change management

The meaning of a change agent is basically 2-fold; to accomplish change themselves and to also encourage the capacity to change in others (Stefancyk, Hancock, & Meadows, 2013). The nurse change agent needs to recognize the question, include the right population, intervention, compare to other groups, and expected outcomes (Eads & Maruzzella, 2016). The first example would have to be years ago when I worked on the surgical step-down unit. The nursing staff on the floor were inundated with our nurse to patient ratio, which was usually 7:1. In the surgical step-down unit, we would give hourly pain medications, multiple antibiotics, do extensive wound care, as well as ambulating patients three times a day. We had an RN patient flow coordinator that would help with bed assignments and discharges. The entire floor petitioned to do away with that position and give us another clinical nurse at the bedside instead. With the lower nurse to patient ratio, we would be able to manage our own discharges and properly take care of our patients. We fought and won and went from 7:1 to 5:1 with one nurse having 6:1 for the day. Another example was in the ICU, where I witnessed our nurse leaders advocating to change our policy on alcohol withdrawal. Our ICU has a 24-hour intensivist and as nurses, we would have to get written orders for each patient experiencing DT’s. Nationally there is a Clinical Institute Withdrawal Assessment (CIWA), that my nurse leaders wanted to initiate. Basically, it would allow the doctor to initiate the CIWA protocol and give the nurses a guideline to follow when treating alcohol withdrawal patients. It was passed due to the efforts of management and the involvement of the intensivists. We now have a standard to follow without having to call the doctor for each medication order.

Once implementation is under-way the results of the new change to systems and structure must be under constant observation. Change never looks exactly like the expectations of the strategic plan and affected individuals will not always respond as expected, either. Leaders must examine and evaluate target objectives revealing if change is reaching desirable results for the organization.

At first, the plan is presented in front of the Quality Care Committee for review and approval. Once granted by the committee, then it is presented in front of the nursing director and managers for consideration. A change management toolkit is the best options to use to well implement change. The several steps in the change process include, finding out the details of change, that is the size and characteristics, the expected outcomes of the new change, and its feasibility in terms of cost, resource, readiness and risk involved (Queensland

These nursing leaders can also be considered change agents. A change agent is someone within or outside an organization who helps transform that organization by focusing on various matters such as organizational effectiveness, improvement, and development. Change agents focus mostly on the people within the organization. They must help motivate and encourage others within the organization to help with the change and to achieve the desired results. There are many skills that nursing leaders must possess in order to effectively facilitate change. They include competence, intelligence, authenticity, and sensitivity. Authenticity is important because these leaders must be the change that they wish to see within the organization. Other members within the organization will not be encouraged or motivated if the change agent is not effectively demonstrating the change that is needed. The nursing leaders must also be sensitive as many people are afraid of change or simply do not like change. Being able to have a better understanding of the feelings of others on the team can help ease the transition and make others more comfortable of the changes to come (Grimsley,

Change is an ongoing and never ending organizational process. Change is often planned because of conflict between the desired and actual state of affairs. Conflict may arise because of difficulties in reaching performance goals or because new goals have been created (Sullivan & Decker, 2009). Making these changes in the workplace is stressful for everyone involved including the staff, the management, and the consumer. The role of the staff is vital for the change process to be smooth and the staff may be resistant to the changes, causing a systematic breakdown. It is the

With our main research question we aim at exploring the importance of effective change management and the characteristics of a successful change management program in a hospital. The main research question can be formulated as: To what extend is change management necessary and how can it most efficiently be implemented in a hospital?

A plan, a desire, and a decision. Which one comes first and how can you align these three aspects to make the change in your life that you need? There are several aspects of change that must be defined before you can figure out which direction you need to go. First, change can enter your life in two ways. You can initiate change or change will be initiated for you. Either way, you need to anticipate and plan for change. It is the "How to plan for change?" where most people make poor decisions. If you are going to initiate change, it is highly recommended that you have a plan. Having a plan is nothing more than laying out the groundwork of strategic goal setting. The planning process is actually quite simple. You can use the following model

NICE (2007) has produced a document which outlines some common barriers for a changing process. These barriers include motivation, awareness, knowledge and skills. A lack of one may cause in a management plan to fail. To facilitate, the lack of the appropriate training can cause lack of skills for staff to embrace a change. Lack of motivation and awareness can cause staff to be unaware of what needs to change and the rationale behind it. Ploeg et al. (2007) introduced similarities in perceptions of these barriers for example poor information exchange on an individual, organisational and system levels respectively. These approaches identified barriers which could occurs any level of the healthcare service. These barriers will be considered in developing a change to the management plan. It is important to choose a suitable change management model is another aspect of a change implementing. A model which has been used for over sixty years in clinical nursing practice is the Lewin’s model (1951) cited in Mitchell (2013) and presented in Figure 3.

1. Diagnose the problem. 2. Assess the motivation and capacity for change. 3. Assess the resources and motivation of the change agent. This includes the change agent’s commitment to change, power, and stamina. 4. Choose progressive change objects. In this step, action plans are developed and strategies are established. 5. The role of the change agents should be selected and clearly understood by all parties so that expectations are clear. Examples of roles are: cheerleader, facilitator, and expert. 6. Maintain the change. Communication, feedback, and group coordination are essential elements in this step

When planning to make changes within the organization, you should consider the total impact to the staff and any laws that are applicable. There are of couple of change management models, which I listed below, in which you can choose to help you in this process. Before you choose your plan of action exam the following to figure out what is the best time-off policy for your organization. You will want to make sure the policy for your time-off requests is fair to all personnel. You will want to communicate with your staff pertinent information regarding the new policy change. Explain how these changes will take place and keep an open line of communication to provide additional details or address any questions or concerns your employees may have. There are many ways to implement changes for an organization, here are a few examples that may work well as you implement the new policy.

According to Burnes, Kurt Lewin’s theory of change management has stayed relevant for over forty plus years, however as of recently, lewin’s approach was met with major scrutiny with critics often pointing out that change management theory applies to to work in situations where the work environment or project is small in nature and applies heavily on the fact that the organisation is stable and ignored instrumental politics in the business and furthermore was criticized for focusing too heaviliy on management driven tactics (Burnes, 2004). Burnes has specifically stated that the intention of the article is to reevaluate and to test the claims against the greater benefits that has been gained. It is very evident from the article that Burnes specifically talks about the social challenges that Lewin has faced and how that has in turn driven Lewin to create the Planned Approach to change and the elements of the change, which are Field Theory, Group Dynamics, Action Research and finally, the

for buy-in, enabling action, creating short-term wins, don’t let up, and making it stick). Bridges

The first lesson is that the change process goes through a series of phases that are long and considerable amount of time. The second lesson is that any mistakes that occur in any phases can have a adverse impact on the momentum of the change process (Mento, Jones & Dirndorfer, 2002).

Change is a common thing that happens all around us on a daily basis sometimes even without us noticing. It can range from family level to international levels, likewise in time frame it can happen on a daily basis, a monthly, yearly or even a decade. In the words of Senior & Fleming (6) Change can be simply defined as process of moving from one state to another. It is this transition that creates distress to the people due to fear of the unknown. We can not stop change but rather we can only manage it. So then what is change management?

1.1 The analysis must include consideration of two current schools of thought on change management and how they have contributed to organizational change