When a variety of healthcare providers is empowered,
there is a greater chance for success. Succeeding in some
aspect of any proposed change becomes the focus for
Kotter’s (1996) sixth phase of the change process, which is
to generate short-term wins. This could mean recognizing
individuals on the unit who embrace the new process.
Tell them how much you appreciate their support of the
new process, policy, or practice. For example, a dietician
begins to routinely visit HF patients in order to assess their
knowledge of low-sodium diets. This action represents a
short-term win. By acknowledging the dietician’s effort,
the opportunity exists to reinforce the change. Each time
someone on the healthcare team role models the desired
practice change, a short-term win is created.
Kotter’s (1996) seventh phase involves consolidating the improvements. Each
time changes can be articulated, there is a greater chance of producing more
change. In the HF discharge process, for example, each time all members of the
healthcare team are united in their efforts to enforce the new process, success
has been achieved. Each success builds on previous successes, perpetuating
adherence to the process. Consolidating improvements that produce more
change also creates a sense of teamwork.
The more successes the healthcare team can recognize, the stronger the
practice becomes, essentially anchoring the change in practice. The process of
anchoring the change is the last, or eighth, phase of the process (Kotter, 1996).
Although identified as the last phase, it should not be considered unimportant.
If change does not become anchored, thus transforming practice behaviors,
then all of our energies have been wasted. The need to consider how change
will be anchored is an aspect that must be considered and identified early in
the change process. You may want to remember this and make sure you think
about how you will anchor a practice behavior change.
From this discussion it should be apparent to you how the concepts of en-
gaging others in the change process and Kotter’s (1996) strategies for change
are intertwined. Depending on the type of evidence we wish to transition to
the bedside, it is important for you to identify and know the stakeholders in
the change process.
Stakeholder Involvement
Whenever you consider a practice change, it is important to consider the
stakeholders. Identification of stakeholders is important because it al-
lows for clarification of the purpose of the proposed change, decreases
FYI
Constant organizational change can be
stressful, and never making any changes
or making changes very slowly can also be
frustrating. It is essential to identify strategies
that make change desirable to others. An
effective strategy is to implement change in
phases: establish urgency, create a coalition,
develop a vision and strategy, communicate
the vision, empower broad-based action,
generate short-term wins, consolidate im-
provements and produce more change, and
anchor new approaches.16.2 Creating Change 441