Change and innovation are inevitable in the healthcare industry
Change and innovation are inevitable in the healthcare industry. They typically occur in one of three ways – through the emergence of events, discussions with others, and development of practices (Huber, 2014). Depending upon their implementation, work environments will either grow from the positive results or suffer from the negative effects. Therefore, it is essential that change and improvements within an organization are effectively managed. The purpose of this post is to discuss the importance of understanding and effectively managing change and innovation. In addition, two examples illustrating how change has been implemented within my organization will also be discussed along with change theory elements.
It is important to understand the differences between change and innovation. Change is a disturbance in work or within an organization. Innovation is the implementation of a new method, product or system (Huber, 2014). It is undeniable that both of these entities co-exist and are needed within the healthcare platform. However, the way that each of these are employed is critical to its successful implementation. That is, change brings about a number of negative emotions – insecurity, frustration, confusion, anger, and resistance. As a result, organizational transformation is extremely difficult, leading to a 70% failure rate (Brickman, 2016).
To be successful, well-planned strategies must be integrated by leaders that are willing to educate staff and provide support systems (Khalil, 2015). Leaders must understand that staff are historically suspicious, cynical, and distrustful (Brickman, 2016). Therefore, leaders need to actively engage, listen and involve staff with its process from the beginning. If those who are directly affected by change are not committed to its implementation, it will fail (Huber, 2014). Simply, ineffective mismanagement of change leads to unsuccessful execution (Huber, 2014). On the contrary, successful leaders implement change by promoting participation, providing knowledge about the process and the reasoning of it, encouraging participants to accept it, and allowing for feelings to be expressed (Huber, 2014).
Currently, I work as a labor and postpartum nurse. Since 2013, our unit has had three different department managers, and our hospital has had two different chief nursing officers – the most recent manager and officer joined our organization in 2017. Since that time, a number of changes have occurred, mainly from our department manager. First, in preparation for the Ohio Department of Health visit this fall, an end-of-shift checklist was recently incorporated within our daily routine. These checklists serve as documented and enforced “reminders” of how to effectively chart on each patient. Nurses scrutinize their own charting each shift and attest that it is complete, accurate and according to hospital policy. At the end of shift, each checklist is validated by the charge nurse. Although this checklist serves as an effective reminder, it was implemented in an authoritarian style with little direction or prior input from staff. As a result, this change felt punitive, which generated feelings of incompetency, discontent and anger among staff nurses.
Another change that occurred is the way our department handles on-call sign-up. When a six-week schedule is released, on-call coverage is also generated – typical for an obstetrics unit. For fairness, the day and night shifts rotate from one schedule to the next, and each employee within that shift also rotates, allowing each nurse a turn to be first. Recently, it was determined by our leadership team (i.e. the department manager and five charge nurses) that there are too few charge nurse incentives, and that charge nurse on-call shifts are not being adequately covered. As a result, it was mandated that these nurses are no longer required to rotate for on-call sign-up. Instead, they are allotted first choice preference each time the call list is generated. Again, this change was implemented in an authoritarian style with no input from the general nursing staff. To make matters worse, the “unfilled” shifts that were supposed to be covered by charge nurses have been left unfilled. To say the least, this change has been unsuccessful in solving coverage voids. On the contrary, it was successful in bestowing power and privilege to a select few. Overall, staff morale is poor and there is harbored resentment among nurses due to this implemented change.
Both of these examples had elements of success and failure – acceptance by a few, rejection by many. Although there were unfreezing periods with both, these periods were only recognized by the leadership team. Mainly, these ideas were created from the collaboration of a select few. Therefore, when change initially occurred in the moving stage, many staff nurses were off-put. Currently, both of these examples rest between the moving and refreezing stages, since they were recently implemented, and at least one revision (i.e. end-of-shift checklist) has occurred.
To foster better acceptance of change and increase general morale, more effective measures could have been incorporated. First, it is important to recognize that successful change and innovation requires mutual collaboration among all staff (Huber, 2014). As a result, discussion and brainstorming about the problems that were the basis of these changes should have been a priority. From many nurses’ perspectives, no unfreezing period took place prior to the moving stage. Simply, it appeared that both of these changes merely generated out of thin air. Secondly, there is a notable disconnect between floor nurses and the leadership team. Problems and information are inadequately translated to all staff, and there is an air of entitlement from leadership. Teamwork should be fostered, and leaders should learn to effectively listen and encourage participation of all affected staff (Huber, 2014). Moreover, unit policies, rules and standards (i.e. on-call order) should be adopted and adhered to by all employees without favoritism.
In conclusion, understanding the dynamics of how change will affect a body of employees is essential to the success of an organization or department unit. Resistance will inevitably occur. To minimize this effect, leaders must be willing to openly discuss problems, creatively form solutions and partnerships with co-workers of varying seniority. As a result, nurses will gain a sense of empowerment, which will inevitably translate into ownership, responsibility, and authority, leading to successful implementation (Huber, 2014).
References
Brickman, J. (2016, November 23). How to get health care employees onboard with change. Retrieved from Harvard Business Review: https://hbr.org/2016/11/how-to-get-health-care-emp…
Huber, D. L. (2014). Leadership & Nursing Care Management. St. Louis: Elsevier Saunders.
Khalil, H. B. (2015). Implementing change in healthcare: evidence utilization. International Journal of Evidence-Based Healthcare, 41-42.
Discussion 2
The purpose of this discussion post is to explain why understanding and effectively managing change and innovation is an essential leadership competency and how change has successfully (in my case) been managed within my organization including change theory elements.
Understanding and effectively managing change is an essential leadership competency because change is happening all the time. Change meaning to make something different over a period of time and unpredictable variables. Innovation meaning the use of a new idea (Huber, 2000). An example of this that I can think of that is most prominent would be how much technology has changed and evolved from when my leaders and managers started to now. In my opinion, technology makes caring for our patients easier, safer and faster. Some of the managers are not up-to-date on how our computers and charting works which is a huge burden when we need extra help on the floor because we have to stop and help them maneuver through the technology. I know it is easier for younger nurses to figure out something electronically but I do believe to be a good leader, one must be continuingly learning, growing and changing as the profession does. This also goes for following the best ways to practice certain tasks (example: not inflating the catheter balloon before insertion) and not just doing what one has learned years ago because that is how one was taught (example: checking the patency of a balloon before insertion).
Using Lewin’s theory of change, I will describe how change was successfully unfrozen, moved and refrozen in my facility (Huber, 2000). The first step and example comes from the unfreezing stage. Many of the nurses on my unit were consistently upset with their schedule being changed (splitting weekends which they should have off) which gave us bad attitudes about coming to work. Balance between work and home life was not happening and boundaries needed to be in place to promote the nurses wellbeing (Oates, 2018). Our house supervisor, who makes the schedule, could tell that we were not happy and asked us to come up with a different and better way to complete the schedule. She was able to be aware of the situation, diagnose the problem and give us an option to help fix it. We respected her for her open mindedness and trusted that she was truly wanting the best for us. We proceeded to implement a new way of creating our schedule which would be the second stage, moving. We worked together to figure out a self-sufficient schedule by self-scheduling. We tested this out before bringing it back to our house supervisor. We explain the steps and presented the mock schedule. She thought I looked good and agreed to test it on the next schedule. Refreezing is the final stage and it all goes right we should be able to self-schedule (Huber, 2000). This would make the floor nurses happier and less work for the house supervisors. Our supervisors praised us for contributing a great idea to the hospital.
In conclusion, change is vital for keeping a team on the same page. It might be hard to initiate change but if it is for the better interest of one’s wellbeing, may that be the nurse or the patient, then it should be done. Lewin’s theory of change as mentioned above can help balance and successfully promote and reinforce change (Huber, 2000). Change is happening all of the time and in every part of our lives. The ability to change is a great quality of a leader.
References
Huber, D. (2000). Leadership and nursing care management. Philadelphia: W.B.
Saunders.
Oates, J. (2018). What keeps nurses happy? Implications for workforce well-being
strategies. Nursing Management – UK, 25(1), 34-41.
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It is interesting that you have acknowledged the inevitability if change and innovation in healthcare. Actually, the general public are expecting more from healthcare organization. There are many organizations operating currently and the only way to remain in business is to continuously perceive and implement………………………………..
APA
405 words
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