Change Management

Issues of Concern

All change initiatives, no matter how big or small, unfold in 3 major stages: pre-change, change, and post-change. Within those stages, healthcare providers working as change agents or change champions should select actions that match change theories. One of the most critical aspects of pre-change planning is involving key stakeholders in problem identification, goal setting, and action planning. Involving stakeholders in change planning increases staff buy-in. These stakeholders should include staff from all shifts, including nights and weekends, to create peer change champions for all shifts[5].

One particular portion of Rogers’ change theory identifies the various rates with which staff members accept changes through innovation diffusion. During pre-change planning, change agents should assess their departmental staff to determine which staff belong to each category. Rogers described the different categories of staff as innovators, early adopters, early majority, late majority, and laggards.[4] He further qualified those change acceptance categories with the following descriptions:

• Innovator: Passionate about change and technology; frequently suggests new ideas for departmental change.
• Early adopter: High levels of opinion leadership in the department; well-respected by peers
• Early majority: Prefer the status quo; willing to follow early adopters when notified of upcoming changes
• Late majority: Skeptical of change but eventually accepts the change once the majority has accepted; susceptible to increased departmental social pressure
• Laggard: High levels of skepticism; openly resist change [4]

Most departmental staff likely belongs to the early or late majority. Change agents should focus their initial education efforts on Innovator and Early Adopter staff. Early adopters are often the most pivotal change champions, persuading early and late majority staff to embrace change efforts[4].

One final critical assessment change leaders should incorporate is a force field analysis, a significant component of Lewin’s early change theory. A force field analysis involves a review of change facilitators and barriers at work in the department. Change leaders should work to reduce change barriers through open communication and education while also aiming to strengthen change facilitators through staff recognition and various incentives.

One of the biggest mistakes a change leader can make during change implementation is failing to validate that staff members perform new processes as planned. Ongoing leader engagement throughout change execution increases the chances of success.[5] Staff resistance remains common during this stage. Change leaders may find conducting another Force Field Analysis during this changing phase helpful to ensure no new barriers have emerged.[3] Further strengthening of change facilitators through staff engagement, recognition, and sharing short-term wins help maintain momentum. As the change process continues, staff may require additional on-the-spot training to overcome knowledge deficits. Finally, leaders must continue to monitor progress toward goals using information like patient satisfaction, staff satisfaction, fall rates, and chart audits.[3]

Once the change has become part of the department’s new culture, change leaders must periodically validate departmental processes and solicit staff feedback. Change agents can redefine their relationship with the staff to take on a less active role in the change maintenance process. However, once the change leader begins to release control over the change process, staff members may slowly revert to old, negative behaviors. Periodic spot-checking and continued data monitoring can solidify the change as the department’s new status quo. Change managers should celebrate wins with staff while continuing to share evidence of success in staff meetings or with departmental communication boards.[5]

Clinical Significance

Change is inevitable, yet slow to accomplish. While change theories can help provide best practices for change leadership and implementation, their use cannot guarantee success. The process of change is vulnerable to many internal and external influences. Using change champions from all shifts, force field analyses, and regular supportive communication can help increase the chances of success.[5] Knowing how each departmental staff member will likely respond to change based on the diffusion of innovation phases can also indicate the types of conversations leaders should have with staff to shift departmental processes.