Communicating the sense of urgency often results in the development of a
coalition, the second phase of Kotter’s model (1996). A coalition is a group of
colleagues who share similar thoughts and a vision for change. In the example
about the HF discharge process for patients, a coalition is created when colleagues
recognize the potential impact on patient readmission rates in the creation of
a discharge process. A benefit of creating a coalition is the collaboration and
cooperation that arise.
A cohesive group sharing similar thoughts and ideas can work toward
developing a vision and strategy for change, the third phase of Kotter’s model
(1996). Through the process of collaboration and cooperation of the coali-
tion members, a clear vision and strategy have the greatest potential of being
developed.
After the vision and strategy for change have been developed, the group must
communicate the vision to others. Communicating the vision is the fourth
phase of the model (Kotter, 1996). Often, it seems that change is not possible
because communication has not been clear. Unclear communication can lead
to misunderstandings and misconceptions about the change that is being sug-
gested, resulting in unnecessary resistance. Communication then becomes an
important phase of the change process. Good communication contributes to
the potential to gain increased support to change the policy.
Creating a sense of urgency, building a coalition, developing a vision and
strategy, and communicating a vision do not cause a policy, process, or practice
to change. Kotter (1996) described this fifth phase as empowering broad-based
action. The diversity of the coalition should be considered. A diverse group of
members from the nursing unit can help develop, communicate, and sustain
the vision for a policy, process, or practice change. The sustained support of
the group is needed to ensure that the new policy is understood and followed.
Empowering broad-based action means that members from all departments
have a responsibility and accountability for the success or failure of any policy,
practice, or process. To understand this idea further, suppose the proposed HF
discharge process has been approved. The process requires that physicians
write recommendations for their patients to monitor their weight, make a
follow-up appointment with the physician, follow a low-sodium diet, take
medications as prescribed, know what to do if symptoms get worse, and
know what type of activity is allowed. The process requires that nurses and
other ancillary staff members, from the perspective of their disciplines, teach
patients about HF. Other healthcare providers also have a responsibility to
notify nurses if they become aware of a patient’s intent or inability to embrace
the recommended plan of care for the management of HF upon discharge. If the
HF discharge process was considered only a nursing process, then the needed
change would be less likely to occur.440 CHAPTER 16 Transitioning Evidence to Practice