Change Management for an Organization Behavior

Problem Statement
This case involves the cardiovascular unit at a large general hospital in a major American city. New equipment and new medications had been introduced within the past month. Healthcare staff received training on the new equipment and information sheets on the new medications. However, both the medication and technology changes were introduced without any accompanying changes to processes, procedures, or protocols.
As a result of lack of planned change, there have been breakdowns in communication and the unit had only narrowly averted a potentially fatal error in patient care. To address this issue, a thorough change to departmental behavior is recommended. The Kurt Lewin change theory offers the basic framework to facilitate change in the cardiovascular unit, aligning practices with the organization’s overall mission, vision, and values.
Proposed Change
The specific, realistic change that could be made to address the issue combines leadership, communication, and focusing on core competencies. It is recommended that healthcare staff align their practices with the organization’s mission to provide quality care first by instituting two main changes. Both of these changes will also promote the implementation of evidence-based practice in the unit. First, all healthcare staff will be trained on the new equipment. Currently, only leaders of the healthcare team have been trained, and this has led to service delays because junior staff needs to call a supervisor any time the equipment is needed for a patient assessment.
Second, all healthcare staff will be trained to input all patient medication changes into the individual databases. The new medication was not properly introduced, and because it might interfere with other medications patients are taking, the healthcare staff needs to leverage the power of informatics to promote the goal of quality of care.
These are two simple, specific, and realistic changes that can be made immediately to address the change management issue. Simply by having the nurse leaders on the unit devote an hour per day to training of the junior staff, it is expected that the proposed changes will result in improved patient satisfaction and improved patient outcomes. Moreover, the proposed changes will result in improved job satisfaction due to improved workflow and improved communications.
Aligning the Change
To be effective, the proposed change should be aligned with the organization’s overall mission, vision, and values, as well as relevant professional standards. The organization’s mission is to provide the best quality healthcare services to all patients. To fulfill this mission, organization management has invested in the latest tools and technologies to help patients in the cardio unit. However, cardio unit staff also needs to contribute to the mission of the organization by ensuring that the new equipment is being used properly. The change will improve knowledge and awareness, and help prevent medical errors.
The vision of the organization is to interface with the community to provide cutting-edge, patient-centered care. The proposed changes perfectly align with that vision. Core values expressed by the healthcare administration include collaboration, compassion, and respect. Collaboration is the primary value the cardiovascular unit leadership needs to focus on while planning for and implementing the change. Relevant professional standards and core competencies in cardiovascular nursing also need to be addressed. Technological competencies and competencies in informatics are of particular importance to the cardiovascular nursing team (Kobayashi & Leite, 2015). Therefore, improving these competencies via regimented, scheduled, specific training programs will help the organization’s to fulfill its own mission and vision.
Change Model
The Kurt Lewin change model involves a three-stage process that is straightforward and easy to implement in the healthcare setting. The first stage is to unfreeze the status quo. To unfreeze does not mean stopping everything the team is doing, but to take an assessment of current practices and procedures, making sure to also be self-aware about bias and “commonly accepted mistakes” about nursing practice (Mulholland, 2017, p. 1). Resistance to change is going to be due in part to clinging to familiar models, so if staff is made aware of the inefficiencies and even dangers inherent in current practices, it will be more possible to initiate the next step of the change model: making the change.
Making the change requires “communication, support, and education,” which is why strong nurse leadership and comprehensive training are the recommended solutions to the problem (Mulholland, 2017, p. 1). Adapting staff to a new technology necessitates upgrades to their skills, which requires training. However, the training sessions alone are insufficient. Nurses also need a mentor or staff leader who is supportive and available for questions and assistance. Rather than being an arbitrary shift leader, the nurse should ideally be someone who serves specifically in this role. Feedback and questions will be directed to the correct individual, reducing miscommunications and also minimizing delays.
Finally, the Lewin change model involves refreezing the new norm. Of course, planned change does require continual vigilance on the part of all nursing staff. Any time a problem is detected, the staff needs to take responsibility for reporting problems to the appropriate leader. Refreezing may also include monitoring and making assessments for data-driven outcomes like improvements to patient care or patient satisfaction.
The Lewin change model applies particularly well to this case study, particularly if it can be integrated with the four-step model of organizational change proposed by Rhydderch, Elwyn, Marshall, et al. (2004), which sets performance criteria at the outset, then develops specific indicators and methods of assessment, followed by data collection and finally, feedback. An organizational development model of change allows the cardiovascular unit at this hospital to become a role model for change, which other units in the organization can learn from and also implement.
Steps to Facilitate Change
Aligned with the Lewin model, the following steps will facilitate planned change to the cardiovascular unit for more efficiently and effectively adapting to new medications and new technologies.
1. Unfreeze the unit. All leaders have an initial meeting for a formative assessment. Leaders frankly address the issue, and schedule the implementation of the training sessions. A follow-up staff meeting with all cardiovascular unit nurses will help illuminate the problem and ensure that all nursing staff is empowered and informed. At this early stage, soliciting input will also help to identify any resistance to change. In fact, Cummings, Bridgman & Brown (2016) point out that the unfreezing stage of change can be further subdivided into steps like these to ensure that change is successful and meets organizational goals.
2. Change. While the Lewin model has been criticized for “oversimplifying” change into the three-step process, there is really no need to complicate matters when it comes to a planned change within a unit like this one (Cummings, Bridgman & Brown, 2016, p. 34). Changing the way the unit operates does require concerted effort on the part of all team members, and a spirit of collaboration. Because collaboration is aligned with the main values of the organization, it is easy to show how the proposed change fits in with the goals of patient-centric care. The specific sub-steps involved in changing include first the training program, which will last for at least one week at one hour per day. Then, there will be a trial implementation period in which all nursing staff work with the proposed changes under supervision. The leadership staff will use instruments to monitor staff performance and also assess patient outcomes, while patient feedback will also be collected.
3. Refreezing. Any vestiges of past behaviors need to be uprooted for the change to take place effectively. Ongoing monitoring and assessments will be used to ensure that the staff is not reverting to old habits and behaviors. Therefore, refreezing is an ongoing step in the three-part change model.
Identifying the People
Everyone in the cardiovascular unit will be involved in the change process, because the new equipment and medication affects everyone. In fact, the entire reason for the planned change is to train junior nurses, who were initially believed to lack the skills competencies to use the equipment or administer the medication. However, assigning these nurses to the medical team ensures that all nurses are aware of proper protocols and there are clear instructions for how to transfer patients to the new machine, monitor patients, and perform readings. There is also a clear chain of command, whereby nursing staff can immediately contact any nurse leader for questions or direction. To reduce medical error and facilitate communication, the proposed changes need to be implemented regularly and under the auspices of the Registered Nurse in charge of the cardiovascular unit. The skills and characteristics that would be required include the ability to listen empathically and actively, the ability to lead through empowerment, and the ability to self-reflect on performance.




References
Cummings, S., Bridgman, T. & Brown, K.G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human Relations 69(1): 33-60.
Kobayashi, R.M. & Leite, M.M.J. (2015). Technological competencies in cardiovascular nursing education. Rev Esc Enferm USP · 2015; 49(6):971-977.
Mulholland, B. (2017). 8 critical change management models to evolve and survive. Process. https://www.process.st/change-management-models/
Rhydderch, M., Elwyn, G. Marshall, M., et al. (2004). Organisational change theory and the use of indicators in general practice. British Medical Journal 13(3): 213-217.