misunderstandings related to the change, and facilitates implementation of
the change. Box 16-2 presents an example of a questionnaire that can be used
to identify stakeholders. The following illustrates how implementing a change
without collaborating with stakeholders can have negative results. Nurses on
a busy medical-surgical unit have discovered that many patients are not being
assessed in the morning. This is causing some difficulty for patients because
physicians need morning assessments completed so they can make treatment
changes. Upon further examination it is discovered that the physical therapy
department, in an effort to balance their staffing and workload, has changed
its routine and staff are now coming to the unit first thing in the morning
before the nurses have had a chance to assess the patients. Nurses on the unit
voice their concerns, but change does not occur, and the physical therapy staff
continues with the new schedule.
What factors contribute to some of the negative outcomes associated with the
physical therapy scheduling change? Had the physical therapy staff identified
all the stakeholders, they might have discovered that their proposed practice
change would affect patient care negatively. Because patients were being taken
out of their rooms before breakfast, nurses were unable to complete morning
assessments; thus, physicians did not have the information to make decisions
about treatment options. The only group that benefited from the change was
the physical therapy department, which was able to balance its staffing andThe following list of questions, when answered, may help to identify many of the stakeholders to
any proposed change of practice, process, or policy.- What is the proposed change?
- Does it affect practice, process, or policy?
- What are the components of the practice, process, or policy?
- What is the setting and context for the practice, process, or policy?
- What is the history behind the practice, process, or policy?
- What is the structure and administrative design of the practice, process, or policy?
- Who participates in the practice, process, or policy?
- Who sponsors the practice, process, or policy?
- Are there any groups that will be excluded by the practice, process, or policy?
- Who are the direct beneficiaries of the practice, process, or policy?
- Are there any indirect beneficiaries of the practice, process, or policy?
- Does the proposed change to practice, process, or policy create opportunities for any
particular group(s)? - Do any particular groups stand to lose power as a result of the proposed change to practice,
process, or policy? - Is there a funding group for the proposed change to practice, process, or policy?
BOX 16-2 Stakeholder Identification Tool
442 CHAPTER 16 Transitioning Evidence to Practice