Change Management in Health Care

Personal Changes
A major change among RNs that challenged them and was difficult for them to make focused on implementing a transcultural care model among the nurses that required the nurses to become more educated about different cultures and how to respond to patients of these various cultures. It required of the nurses the need to maintain two different perspectives and sets of beliefs in the minds at once—their own beliefs and an empathetic view of the beliefs of the patient of the different cultural background. As Kodama and Fukahori (2017) noted, the main challenge for RNs tasked with a change of this nature is to develop respect and empathy for others while holding a micro and macro perspective. This paper will describe the different perspective on change by those who like it and those who dread it, explain why readiness for change is so crucial to its success, show how change agents are essential for employee engagement, discuss how different perspectives and agendas impact the change, and explain how change can best be managed.
Change Management is a process that proceeds in steps, which generally consist of preparation, management, and reinforcement (NHS, 2011). The first of these steps—preparation—requires that the change manager gain a sense of what stakeholders think about the way the environment currently is and what they think about proposed change. As Doll, Cornelison, Rath and Syme (2017) explain, actualizing change depends upon involving stakeholders and obtaining their input and feedback on various proposals and change ideas. The more involved stakeholders are in the process of change, from the beginning, the more likely they are to embrace the change during the implementation stage.
The management stage, which is where implementation goes live, requires managers to use change agents—stakeholders (generally employees) who are supportive of the change and can promote it among other employees. Resistance to change occurs when management has failed to identify all the perspectives and opposing points of view to change. To promote change, the manager must explain rationally why the change is needed, give a vision of the benefits that the change will bring, and demonstrate supportiveness. Not everyone is going to like the change, but that does not mean they have to resist it. Resistance is a consequence of a failure of communication—and it is the change manager’s job to communicate the vision to those who do not like the idea of change. The big reason resistance occurs and change fails is that managers are not able to adapt to the problem areas they face: Tobias (2015) points out that “the brutal fact is that about 70% of all change initiatives fail. The failure of leaders to challenge themselves to change, and then model the behavior they seek in others, may be a large contributor to these failures” (p. 35). In other words, change managers have to be equipped with the ability to model the type of behavior they want their employees to demonstrate—and they must be able to logically explain why the new behavior (in the case of the RNs transcultural nursing) is needed. This is also an excellent way to reinforce the changes once they are implemented.
Readiness for change in a group that mixes those who like the change and those who dislike it requires a similar tactic: having change agents in place who can demonstrate empathy for those with opposing views while also explaining the importance of the change and why it is necessary (Joshi, 2014). One way to help develop the readiness for change among a diverse group is to use Kotter’s change model, which is comprised of 8 steps:
1) Create a sense of urgency
2) Create a guiding coalition
3) Create a vision for change
4) Communicate the vision
5) Remove obstacles
6) Create short-term wins
7) Consolidate improvements
8) Anchor the changes (Kotter’s 8 Step Change Model, 2018).
To bring the group together, one must create a sense of the urgent need for change. This will help to break down barriers that exist for those who do not want to change and get those employees aligned with the workers who are accepting of change. Secondly, a guiding coalition has to be formed—and this makes sure that the group is on the right track to change and not just spinning aimlessly, bouncing from one viewpoint to another. The coalition embraces the reasons for change and guides the rest of the group through the change implementation process.
This is where change agents come into play. They have to be able to engage employed staff as well as physicians in change initiatives. In the hospital where transcultural nursing was being implemented, change agents had to explain to both nurses and to doctors why the change was needed, what the expected outcomes were, and how nurses were expected to achieve these outcomes. Support from physicians was necessary to create the right kind of culture that would facilitate the change, and change agents were instrumental in making that happen.
Differences in perspectives and agendas are always going to be a problem, but as Kotter shows differences can be overcome by embracing feedback from stakeholders and inviting workers to be part of the change process by sharing their opinions and experiences. The more engaged workers are in the process, the more likely those differences of perspectives and agendas are to melt down into one, unified, coherent vision and mission that will allow the change to proceed effectively.
The best way to manage the change process so that everyone can feel they are heard and that some common ground can be achieved is to adhere to the Kotter 8 Step Model of Change management. This allows for the integration of employees’ opinions and thoughts throughout the change process from beginning to end. The more that management allows workers to invest in the process, the more willing employees are to take ownership of the change process and embrace it as something that they themselves are doing rather than as something that is being done to them.
In conclusion, change is a process that has numerous psychological and sociological components: managers must be aware of the risk of resistance and of ways to mitigate that risk. If managers in a health care setting can incorporate the views of nurses and physicians into the change process they will benefit from involving stakeholders at the earliest stages and reduce the risk of obstacles to change developing later on. Change agents and a guiding coalition made up of workers who are supportive of and knowledgeable of the change should be used by change managers to facilitate the process overall. A clear rationale for the change should always be given as the foundational explanation for why the change is required.
References
Doll, G. A., Cornelison, L. J., Rath, H., & Syme, M. L. (2017). Actualizing culture change: The Promoting Excellent Alternatives in Kansas Nursing Homes (PEAK 2.0) program. Psychological services, 14(3), 307.
Joshi.(2014). Change is Constant, but Improvement is Rapid. H and HN: Hospitals and Health Networks (2014).
Kodama, Y., & Fukahori, H. (2017). Nurse managers’ attributes to promote change in their wards: A qualitative study. Nursing open, 4(4), 209-217.
Kotter’s 8 Step Change Model. (2018). Retrieved from https://www.toolshero.com/change-management/8-step-change-model-kotter/
NHS. (2011). Overview – Change Management – the Systems and Tools for Managing Change. Retrieved from https://www.england.nhs.uk/improvement-hub/wp-content/uploads/sites/44/2017/11/Overview-Change-management.pdf
Tobias, R. M. (2015). Why do so many organizational change efforts fail?. Public Manager, 44(1), 35