Change Implementation in Healthcare
Bringing quality improvement processes to nursing practices invariably means that nursing leaders must give considerable attention to the management of change. Resistance to change is an integral aspect of any quality improvement effort. Sometimes the resistance stems from fear or the inability to see how things can improve. When patients present challenging behavior problems, staff may naturally be concerned for their own safety and be worried that the challenging behaviors are getting in the way of providing the best possible nursing care. This paper examines the implementation of a change process for addressing challenging behavior in patients within the framework of Kurt Lewin's change management theory (Sare and Ogilvie, 2009).
Veterans with cognitive problems from memory loss and dementia were regularly exhibiting the hitting, kicking, biting, yelling, spitting, repetitious questioning of staff,...
Staff began a series of Challenging Behavior Meetings twice a month to discuss ways of dealing with Veterans who exhibited this type of behavior. The purpose of the behavior-focused meetings was to establish a menu of responses that staff could use when dealing with challenging behaviors ("Behavior Chain," 2005; "eCaring," 2012). While there was general understanding among the staff that any behavior response system needed to be flexible, there was also general appreciation for the need for a consistent system that would not be perceived as random and unanticipated by the Veterans ("Behavior Chain," 2005; "eCaring," 2012).
Certainly the cognitive processing difficulties of the patients did not enable them to make a great deal of sense out of staff responses to their problem behaviors, but there was an overarching desire by staff not to add chaos to the Veterans' already disrupted lives by responding in ways that seemed capricious ("Behavior Chain," 2005; "eCaring," 2012). Lewin argued that, "group life is never without change, merely differences in the amount and type of change exist" (1947, p. 13). Levin's theory about change in social groups and his theory of change management provide a framework for considering the processes in which the staff participated in their efforts to provide good nursing care when faced with the challenging behaviors of the Veterans. As staff considered various ways to approach this situation, a paramount concern surfaced: establishment and maintenance of a care environment that would be safe for the Veterans and safe for staff ("Keeping Patients Safe," 2004).
Lewin's Force Field Analysis model encompasses three phases that groups go through when faced with change: Unfreezing, moving, and freezing or refreezing. The unfreezing stage lays the groundwork for the change participants to understand the difficulties associated with the problem of interest (Jones, 2012). The primary tasks of the unfreezing stage are to develop strategies to strengthen the forces driving the…
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