having some structured discussions online, coupled with face-to-face meetings
(Wilson et al., 2015). If you do not feel comfortable taking the lead on this, ask
a nurse manager, nurse educator, advanced practice nurse (APN), or nursing
administrator in your organization for help.
Many of the preceding examples for engaging others in the change pro-
cess were at one time voluntary. However, in today’s current healthcare
environment, meeting established outcomes is mandatory and influences an
organization’s financial bottom line where payers reimburse based on those
outcomes. For example, the American College of Cardiology (ACC) and the
American Heart Association have strong evidence for how to treat patients
with HF and myocardial infarcts. The ACC has developed guidelines that
have demonstrated improved patient outcomes when the guidelines are fol-
lowed. Payers are evaluating the effect of these guidelines on patient outcomes.
Organizations that have initiated practice, process, and policy changes are
recognizing that high-quality, low-cost care that patients receive means better
patient outcomes with increased reimbursements. Organizations are chang-
ing by using standardized order sets where practice guidelines are embedded
into physician orders or nursing care plans, care maps, clinical pathways, or
electronic documentation systems. Care maps and clinical pathways tend to
be multidisciplinary in nature and outline for practitioners how a patient’s
hospital stay will proceed within a particular diagnosis. With the advent of the
electronic documentation system, best practice interventions are identified as
pop-up screens or highlighted electronic reminders. Healthcare providers are
expected to follow the guidelines. Care maps or clinical pathways, although
not mandatory, are effective means to incorporate EBP.Making Change Happen
What can we say about change? Because individuals do not view the concept of
change in the same manner, identifying strategies to make change less frequent
or less frightening for others is desirable. Constant organizational change can be
stressful. Think how you would feel if every 6 months the policies related to chart-
ing changed. It would be frustrating to learn a new way of charting so frequently.
Conversely, never making any changes or making changes very slowly can also be
frustrating. Much has been written about the change process. John Kotter (1996)
is known for his work on change. He proposed an eight-step process that has been
described as a top-down transformation process (Fullan, 2001). Although not
widely noted in the nursing literature, Kotter’s eight change phases model is useful
here because of its simplicity. The phases of the model are as follows: establish
urgency, create a coalition, develop a vision and strategy, communicate the vision,
empower broad-based action, generate short-term wins, consolidate improve-
ments and produce more change, and anchor new approaches (Figure 16-3).KEY TERM
change phases
model: An eight-
phase process
to describe
organizational
change438 CHAPTER 16 Transitioning Evidence to Practice