Change Project and Nursing

Change Project and Nursing

1. Introduction

(a) Identification of the problem or issue and its impact in terms of quality, efficiency, safety, etc.

The goal of improving patients’ outcomes has driven many changes in health care setting. Many leaders have been challenged with complex adaptive systems where change is a complex process with varying degrees of complexity and agreement among disciplines (Plsek & Greenhalgh, 2001; Porter-O’Grady & Malloch, 2011). According to research findings, nurse engagement correlates directly with critical safety, quality, and patient experience outcomes, understanding the current state of nurse engagement and its drivers is critical (Dempsey & Reilly, 2016).

2. Background

    (a) Description of the planned change:

Hospital environment requires that nurse executives demonstrate collaborative problem solving across the spectrum of care. Nurse leaders and executives’ formal training supports frequent use of Lewin’s Three-Step Model for Change Management (Wojciechowski, et al. 2016). The planned change will involved implementing strategies to enhance nurse engagement at the hospital. Some of the planned changes will include having regular unit meetings nurse managers, improving salaries and bonuses for nurses, restructuring the current schedule for nurses to get support from supervisors, and introduction of training and development programs to help nurses have a clear career path.

(b) Justification for change supported through research

A nurse is said to engaged when they are satisfied with their job are also fully committed to their job (Dempsey & Reilly, 2016). A recent survey has shown that among the healthcare workforce, nurses are the least engaged and yet they are among the frontline staff in any healthcare facility. When it comes to care transformation, the nursing staff plays a very critical role and it is disturbing to know that close to 7.4% of RNs are disengaged (Virkstis, 2014). In the current environment that is very complex and dynamic, there is an increasing need for frontline nurses to deliver high quality care and be committed to goals and mission of the organizations they are working for and be fully engaged in their work. It is because of this reason that some changes are in order to enhance nurse engagement because it has been falling short in the recent years (Virkstis, 2014). Lack of nurse engagement may lead to nurse retention problems as well as a decline in productivity.

(c) Selection and description of an appropriate theoretical framework for the change including how the framework will be used to facilitate the change

The theoretical framework I selected to facilitate change is Lewin’s change management model. I selected this framework because it is an excellent method to bring about a mentality change among health care workers. I believe that Lewin’s change management model demonstrates that multiple disciplines are able to utilize a common framework for leading and sustaining change to support outcomes of high quality and safe care, and capitalize on the opportunities of multiple views and discipline-specific approaches (Wojciechowski et al. 2016).

The framework used to facilitate the change by three phases: (1) unfreezing, (2) movement and (3) refreezing (Lewin 1951 as cited in Marquis & Huston 2006). During unfreezing individuals become aware of and believe there is a need for change. The movement phase includes the planning and implementation of the change. The final phase, refreezing, integrates the change into the current work environment. Complex adaptive systems require that, in order for organizations to maintain equilibrium and survive, the organizations must respond to an ever-changing environment. Healthcare organizations are Lewin’s Change Management Theory (Lewin, 1951) is a common change theory used by nurses across specialty areas for various quality improvement projects to transform care at the bedside (Chaboyer, McMurray, & Wallis, 2010; McGarry, Cashin & Fowler, 2012; Shirey, 2013; Suc, Prokosch & Ganslandt, 2009; Vines, Dupler, Van Son, & Guido, 2014).

Lewin’s theory proposes that individuals and groups of individuals are influenced by restraining forces, or obstacles that counter driving forces aimed at keeping the status quo, and driving forces, or positive forces for change that push in the direction that causes change to happen. The tension between the driving and restraining maintains equilibrium. Changing the status quo requires organizations to execute planned change activities using his three-step model. This model consists of the following steps (Lewin 1951; Manchester, et al., 2014; Vines, et al., 2104).

1. Unfreezing, or creating problem awareness, making it possible for people to let go of old ways/patterns and undoing the current equilibrium (e.g., educating, challenging status quo, demonstrating issues or problems)
2. Changing/moving, which is seeking alternatives, demonstrating benefits of change, and decreasing forces that affect change negatively (e.g., brainstorming, role modeling new ways, coaching, training)
3. Refreezing, which is integrating and stabilizing a new equilibrium into the system so it becomes habit and resists further change (e.g., celebrating success, re-training, and monitoring Key Performance Indicators [KPIs])

Lewin’s theory can lead to a better understanding of how change affects the organization, identify barriers for successful implementation and is useful for identifying opposing forces that act on human behavior during change, therefore overcoming resistance and leading to acceptance of new technologies by nurses.

3. Proposed Implementation

    (a) Description of implementation strategies including goals and objectives

There are quite a number of strategies that can be adopted in order to improve nurse engagement with a healthcare facility. To begin with, the leaders at the healthcare organization should create a culture of continuous improvement and trust by showing commitment to the organization’s values and mission (Oshiro, 2016). Nurse engagement is more likely to improve when the physicians and administration adhere to the organization’s values. The leadership should provide a safe and open environment that can encourage transparency in discussions and when coming up with corrective actions for existing errors because this will help in ending the culture of blame and unfair judgment. Stress and burnout are some of the leading causes of nurse disengagement and it is important to have strategies in place to address these issues. In order to reduce stress and burnout among nurses, some of the strategies  that should be used include  restructuring nurse management approach to provide more support for nurses and reduce workload, ensuring that each nurse understand his or her expectations and responsibilities, recognizing nurses for their efforts through rewards and enhancing the social connection between nurses and nurse mangers (Oshiro, 2016). The managers should spend more time with their units to avoid losing the social connection. Nurses need to be offered a clear career path in order to remain engaged and this can be achieved by offering them training and development opportunities. Finally, adopting a team-based approach to care will help in reducing burnout and empowering nurses (Oshiro, 2016).

   (b) Analysis of the impact of the change on the organization in terms of the mission of the

          organization, employee and patient satisfaction, cost, quality, etc.

            Implementing changes that that will enhance nurse engagement in a healthcare organization will benefit the organization in many different ways. Engaged nurses are more committed to the hospital’s mission and this therefore makes it possible for the organization to achieve its mission. Nurses that are engaged are also satisfied with their jobs and this therefore leads to an improvement in healthcare outcomes that eventually satisfy patients (Dempsey & Reilly, 2016). In addition to that, nurse engagement leads to high productivity and as a result leads to increased revenues. A recent survey revealed that a single nurse that is disengaged can make a hospital to lose up to $22,200 in revenue (Dempsey & Reilly, 2016). This is a clear indication of the high cost implications associated with disengaged nurses. Furthermore, the quality of care provided by an engaged nurse is high because they are more committed to their job.

(c) Identification and analysis of supports and obstacles to the change

            The first major obstacle to the change may be failure to involve employees in the change process. Nurses are more likely to resist the new changes if they are not involved in the process because employees always have a natural fear of change. Lack of effective communication from the top leadership may lead to resistance. By assuming that the nurses will adjust to the new situation after an announcement may lead to massive failure. Announcing new changes without explaining to the affected parties how they will adapt to the change how the change will affect them is a major obstacle to change. Restructuring the existing systems without taking into consideration how people work, reason and feel may also lead to resistance. Furthermore, introducing change without a clear understating of the existing system can also complicate transition to the new system. Finally, change implementation may be more complex if the existing organizational processes are very complex.

    (d) Description of plans for management of resistance

In order to mange resistance, it will be important to hold meetings with nurses and explain to them how to implement and adjust to the new changes and how the changes will affect their work. It will be important for the nurses to understand what the change is all about in order to avoid resistance. There will also be training programs to educate nurses on their roles and expectations. The training programs will also be used to empower their nurses so that they can feel valued in the change process. Resistance will also be reduced when the nurses are actively involved in the entire change implementation process. In addition to that, the changes should be introduced gradually because drastic implementation may scare nurses. The hospital should have a clear blueprint on how to implement the new changes to avoid confusion and for adequate preparations or plans to be put in place.

    (e) Incorporation of the management functions into the proposed implementation process

            The management will play a critical role in promoting nurse engagement at the facility because it is in charge of developing and implementing new policies. The change process will require some planning, organization, leadership and some controlling. Nurse Managers in charge of various units will have to plan and organize for the implementation of the suggested change strategies. In addition to that, the managers have to lead by example and put in place measures to control the change process.

4. Evaluation of Planned Process for Change

    (a) Incorporation of and justification for planned evaluation strategies (for example, how will the impact of the change be measured?)

Comparing the outcomes of the old processes and systems with the new system is one of the most effective methods of measuring the impact of change. It is important to accurately collect data after implementation of the new changes and compare it to previous data in a statistical analysis. Organizational documents and records are important sources of data when evaluating the impact of change (Bond, 2013). Some of the variables that can be compared in this case include job satisfaction, patient satisfaction, productivity, revenue, healthcare outcomes and efficiency. Apart from statistical analysis, getting feedback from nurses and all other major stakeholders can help in knowing the impact of change. This can be done by using methods such as interviews and questionnaires (Bond, 2013). Finally, those in charge of implementing change can use observational techniques to determine the impact of change.

References

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Bakker, D., & Keithley, J. K. (2013). Implementing a centralized nurse-sensitive indicator management initiative in a community hospital. Journal of Nursing Care Quality, 28(3), 241-249. doi: 10.1097/NCQ.0b013e31827c6c80.

Bond, B. (2013). Strategies for Measuring Organization Change. Suffolk: Suffolk University.

Dempsey, C., Reilly, B., (2016). Nurse Engagement: What are the Contributing Factors for Success? OJIN: The Online Journal of Issues in Nursing, 21(1), Manuscript 2. DOI: 10.3912/OJIN.Vol21No01Man02

Greene, S. M., Tuzzio, L., & Cherkin, D. (2012). A Framework for Making Patient-Centered Care Front and Center. The Permanente Journal, 16(3), 49–53.

Marian W., et al. (2016). Caring Compassionately for Hospitalized Patients: Can Nurse-Delivered Massage Address Compassion Fatigue. International Journal for Human Caring, 20(3): 146-154.

Oshiro, B. (2016). The Best Way Hospitals Can Engage Physicians, Nurses, and Staff. Retrieved 25 November, 2016 from https://www.healthcatalyst.com/the-best-way-hospitals-engage-physicians-nurses-and-staff.

Stevens, K., (2013). The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas. OJIN: The Online Journal of Issues in Nursing, 18(2), Manuscript 4. DOI: 10.3912/OJIN.Vol18No02Man04

Virkstis, K. (2014). The National Prescription for Nurse Engagement. Retrieved 25 November, 2016 from https://www.advisory.com/research/nursing-executive-center/studies/2014/national-prescription-for-nurse-engagement

Wojciechowski, E., et al. (2016). A Case Review: Integrating Lewin’s Theory with Lean’s System Approach for Change. OJIN: The Online Journal of Issues in Nursing, 21(2), Manuscript 4. DOI: 10.3912/OJIN.Vol21No02Man04