Managing Change One Person at a Time

Nursing Forum

Hospital X is changing its documentation from one system of computerized charting to another. Your critical care unit has been selected to trial the new computerized documentation and make recommendations about its use. As the nurse manger, how would you proceed in this change process when your staff have openly expressed concerns about using a more sophisticated system for documentation? (6 points total possible)

I would frame my perspective from the standpoint of Rogers' Diffusion of Innovation, which has been applied to many change management situations in nursing. What I appreciate about Rogers' theory is that it begins with the assumption that people will adapt innovation at different rates and that a small minority will be non-adapters. Moreover, Rogers provides strategic approaches to bringing about organizational and individual change that acknowledge the social realm in which change occurs -- a factor that is particularly true in nursing where concern about the benefit to patients is the ultimate criterion.

Rogers theory asserts that innovation is communicated across channels and among the members of an institution through the social system, in much the same way that influencers in Malcolm Gladwell's book The Tipping Point operate. Confident and enthusiastic first adopters influence their peers to give the innovation a try. Often, the motivating factor is that first adopters are recognized by leaders and well-regarded peers -- a factor that can give adoption a boost. Each person must work through decisions about the innovation in order for a full and beneficial adoption to occur. The pattern of adoption decisions develops along these lines (Rogers, 162): 1) Knowledge about the innovation; 2) Persuasion occurs that is either sufficient or insufficient to generate a positive attitude toward the innovation; 3) Decision is made, at which point the individual acts in a manner that leads to adoption or rejection of the innovation; 4) Implementation occurs as the person folds the innovation into their practice; and 5) Confirmation takes place as the person evaluates the utility of their decision and integrates it into their mind-set. Whether this process is formal, as Marquis and Huston (2015) suggest it should be, or informal as Rogers indicates is the universal practice that underlies any formal structure for change management, the important thing is that "subordinates feel that they have played a valuable role in the change" (Marquis & Huston, 2015). The successful diffusion of an innovation can be characterized by an S-shaped curve that depicts the adoption by members of a social system. Usually, about 10 to 25% of the members of a social system rapidly adopt the innovation while the other members slowly pick up on the new practice. The primary hurdle to be overcome is the uncertainty of individuals regarding the enhanced utility of the innovation over the earlier practices with which they are familiar and in which they are likely to be fluent. A strong reason for reticence to change is a lack of confidence about the capacity of the system and resources available to the change agent to accomplish the change over to the innovation (Marquis & Huston, 2015).