Establish urgency- Collect data to show
clinical issue• Raise
aw about the areness
issue by talking with
colleagues• Meet with
management• Provide
relevant readings to
journal clubs
Create a coalition- Find people who share
concerns about the
issue• Hold open
forums to discuss the
issue• Form a
committee or task force - Create communication
plan to interested keep
people engaged
Develop vision- Draft a vision statement
- Obtain input from
stakeholders about the
vision• Revise the
vision statement as
needed• Create a
plan for implementing
change
Communicate the vision- Hold unit meetings
- Send e-mails to staff
- Hold inservices
for teaching about vision
and/or change• Create an
on-line teaching
module• Put
information in organizational
newslet• Put posters in ter
prominent places - Lead by example
Empower action- Remo barriers tove
change• Identify
change champions - Provide resources for
the change • equipment
(^) time• release
(^) • Elicit • photocopying
feedback about how
change is progressing
- Reinforce the vision
- Keep communication
lines open
Generate short-term
wins- Pilot change in select
areas of organization - Set achievable
short-term benchmarks - Share outcome
data• Publicize
successful outcomes - Acknowledge or reward
people engaged in
successes
Consolidategains/
produce more- Adapt processes
and structures
throughout the
organization• Continue
recognition efforts - Continue communication
about outcomes - Widen network of
suppor• Elicit ters
feedback about how
change is progressing
Anchor approaches- Continue monitoring
process and outcomes - C long-term ommunicate
goals and outcomes - Keep stakeholders
informed• Celebrate
successful outcomes - Link emerging to
changes in the
organization
FIGURE 16-3 Phases of Change Model
Kotter’s model (1996) can be applied to clinical situations. For example,
suppose there is a desire to develop a policy about patients leaving the unit to
smoke, but a consensus cannot be reached about what the policy should be.
Because there is no policy, nurses do not feel that they have the authority to
stop patients from leaving the unit. Frustration builds after repeated attempts
to create a policy are unsuccessful.
How could this situation be changed? Using Kotter’s model of change (Kotter,
1996), the first phase is to create a sense of urgency. One strategy to accomplish
this is to collect data about the problem. Data can be a powerful tool for creating
a sense of urgency by communicating the scope of an issue. For example, sup-
pose you learn that an organization’s all-cause read-mission rate for HF patients
is 25%. This high rate is problematic because patient satisfaction decreases
for patients who experience frequent readmissions and organizations are not
reimbursed for readmissions. It is important for an organization to understand
why this is occurring and to reduce the rate of readmission. In your work to
understand why HF patients are being readmitted, you realize the discharge
process may not be as complete as it needs to be. Now consider how much
strength could be added to the description of the problem if colleagues from
other units were engaged in collecting data. By taking the time to collect data
about an issue and present it to others, a sense of urgency is created.
16.2 Creating Change 439