Change Management in Hospital and Nursing Home Settings

Introduction: The Challenge of Change in Health Care

There are perhaps few environments and professions within which change is both as important and as difficult as it is within health care. While there are many barriers to the change process, there are at least an equal number of drivers that indicate the necessity for change. In evidence-based practice, nursing practitioners, administration personnel, management personnel, and all others involved in the health care profession need to form teams with patients and family members in order to ensure an optimal environment for change. This is not a process that will happen overnight, especially in hospital and nursing home settings, where recognizing the need for change is often subordinate to more immediate and severe problems such as personnel and funding shortages.

Barriers to Change in Hospital and Nursing Home Environments

The readiness for change in hospital and nursing home environments is often subordinate to practical day-to-day challenges, including severe personnel and funding shortages. These create an environment within which adequate services cannot be provided. Nurses tend to be so overworked by the care that residents require that they cannot spare the time for research to maintain a current perspective on the nursing environment and evidence-based practice.

Another significant barrier to change is resistance (White, 2012, p. 50). Such resistance, according to White, is usually related to two basic paradigms: (1) the threat of disturbance to the status quo or equilibrium, which generally involves unfamiliar territory, and (2) intellectual shortcomings, which involve an inability to think outside of current boundaries and belief systems.

Lewin's Force Field Analysis: Driving and Restraining Forces

The barriers to change described above are applicable to many hospital and nursing home environments. The first step in overcoming these barriers is to analyze them. For this purpose, the initial framework employed is Lewin's Force Field Analysis (White, 2012, p. 51). At its foundation, this analysis recognizes three basic components related to change. In the middle lies the desired or current state, while driving forces occur to the left and restraining forces to the right. As noted above, the main restraining forces to change within hospital and nursing home environments are a lack of funding, personnel shortages, and a lack of recognition that change is required.

The driving forces for change include the conditions currently experienced by patients and residents who do not receive adequate care. Complaints from family members — who often pay high fees for nursing home residents — have been increasing. Research conducted in nursing homes and hospitals has also demonstrated a lack of the quality care that people in these settings merit.

Lewin's Three Stages of Change Applied to Nursing Practice

To analyze these driving and restraining forces adequately, it is important to implement Lewin's three stages (Current Nursing, 2011). First, there is the unfreezing stage, during which old, unproductive patterns are discarded. This can be a very long process, depending upon the severity of the barriers to change described above. In the nursing context, the greatest barrier is the fear of moving beyond the status quo, especially among managers, combined with a basic lack of authority among nurses to implement the changes they regard as necessary. To overcome this, a more open channel of communication needs to be established between management and nursing personnel. This can be addressed via the hierarchy of leadership, by first approaching an immediate superior, who can then raise the matter with senior managers.

These initial steps can then be followed by Lewin's second stage: Movement (Current Nursing, 2011). This stage involves specific actions to move to a new level of thinking or action, implementing the changes that have been identified as necessary. One such movement could be to create teams among nurses, managers, and family members. One team member can be responsible for theoretical research, another for practical research, a third for determining specific research needs, and another for implementing change. This approach removes the burden of handling all responsibilities from a single personnel member while also improving communication among nurses, patients, family members, and management. White (2012, p. 52) warns that sufficient time should be allowed for this change process in order to minimize resistance and optimize the benefits of the changes to be implemented.

The final stage is Refreezing, which establishes the change as a new habit that becomes the standard for future operations. This is a critical stage, because neglecting it will simply result in a return to old habits and the previous status quo.

Conclusion: Sustaining Change in Nursing Care

There are many ways in which change can be optimized and secured within the nursing environment when it comes to hospitals and nursing homes. Corporate culture is an important component of this (Williams, 2012, p. 175). The need for change must be assessed in practice and established by theoretical research (Pipe et al., 2005). Only then can the barriers to change be addressed and mitigated (Dudley-Brown, 2012, p. 192). In the nursing profession, one cannot deny that regular change is vital to ensure continued health and well-being for those in the care of these professionals.