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Leading change

  1. 1. LEADING CHANGE Nursing 408 Debbie-Jo Bubela, Chona Dick & Lora-Lee Pacheco
  2. 2. 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.
  3. 3. Leading Change Change of any type may be met with resistance if not approached correctly
  4. 4. 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.
  5. 5. 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 exist 4.) Build partnerships between physicians and the administration 5.) Create a culture of continuous commitment to change 6.) Ensure that change begins with leadership 7.) Ensure that change is well communicated 8.) Build in accountability for change. (Weber, 2000) 5 28/02/2012
  6. 6. 1. Develop A Vision For Change Absolute identity with one's cause is the first and great condition of successful leadership. -Woodrow Wilson-
  7. 7. • The vision should be easily understood • Able to be quickly communicated • Consistent with accepted organizational values • Intellectually solid • Understood by All within the organization
  8. 8. 2. Focus on the change process Great changes may not happen right away, but with effort even the difficult may become easy. -Bill Blackman-
  9. 9. • 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 28/02/2012 9
  10. 10. Working Toward Change Acceptance of Change Overall Performance Introducing Change Time Spent Retrieved from
  11. 11. Cycle of Change Change Analysis Vision Continuous Improvement An ongoing process Design Implementation
  12. 12. 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-
  13. 13. 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 13 28/02/2012
  14. 14. “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
  15. 15. To some change is more of a difficult transition and in fact an actual grieving process HTTP://WWW.YOUTUBE.COM/WATCH?V=UD95SNWCAKS
  16. 16. The Process of Transition This can What work Denial impact will and be Can I At Last this have? Change? good cope ? something’s How will it What Change? going to affect me? change ! I can see This is bigger myself than I Disillusionment in the thought! I’m off!! future … this isn’t for me! Moving Did I Forward really do that Who am I? Happiness Anxiety Gradual Acceptance Fear I’ll make this work Threat Guilt Depression if it kills Hostility me!! © 2000-3 J M Fisher. Not to be sold or published. Sole risk with user. A free resource from
  17. 17. 4. Build partnerships between Physicians and the administration ALONE WE CAN DO SO LITTLE; TOGETHER WE CAN DO SO MUCH. -HELEN KELLER-
  18. 18. • 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. 28/02/2012 18
  19. 19. 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-
  20. 20. • To have the commitment to change, employees need to be provided the tools to perform their jobs. • EMRs • Telehealth • Nurse Practitioners • Education 28/02/2012 20
  21. 21. EMRs (electronic medical records)
  22. 22. Education Ongoing education is necessary to both implement and support change.
  23. 23. Nurse Practitioners 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)
  24. 24. Telehealth http://www.nursingchann ory/index.html (This link is also available on the main Blog page)
  25. 25. "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
  27. 27. Nurse Leaders "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 27 28/02/2012
  28. 28. 7. Ensure that change is well communicated THE ART OF COMMUNICATION IS THE LANGUAGE OF LEADERSHIP. -JAMES HUMES-
  29. 29. • EMR’s • CAIS • Communication systems • Gallup poll Reference 28/02/2012 29
  30. 30. 8. Build in accountability for change Coming together is a beginning; keeping together is progress; working together is success. -Henry Ford-
  31. 31. Summary In 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).
  32. 32. References • Effecting and leading change in health care organizations. Jt Comm J Qual Improv. 2000 Jul ;26(7):388-99 • (2012). How to Create a Powerful Vision for Change. Retrieved on February 25, 2012 from create-a-powerful-vision-for-change/ • -McGrath, K (2008). The Medical Journal of Australia. Implementing and Sustaining Transformational Change in Healthcare. Retrieved from fm.html • -McIntyre, M, & McDonald, C. (2008). Realities of Canadian nursing: Professional, practice, and power issues (3rd ed). Philadelphia: Lippincott. • -
  33. 33. 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?
  34. 34. Doing Your Best Work • Working from home • Working offsite • Technology requirements