NR 554 Week 2 Discussion, Leading Change

Week 2 TD: Leading Change Consider an educational or healthcare organization with which you are familiar. Analyze the organization with respect to its attitude toward change. Identify a healthcare policy that has been adopted by this organization and determine the change model used throughout the change process (if any). Include the history of the change in terms of how the issue was identified, who the stakeholders were, and how the implementation and evaluation were received. Healthcare is a rapidly changing and healthcare organizations need to be able to accommodate such changes. Changes in organizational policies occur in the clinical setting to adapt to maintain evidence-based practices (EBP). The nursing profession is expected to function and adapt to change as it occurs. Nurses have the responsibility to look for ways to facilitate and impact change. One of the largest healthcare organizations that facilitates change in the nursing profession through EBP is the Stanley Shalom Zielony Institute for Nursing Excellence within the Cleveland Clinic. The Stanley Shalom Zielony Institute for Nursing Excellence has been deemed the Center of Excellence for Nursing Education by the National League of Nursing (NLN) in Washington D.C. (Cleveland Clinic, 2017). This institute promotes nurses to play an important role in implementing EBP into their nursing practice that promote positive, safe patient outcomes. At the Cleveland Clinic, nurses on the frontlines are encouraged to facilitate change and become change agents by being involved in decision-making. This involvement joins unit-based, shared governance committees and councils that function for a specific unit. The Cleveland Clinic has implemented and EBP intervention that has been implemented as a policy. This policy was then introduced to shared governance committees by nurses and other caregivers known as purposeful rounding. Purposeful rounding is known as a proactive, systematic, nurse-driven, evidence-based intervention that helps nurses anticipate and address patient needs (McLeod & Tetzlaff, 2015). Purposeful rounds are made hourly to patient’s rooms and engages patients, family, and nurse by promoting communication between the patient, family, and nursing staff. The change model used to implement this policy is Kurt Lewin’s Change Theory Model. Lewi’s change model focuses on a three-stage change model known as unfreezing-change-refreeze (Current Nursing, 2011). In Lewin’s model, prior education is to be forgotten and replaced with new education by using/stating behavior as “a dynamic balance of forces working in opposing directions” (Current Nursing, 2011). Lewin’s model provides the highest-level change approach (Shirey, 2013). The first step in Lewin’s model is unfreezing. This step involves finding a method that makes it possible for people to let go of old habits that was counterproductive. This step is very important because it forces people out of their comfort zone and forces them to think outside the box. Unfreezing is achieved by increasing the driving forces that redirect current behaviors/habits away from the current process; decreasing the restraining forces that are causing negative movement; and combining these two processes to redirect people to change. The second step in Lewin’s model is change. This step involves the process of change in thoughts, behaviors, and feelings so that they become more positive towards change so that they become more productive. The third step in Lewin’s model is refreezing. This step involves establishing new changes a habit so that it becomes the new standard and old standards are completely forgotten. If this step does not occur, then the process will not work, and people will return to old habits. Stakeholders are people within an organization that have a common interest or concern (Spacey, 2016). Stakeholders involved in the change process are patients, family members, nursing leaders, direct care nurses, and ancillary staff. Nursing leaders should audit hourly rounds to evaluate the success and the change. Purposeful, hourly rounding has improved HCAHPS scores for the Cleveland Clinic as well as other healthcare organizations that have implemented this change. According to The Joint Commission (2015), when nurses always rounded there was a increase to the 90th percentile for many healthcare organizations as well as a 52% reduction in the amount of falls during a hospital stay. References: Cleveland Clinic. (2017). Cleveland clinic’s Stanley Shalom Zielony Institute for Nursing Excellence awarded Center for Excellence in Nursing Education. Retrieved from Current Nursing. (2011). Change theory: Kurt Lewin. Retrieved from McLeod, J. & Tetzlaff, S. (2015). The value of purposeful rounding. American Nurse Today, 10(11). Retrieved from Shirey, M. (2013). Lewin’s theory of planned change as a strategic resource. The Journal of Nursing Administration, 43(2), 69-72. Retrieved from Spacey, J. (2016). 9 examples of stakeholders. Retrieved from