Debbie-Jo Bubela, Chona Dick & Lora-Lee Pacheco
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.
Change of any
type may be met
with resistance if
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.
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
4.) Build partnerships between physicians and the
5.) Create a culture of continuous commitment to
6.) Ensure that change begins with leadership
7.) Ensure that change is well communicated
8.) 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.
• The vision should be easily understood
• Able to be quickly communicated
• Consistent with accepted organizational
• Intellectually solid
• Understood by All within the
2. Focus on the change process
Great changes may not happen right away, but with
effort even the difficult may become easy.
• 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
Working Toward Change
Retrieved from http://www.mybusinessprocess.net/change-process/
Cycle of Change
Improvement An ongoing
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.
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
• Nursing shortage
– Nurses are fatigued from overtime shifts and do
not have the energy to think about change
“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
-Rosabeth Moss Kanter
To some change is more of a difficult
transition and in fact an actual grieving
4. Build partnerships between
Physicians and the administration
ALONE WE CAN DO SO LITTLE; TOGETHER WE CAN DO SO MUCH.
• 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
• This concept can be attempted for all levels
of hierarchy in the healthcare system.
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-
• To have the commitment to
change, employees need to be provided
the tools to perform their jobs.
• Nurse Practitioners
Ongoing education is necessary to both implement and support change.
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)
(This link is also available on the main
"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
6. Ensure that change begins
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.
"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
• Mary Breckinridge
• Ethel Johns
7. Ensure that change is well
THE ART OF COMMUNICATION IS THE LANGUAGE OF LEADERSHIP.
• Communication systems
• Gallup poll
8. Build in accountability for change
Coming together is a beginning; keeping together is progress; working
together is success.
In today's world we are in
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
McDonald, “each of us as a
professional nurse has the
potential and perhaps the
responsibility to provide
• 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
• -McGrath, K (2008). The Medical Journal of Australia. Implementing and
Sustaining Transformational Change in Healthcare. Retrieved
• -McIntyre, M, & McDonald, C. (2008). Realities of Canadian nursing:
Professional, practice, and power issues (3rd ed). Philadelphia:
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
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