Professional literature is full of change theories. For the purposes of this course, two will be discussed in detail. The first theory is Kotter’s Change Model. Although not frequently used as a framework for nursing or healthcare-related change initiatives, Kotter’s change model:
The other change theory is IHI Psychology of Change Framework, which consists of five interrelated domains of practice that can be used by organizations to promote and sustain change (Hilton & Anderson, 2018). These domains are:
Figure 1. IHI Psychology of Change Framework. By Hilton K, & Anderson A, 2018. Copyright 2018 by Institute for Healthcare Improvement.
Thomas is a nursing unit manager at a community hospital. Recently, he noted an increase in drug administration errors in the unit. As a result, Thomas decided to review the staffing and assignment data and compared them with the rate of the errors. Data analysis revealed that drug administration mistakes occurred most frequently on weekends when the unit is typically understaffed. This discovery created a sense of urgency to adjust the nursing staff schedule.
The health system is transforming constantly due to various triggers such as the use of technology and social media, consumerism, government regulations, and differences in disease patterns. Meanwhile, nurses are expected to adhere to these changes and improve the quality of patient care. Changes are usually encountered with fear and anxiety. And thus, nurse managers like Thomas have to understand the underlying psychology of change in order to guide their team through them.
The Institute for Healthcare Improvement or IHI's psychology of change framework is an approach to advancing and sustaining improvement in health care. The framework is organized through five interconnected domains. According to the framework, Thomas has to unleash the nursing staff's intrinsic motivation for this shared purpose. Intrinsic motivation means doing something for the inherent satisfaction that it provides without expecting an extrinsic reward or recognition.
Thomas has to help them see how increasing the nursing staff during the weekends and decreasing the number of patients assigned to each nurse will reduce errors. Understanding the value of the change will generate greater engagement and commitment.
In addition, Thomas has to co-design the change along with his colleagues. The people who are affected the most should have input on the changes being made. Another key domain in the framework is co-producing in an authentic relationship, which means building an environment where people are encouraged to express their thoughts. Thus, in our case, Thomas has to listen to his colleagues' concerns about the change and discuss possible solutions.
In addition, it is essential to distribute the power so that each team member's full potential is applied in order to create the best possible outcome.
Back to our case. After listening to the feedback and discussing his plan, Thomas adjusted the schedule so that the entry-level nurses share weekend shifts with more experienced nurses that can show them how to administer drugs correctly.
Finally, it is also important to adapt in action. Thomas should urge the team to follow the new schedule and share their stories of failure and success. He should also keep track of their progress and provide them with both positive and negative feedback.
As a nurse manager, you have been tasked with implementing a new shift-to-shift hand-off communication process.
Authored by Anne E. Lara, Ed. D., MS, RN, CPHQ, CPHRM