Planned Change in Nursing

Problem Statement
Planned change is necessary in the healthcare setting. Described as “purposeful, calculated, and collaborative,” planned change helps prepare nursing staff for a new technology or process, ensuring its safe and effective implementation (Mitchell, 2012, p. 32). The issue that I wish to address within my organization is technology upgrades. Nurse administrators would like to invest in portable electronic devices for all nursing staff, which would enhance quality of care and promote accuracy and efficiency: which are embedded in the mission and goals of the organization (Leape, Rogers, Hanna, et al., 2006). However, the technology has not been implemented properly because underlying processes and procedures have not yet changed. We need a change management strategy that builds on the Kurt Lewin model of unfreezing, moving forward, and then refreezing. Ultimately, the change needs to result in changed norms of behavior.
Medication errors had been either steady or even slightly increasing over the least two years in our organization. To respond to this problem, administrators investigated a number of systems upgrades to patient databases and electronic health records. The nursing staff already received proper training on how to use the new portable devices, which are linked to centralized databases and client software installed on all station computers. Administrators believed this would be sufficient to implement the new technology, but it was not; medication errors remain a problem.
Realistic Change to Address the Issue
The specific and measurable change I would suggest to address this issue is to transform the ways medications are color coded in the system, and to have a redundancy system in place. Currently, the medications are not color-coded. Nurses need to read through the long list of medications and only see the red dots when there is a medication contraindication, and not when more minor medication conflicts could also arise. Similarly, the new technology does not automatically preclude human errors: such as accidentally inputting a medication with a similar name or misreading the doctor’s handwriting. My proposal is to have a whole new policy whereby no doctor is permitted to use handwriting and must use the portable electronic device to make the prescription, and also have our systems analyst alter the color coding procedure for all medications. This proposal aligns with the research showing that new technology in nursing “can improve the quality of care, reduce costs, or enhance working conditions,” (De Veer, A. J.D., Fleuren, M.A.H., Bekkema, N., et al., 2011, p. 1).
Aligning the Change
This change aligns perfectly with our organization’s mission and vision, which include a commitment to patient care, to patient autonomy and safety, and to continually striving to improve. As Hamer (2013) also points out, nurses can use technology to improve practice, but the technology does not act alone (p. 1). My proposal also aligns with professional standards and competencies; streamlining the patient medical records also promotes a culture of safety. As Gesme & Wiseman (2010) put it, “stagnation can jeopardize the future of your practice,” (p. 257).
Change Model
The Kurt Lewin model of planned change only has three parts: unfreezing, moving, and refreezing (Shirey, 2013). Although other models may be more detailed and complex, the Lewin model is ideal because of its simplicity. However, the Lewin model might not take into account the power of resistance. The reason why change is so difficult to take root in healthcare organizations is that staff get used to a patterned way of doing things and it seems inefficient at first to alter their workflow. Unfreezing the current ways requires educating nurses about the importance of the change, pointing out that the rewards will far outweigh the drawbacks of having to learn new techniques. The actual change stage involves a multi-step process described below, starting with training and finishing with assessments. Finally, the refreezing means entrenching the new methods into organizational policy so that all new nursing staff will only be trained on the new system.
Implementing the Change
Steps
1. Unfreeze. Unfreezing begins with an informational meeting, whereby all staff learn about the organization’s medication error record and the need to make improvements. An email will be sent to all staff. Then, the nursing staff and all physicians will learn about the importance of the new technology and how to leverage it to reduce medication errors.
2. Change. The change will progress in three stages. First, the systems analyst will help develop new color-coding systems that highlight all types of medication conflicts including those related to patient bodyweight, gender, and other factors that are sometimes overlooked. Second, nurses and physicians receive training on the new color-coded system. The redundancy procedure is also in place, and physicians are instructed on how to use only the portable electronic device or the software instead of paper prescriptions. Third, nurse managers supervise the staff on the new system for a period of three weeks.
3. Refreeze. The refreezing period includes having human resources and the administration rewrite the organization code of behavior and protocols for entering medication and writing prescriptions.
Staff
I will initiate the change with the help of two members of senior management. To implement the change, we will require the cooperation of all lead nurses, as well as all lead physicians. We also need to work closely with our IT department to discuss how to upgrade the color coding system before fully implementing the change. Then, we will be relying on quality assurance professionals to monitor and assess the change and make sure that after a six month period our medication error record has indeed reduced.



References
De Veer, A. J.D., Fleuren, M.A.H., Bekkema, N., et al. (2011). Successful implementation of new technologies in nursing care: a questionnaire survey of nurse-users. BMC Medical Informatics and Decision Making 11(2011). https://bmcmedinformdecismak.biomedcentral.com/articles/10.1186/1472-6947-11-67?utm_source=twitterfeed&utm_medium=twitter
Gesme, D. & Wiseman, M. (2010). How to implement change in practice. Journal of Oncology Practice 6(5): 257-259.
Hamer, S. (2013). Involving nurses in developing new technology. Nursing Times. 22 Nov, 2013. https://www.nursingtimes.net/clinical-archive/healthcare-it/involving-nurses-in-developing-new-technology/5065667.article
Leape, L.L., Rogers, G., Hanna, D., et al. (2006). Developing and implementing new safe practices: voluntary adoption through statewide collaboratives. Quality and Safety in Healthcare 15(4): 289-295.
Mitchell, G. (2012). Selecting the best theory to implement planned change. Nursing Management 20(1). http://home.nwciowa.edu/publicdownload/Nursing%20Department%5CNUR310%5CSelecting%20the%20Best%20Theory%20to%20Implement%20Planned%20Change.pdf
Shirey, M.R. (2013). Lewin’s Theory of Planned Change as a Strategic Resource. Journal of Nursing Administration 43(2): 69-72.