The healthcare industry is in a constant state of transformation. These triggers include:
Nurses need to be aware of the ever-present forces both the internal and external that create a sense of urgency and requirements to make changes in practice, processes and people. They need to analyze data and use it to drive decision making, provide the foundation for an intervention, and to evaluate the impact of the plan. Understanding the human reaction to change is essential to help nurse leaders successfully execute plans to improve patient care, operational efficiency, staff engagement, and organizational solvency. Of all the many influences that compel healthcare agents, like nurses, to manage change, technology and consumerism have been the most impactful (Bavier, 2018).
The use of electronic health records (EHR) including computerized physician order entry (CPOE), and bar code medication administration (BCMA) intended to improve patient safety has necessitated vast workflow process changes in organizations. These changes have been fraught with anger, confusion, dissatisfaction, expense, and anxiety. Nurses have led efforts to improve the EHR implementation and utilization and have been recipients of the wide range of reactions to the associated practice and process changes (Rathert, Porter, Mittler, & Fleig-Palmer 2019).
Amid technology implementations and optimizations, nurses continue to be expected to deliver high quality and safe patient care. Patients, the consumers of healthcare, demand nothing less and are given opportunities to express both their gratitude and/or displeasure formally via patient satisfaction surveys. The Hospital Consumer Assessment of Healthcare Providers as Systems is one of, if not the most influential surveys, resulting in organizational change. ”The HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey is the first national, standardized, publicly reported survey of patients' perspectives of hospital care. HCAHPS (pronounced "H-caps"), also known as the CAHPS Hospital Survey, is a survey instrument and data collection methodology for measuring patients' perceptions of their hospital experience. While many hospitals have collected information on patient satisfaction for their own internal use, until HCAHPS, there was no national standard for collecting and publicly reporting information about patient experience of care that allowed valid comparisons to be made across hospitals locally, regionally and nationally”(HCHAPS, 2019).
Survey results are published four times per year and are viewable by the public on the Medicare Hospital Compare website. Low or below expected satisfaction scores trigger changes in people, practice and/or processes throughout an organization. What is required to lead such changes? One key to successful change initiatives is understanding theories about the process itself.
Mary is a nurse manager at a small community hospital. Recently, the hospital has experienced an increase in documentation errors. And she's been tasked with implementing computerized nurse charting instead of paper charts. Mary is uncertain of how she can engage the nursing staff in this change.
The health care environment is in a constant state of transformation. Changes are triggered by multiple factors like the use of technology, social media, consumerism, and shifts in disease patterns. Nurses are expected to adapt to these changes in order to improve the quality of patient care. Nurses need to be able to collect and process data so that they can decide what changes will improve their performance based on evidence.
There are a variety of data sources, including the electronic health record or EHR, reports, patient or staff satisfaction surveys, and financial statements. Evidence from the data should be summarized and translated into evidence-based practice changes. The next crucial step is to guide the team through the change.
OK, back to Mary's case. Understanding the human reaction to change is essential. A widely-known theory is the Institute for Healthcare Improvement or IHI's psychology of change framework, which consists of five interconnected domains.
According to this theory, Mary has to unleash the nursing staff's intrinsic motivation to commit to the change. They have to truly believe in the value of using computerized charts. Also, to increase the likelihood that the improvement efforts will succeed, she has to co-design the change along with her colleagues in ways that are feasible to them.
In addition, it's important to co-produce in an authentic relationship, which means recognizing and supporting the differences between each individual and creating a relationship where each member's thoughts can come forward. Thus, Mary has to inquire and listen to her colleagues' concerns about the change.
Another key domain is to distribute power so that each individual can contribute their unique skills. For instance, in our case, a nurse with computer skills can help a nurse who skills are lagging.
Finally, another key to success is to adapt in action. Mary should urge the team to start using the computerized charts and share their stories of both failure and success. It's important to keep track of the progress and let people see the outcomes of their efforts.
But change management is only one of the competencies a nurse should have to successfully lead in today's health care system. Other essential competencies include having a global perspective or thinking about a situation as it relates to the rest of the world, computer skills, expert decision-making skills, and team spirit.
