95SNWCAKS

To some change is more of a difficult transition and in fact an actual grieving process

The Process of Transition

Anxiety

Can I cope ?

Happiness

At Last something’s

going to change !

Fear

What impact will this have?How will it affect me?

Threat

This is bigger than I thought!

Guilt

Did I really do that

Depression

Who am I?

Gradual Acceptance

I can see myself in the future

Moving Forward

This can work and be good

Hostility

I’ll make this work if it kills me!!

© 2000-3 J M Fisher. Not to be sold or published. Sole risk with user. A free resource from www.businessballs.com.

Denial

Change? What Change?

DisillusionmentI’m off!! … this isn’t for me!

ALONE WE CAN DO SO LITTLE; TOGETHER WE CAN DO SO MUCH.-HELEN KELLER-

4. Build partnerships between Physicians and the administration

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• 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.

NOT EVERYTHING THAT IS FACED CAN BE CHANGED.BUT NOTHING CAN BE CHANGED UNTIL IT IS FACED.

- JAMES BALDWIN-

5. Create a culture of continuous commitment to change

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• To have the commitment to change, employees need to be provided the tools to perform their jobs.

• EMRs• Telehealth• Nurse Practitioners• Education

www.youtube.com/watch?v=Uhb1SeBL00s

EMRs (electronic medical records)

EducationOngoing education is necessary to both implement and support change.

Nurse PractitionersA 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)

Telehealthhttp://www.nursingchannel.ca/programs/daniels_story/index.html

(This link is also available on the main Blog page)

"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

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-

6. Ensure that change begins with leadership

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Nurse Leaders

• Dr. Moyra Allen http://freepdfhosting.com/241d42bfce.pdf

• Mary Breckinridge http://freepdfhosting.com/6d8a164da9.pdf

• Ethel Johns http://freepdfhosting.com/a78649c1a0.pdf

"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-

THE ART OF COMMUNICATION IS THE LANGUAGE OF LEADERSHIP.-JAMES HUMES-

7. Ensure that change is well communicated

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• EMR’s• CAIS• Communication systems• Gallup poll

Reference

8. Build in accountability for change

Coming together is a beginning; keeping together is progress; working together is success.

-Henry Ford-

SummaryIn 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).

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 in your place of work?

3. What has your experience with Nursing leadership been through a change process?

Doing Your Best Work

• Working from home• Working offsite• Technology

requirements