The amount of project management depends on the complexity and degree of the change to existing processes, systems, organizational structure and job roles.
Change management engagement depends on the amount of disruption created in individual employees’ day-to-day work. It also depends on the organization’s attributes, such as culture, value system and history with past changes.
There are several tools that can be used to combat resistance to organizational change to increase the chances of effective organizational implementation....
Change often fails from ineffective management of the internal and external forces of resistance opposing change (Kotter & Schlesinger, 2008; Oreg, 2003; Palmer et al., 2009).
Upenieks, V.V. 2003. "The Interrelationship of Organizational Characteristics of Magnet Hospitals, Nursing Leadership and Nursing Job Satisfaction." 22(2): 83–89.
While concrete objectives such as waiting times are important toidentify, concentrating on only the technical aspects of a changedoes not produce success (Cohen et al. 2004). It is important toalso consider the impact of the modifications on those experiencingthe change (Shanley 2007). Attempts were made to measure thisthrough the use of the TES and site visits. Feedback indicated,however, that the new providers experienced some difficulties,isolation and resistance from former colleagues in moving throughthe implementation process. While assessing cultural issues remainsa significant challenge (Marshall et al. 2003), more work should bedone to reduce their impact on change. The opposition andfrustration that may occur at the personal level can serve asbarriers to change if not managed correctly (Narine and Persaud2003; Pattison 1996). It is important that managers understand theemotional consequences that can come with such programs(Schoolfield and Orduna 2001).
The strengths-based movement has the potential to become a "game changer" in nursing and to transform healthcare. It redirects the focus from deficits, problems and weaknesses to use strengths that include assets and resources to manage problems and overcome and contain weaknesses. The common wisdom is that most problems can be "fixed" by throwing more money at them or cutting waste from the system. After many years of trying to fix problems, results have been limited and, in many cases, disheartening. The deficit approach has tended to yield short-term, expensive solutions that have proven to be non-sustainable over the long-term.
Dowding, D. 2001. "Examining the Effects That Manipulating Information Given in the Change of Shift Report Has on Nurses' Care Planning Ability." 33(6): 836-46.
Through the interpersonal communication (communication between two or more people) process, people can exchange information, create motivation, express feelings or apply penalties for inappropriate behavior, all within the workplace (Robbins, et al, 2009).
One of the challenges to physician involvement was the issue offunding. Innovations that affect physician income or professionalautonomy or that may negatively impact patient care are likely tobe unsuccessful (Gross et al. 2007; Martin 1999). In this case,physicians educated the new providers without compensation fortheir training time. A lack of resources such as this can have anegative impact on the progress of change (Grol and Grimshaw 2003;Rivera 1999). In addition, primary healthcare nurse practitionerswere seeing out-of-province and WSIB patients, thereby nullifyingthe fees that physicians would normally collect.
While the change management process used to introduce the newproviders led to improvements, additional adjustments could havebeen made to allow for greater overall success. The results andfeedback indicated that there was a need for a better understandingof the cultural environment, more consistent communication withstakeholders, better engagement of physicians, more resources tosupport staff involvement and the management of expectations. Somekey strengths were also discovered: the benefit of using ateam-building process to motivate and support change, theapplicability of the PEPPA framework and the values of advancedenvironmental scanning. Hopefully, the lessons learned from thismodification will be of benefit to others looking to make changeswithin the healthcare setting.
Physician engagement, while necessary for any innovation in thehealth setting (Peterson and King 2007), is also one of the biggestchallenges (Ferlie and Shortell 2001). Physician champions need tobe engaged from the very beginning (Kresse et al. 2007) as theseearly adopters are key to overall acceptance. Their support willeventually lead to the diffusion of the innovation to otherphysicians within the department (Berwick 2003; Weber and Joshi2000). In addition, physicians who are involved in settingstandards and designing objectives are more likely to embrace thechange (Audit Commission 2004; Forthman et al. 2003). Those sitesthat had physician leaders and physician involvement were moresuccessful in the implementation of the new roles.
The purpose of the TOA project was to provide an evidence-based framework to support nurses' handover of patient care, and to implement a standardized approach to TOA to promote patient safety. TOA guidelines were developed, pilot-tested and evaluated. Results of the pilot study were used to inform clinical practice. This was achieved by developing nursing standards for patient safety during transfer of accountability and introducing written tools, a bedside patient safety checklist and face-to-face reporting. The standardized approach to TOA improves the effectiveness and coordination of communication among nurses at shift change, and fosters complete communication of information related to patient needs during provision of care. The next step of this project is to understand and enhance handover practices within and between other care providers and facilities.