Today, change is inevitable in healthcare organizations as they seek to stay relevant, deal with global changes, integrate technological changes in their operations as well as undergo organizational restructuring, employee retention and quality improvement. Numerous forces are attributed to driving change within healthcare organizations including nursing workforce shortages, technological advancements, rising medical costs, declining reimbursement, information availability and an increasingly elderly population. Williams defined various reasons for designing orderly change in an organization namely 1) to increase profitability, 2) to promote human work for people, 3) to enhance the means of satisfying economic needs, and 4) to enhance individual satisfaction and social well-being (Marquis & Huston, 2015). Change may either be planned or change by drift.
Nurse leaders and other healthcare managers must facilitate and manage change in the workplace regardless of its size or revenue so as to solve a certain problem effectively and also to improve patient-care delivery continually. These healthcare leaders must have an extensive understanding of the various change theories as well as be able to apply such theories appropriately so as to solve organizational challenges and use the change to assist the organization to achieve its goals. In this paper, I will describe Kurt Lewin’s change theory, compare it with other change models and theories, and use it to manage a planned change at a unit level, in which a plan will be developed to guide the change effort.
Identified Problem within a Unit Level
The problem identified at the unit level is ineffective communication that has led to numerous healthcare issues. In all healthcare organizations, effective communication and teamwork are significant in ensuring the delivery of high-quality, safe patient care (Bramhall, 2014). In nursing, effective communication between nurses and patients and between nurses and physicians assists to increase the number of positive patient care outcomes. Good communication plays vital roles in all nursing activities and in all the nurse’s interventions that include treatment, therapy, disease prevention, rehabilitation, and healthcare education and promotion. All the nursing personnel in a healthcare organization must have knowledge of the principles of effective communication as well as implement and possess an attitude of wanting to improve their communication skills (Kourkouta & Papathanasiou, 2014). However, the hospital faces several communication failures that have undermined its ability to achieve its objectives as well as provide quality patient care. One of the critical communication failures is that the healthcare team including physicians, nurses and social workers, do not communicate adequately with each other concerning the patient needs. This communication challenge is attributed to the difference in training among all the professionals as well as organizational hierarchies and other communication barriers. This communication gap, which is most common during handoffs, is attributed to a broad range of issues occurring in the hospital including inefficient care delivery, near misses, clinical errors, and frustrations. The second communication failure is between the nurses and patients, as most of the nursing staff does not provide adequate information to the patient about the care they are receiving. Effective communication between the nurse and the patient is integral in creating a healthy relationship and delivering high-quality, compassionate patient care. Good patient-nurse communication assists the vulnerable patients to deal with as well as make well-informed decisions about their health and treatment.
Communication failures within hospitals and clinical centers are the primary causes of inadvertent patient harm and medical errors (Mason, Leavitt & Chaffee, 2013). The unintended harm caused to a patient experienced during therapy due to poor communication strategies that include prescribing or administering wrong medicine, errors occurring during medical interpretation or miscommunication. Miscommunication among the care team provides an opportunity for incorrect or incomplete transfer of critical information when a patient is being transferred from one provider to another. The problem of ineffective communication within the unit level needs to be fixed as soon as possible so as to prevent any future healthcare errors and safety issues as well as improve the care delivery. The healthcare problem must be tackled so as to avoid any legal issues that the organization may face as a result of harming a patient.
Realistic Change Addressing the Issue
In this healthcare organization, various strategies may be employed to assist in improving the communication. First, the organization should integrate technology into the healthcare system as it will assist improve communication through enhancing connectivity and also facilitate information flow between different care providers. Information and communication technologies provide powerful ways for restructuring health service processes and comprise of a wide variety of communication channels, media, and gadgets that can be used to construct the communication services. The use of electronic health records (EHRs) will allow all the care providers in the healthcare system to access and share a person’s health information in an online platform because all the health-related information will be transmitted electronically. The EHRs provide many benefits to the hospitals such as reduced paperwork for doctors and patients, reduced medical errors, improved patient care, minimization of medical costs, expanded access to affordable care, prevent readmissions, decrease duplicate testing, growth in administrative efficiencies and increased involvement of patients and families (Chin & Sakuda, 2012). The second solution to the poor communication between the nurse and the patient is the use of a technology health record system known as VitalScore. This system consists of a wide range of patient engagement tools that assist in increasing the frequency as well as the consistency of patient-provider interactions (Gordon, Deland & Kelly, 2015).
Mission, Vision, Values
The mission of the health organization is to improve the lives and preserve health through allowing the access of comprehensive, completely integrated network of high-quality and affordable care (Rochester Regional, 2017). This mission aligns with the change because improving the communication assists to deliver the highest quality care as promised in the hospital’s mission.
The mission of the care organization is to lead the evolution of healthcare so as to allow all community members to enjoy better, healthier life (Rochester Regional, 2017).The change in the organization will improve the engagement of the community members who are served at the hospital; hence enabling them to enjoy a better, healthier life.
The values of the healthcare organization are compassion, quality, respect, collaboration, and foresight. The change in the organization will improve collaboration as it allows effective communication among the care team and also permits the provision of quality and compassionate care by improving nurse-patient communication.
Relevant Professional Standards
The American Nurses Association (ANA) and the American Organization of Nurse Executives (AONE) emphasize the importance of communication in health systems so as to provide quality, safe patient care. The ANA code of ethics requires nursing staff to have effective communication skills and maintain a good relationship with colleagues, physicians, patients, and family. The ANA and AONE give several principles of effective communication namely 1) active engagement in listening to information, 2) understand the aim of message and its expectations, 3) foster an open, safe environment, 4) ensure accuracy of information, and 5) ensure communication to the right person (Murray, 2017).
Change Model to Guide Planning for Change Implementation
Kurt Lewin (1951) identified three stages involved in managing change so as to transform planned change to be part of the system, namely unfreezing, movement and refreezing (Roussel, 2006). In the unfreezing phase, the change agent convinces the stakeholders in the organization to change. During the movement phase, the change agent managing the change identifies, plans and executes proper strategies while ensuring that the driving forces exceed restraining forces. The last phase of refreezing involves stabilization of the change in the system so as it becomes integrated into the status quo. Lewin’s change model was selected to be used in this change process in the organization because it provides a framework for understanding organizational change and allows for systematic implementation as well as enabling the change agent to manage the change.
Outlined Steps to Facilitate Change
The phases that should be followed in the change process are;
– Create a Change Baseline
– Define Change Strategies
– Change the Measurements
– Communicate Change Details
– Communicate Successful Changes
– Measure Change Progress
– Ensure Change Lasts
The various steps to be followed in effort can be aligned in the Lewin change model three phases involved in the change process. Creating a changing baseline in the organization would be in the unfreezing phase of the Lewin, change model. The steps of defining change strategies, changing the measurements, communicating change details and communicating successful changes would be in the movement phase of the Lewin, change model. The steps of measuring change progress and ensuring change lasts would be in the freezing phase of the Lewin, change model.
Individual Initiating/Managing Change/Skills
The nurse leaders in the organization would be responsible for facilitating effective implementation of the change in the healthcare system. The nurse leaders must manage the change process effectively so as to ensure that the change implemented assists to improve service delivery and to achieve the organizational goals. The nurse leaders who are the change agents must have proper leadership and managerial skills and excellent communication skills. The characteristics of a successful change agent include empathy, proximity, openness, reward, Synergy, and reward (Lunenburg, 2010).
Summary
Poor communication and miscommunication in the health system can lead to severe adverse events that affect the patients and the organization. The problem can be addressed through implementation of change using the Kurt Lewin’s change model. The nurse manager who will be the change agent in the change process must understand the change model applied as well as know how to use it so as to implement the change effectively.
References
Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing standard, 29(14), 53-59. doi: 10.1136/qshc.2004.010033
Chin, B. J., & Sakuda, C. M. I. (2012). Transforming and improving health care through meaningful use of health information technology. Hawai’i Journal of Medicine & Public Health, 71(4 Suppl 1), 50. PMCID: PMC3347738
Gordon, J. E., Deland, E., & Kelly, R. E. (2015). Let’s talk about improving communication in healthcare. Col Med Rev, 1(1), 23-27. doi: 10.7916/D8RF5T5D
Kourkouta, L., & Papathanasiou, I. V. (2014). Communication in nursing practice. Materia socio-medica, 26(1), 65. doi: 10.5455/msm.2014.26.65-67
Lunenburg, F. C. (2010). Managing change: The role of the change agent. International Journal of Management, Business and Administration, 13(1), 1-6.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application. Lippincott Williams & Wilkins.
Mason, D. J., Leavitt, J. K., & Chaffee, M. W. (2013). Policy and Politics in Nursing and Healthcare-Revised Reprint. Elsevier Health Sciences.
Murray, E. (2017): Nursing Leadership and Management: For Patient Safety and Quality Care: F. A. Davis: pp. 134
Rochester Regional (2017): Rochester Regional: Our Mission, Vision and Values.
Roussel, L. A. (2006). Management and leadership for nurse administrators. Jones & Bartlett Learning.
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