What Is Healthcare Transformation?

Transformation requires healthcare leaders willing to take bold steps to: Adopt a consumer-centric focus. Shift to preventive and outcomes-based care models. Embrace digital and technology enablers. Engage nontraditional value chain partners.

What does it mean to transform healthcare?

Healthcare informatics has tremendous power to transform care delivery and response in a crisis, from sophisticated data analyses that pinpoint populations most at risk, to technological support for outbreak management. Considering how to use advancements in healthcare information systems and science to drive healthcare transformation is critical.

1. That means making real people-focused connections at the point where interoperability, clinical intelligence, and electronic health record (EHR) utilization meet to advance patient care and outcomes.
2. Advancements in care through EHR technology are a primary goal of healthcare transformation.
3. A fundamental goal of healthcare transformation is to enhance patient and provider experience by allowing a flexible bidirectional healthcare exchange.

Success lies in an organization’s ability to create health interactions that place patients and providers top of mind. To understand these needs, organizations must invest in transformation that prioritizes patient and provider satisfaction while acquiring data, interactions, and analytics to deliver actionable insights.

The gold standard of technology implementation is Stage 7 of Healthcare Information and Management Systems and Society’s (HIMSS) Electronic Medical Record Adoption Model (EMRAM). At this stage, hospitals no longer use paper charts to deliver and manage care. Instead, all stakeholders in care have electronic access to clinical information.

Data warehousing analyzes patterns in clinical data to continuously improve care quality, efficiency, and patient safety, and rates of adoption for physician documentation and computerized practitioner order entry total 90% or higher. But today, fewer than 7% of healthcare organizations have reached Stage 7 EMRAM Maturity Status.

It’s an especially challenging task for public agencies, which have been slower to undertake EHR modernization. However, the benefits of data-driven advancements in care are clear: organizations that achieve Stage 7 Status report higher levels of physician satisfaction, deeper adoption of EHR personalization functionality, and better teamwork between clinicians and health IT teams, according to a survey by KLAS and HIMSS Analytics 1,

To reach this state, healthcare organizations must connect people, processes, and technology, In working with hundreds of commercial healthcare clients and numerous EHR systems, including Allscripts, athenahealth, Epic, Meditech, McKesson, and Cerner, Guidehouse has found that these three elements are critical to the success of any healthcare informatics initiative, regardless of size or type.

But aligning people, processes, and technology toward a unified outcome requires a deep understanding of the critical stakeholders involved in an initiative, the processes they will use, and the technology they will leverage to advance health outcomes. The single most crucial denominator is clinical integration 2,

Clinical transformation and related change management support should reside outside the technology vendor. The technology vendor’s core competency is configuring and deploying a technology that meets the functional (end-user) requirements, technical/security requirements, and functions as intended. How can healthcare leaders set a solid people-focused foundation for value using healthcare informatics?

What is transformational change in NHS?

This means that in the coming years, providers across the country need to undergo transformational change. In other words, they need to find fundamentally different ways of delivering care to be much more effective and this, in turn, will require new capabilities as well as new processes.

What is transformational change nursing?

‘Transformation is a deliberate, planned process that sets out a high aspiration to make dramatic. and irreversible changes to how care is delivered, what staff do (and how they behave) and the role. of patients, that results in substantial, measurable improvement in outcomes, patient and staff.

Why is change so important in healthcare?

Importance of Change Management in Healthcare – Change management helps practices achieve their organizational goals with minimal resistance to change from care staff. Healthcare executives must build focused, structured change management plans to effectively guide personnel to achieve desired outcomes.

What is the change theory model in healthcare?

• Elizabeth Wojciechowski, PhD, PMHCNS-BC Elizabeth Wojciechowski is a doctorally prepared APN in mental health nursing with 25 years of experience in clinical management, strategic planning, graduate-level education, and qualitative and quantitative research. Her most recent professional experience as Education Program Manager and Project Consultant includes collaborating with professionals on hospital-wide change management projects; developing a website and hospital-wide patient and family education system; project lead for strategic planning for a new cancer rehabilitation center; and leading the inception of the nursing research committee. Former experience as an associate professor of nursing and a nurse manager includes serving on a university IRB board; teaching epidemiology, research, leadership and management at the graduate school level; developing and administering an outpatient dual-diagnosis program servicing children and families; and securing outside funding to pursue clinical research projects that resulted in publications in peer-reviewed journals and awards.
• Tabitha Pearsall, AAB, Lean Certification Tabitha Pearsall, AAB, Lean Certification Tabitha Pearsall received a business degree in Seattle, WA and has 25 years operations experience, 11 years of experience utilizing Lean or Six Sigma improvement methodologies, with the last eight years focused in healthcare. She is Lean Certified through John Black & Associates, whose method is modeled after the Toyota Production System. She has implemented improvement programs in three organizations, two of which are in healthcare focused on Lean. Currently, Director of Performance Improvement at a large acute rehabilitation hospital, creating structure and implementing plan for integrating Lean methods and facilitating improvements hospital wide.
• Patricia Murphy, MSN, RN, NEA-BC Patricia Murphy, MSN, RN, NEA-BC Patricia J. Murphy has over 30 years of experience in nursing leadership and education. She currently is the Associate Chief Nurse at a large acute inpatient rehabilitation institute where she is responsible for the operations of seven inpatient-nursing units, the nursing supervisors, radiology, respiratory therapy, laboratory services, dialysis, and chaplaincy. In this leadership role, she identifies, facilitates, implements, supports, and monitors evidence based nursing practices, projects and nursing development initiatives in order to improve nurse sensitive patient outcomes and add to the body of knowledge of rehabilitation nursing practice. Former experience includes Director of Oncology Services and Hospice; strategic planning of a new cancer center; leading quality projects in oncology and within the stem cell transplant unit; designing and implementing an oncology support program; and developing and implementing a complementary therapy program to support inpatients, outpatients, and the community.
• Eileen French, MSN, RN, CRRN Eileen French, MSN, RN, CRRN Eileen French received a BSN from Northern Illinois University and an MSN from Loyola University. She is certified in rehabilitation nursing and has worked for over 30 years at a large acute inpatient rehabilitation institute, as a direct care nurse, clinical educator, clinical nurse consultant, and nurse manager. She is currently Manager of Nursing Outcomes, and has led a group of nurses responsible for planning and initiating bedside shift report in this rehabilitation setting.

• Article
• Figures/Tables

Abstract The complexity of healthcare calls for interprofessional collaboration to improve and sustain the best outcomes for safe and high quality patient care. Historically, rehabilitation nursing has been an area that relies heavily on interprofessional relationships.

1. Professionals from various disciplines often subscribe to different change management theories for continuous quality improvement.
2. Through a case review, authors describe how a large, Midwestern, rehabilitation hospital used the crosswalk methodology to facilitate interprofessional collaboration and develop an intervention model for implementing and sustaining bedside shift reporting.

The authors provide project background and offer a brief overview of the two common frameworks used in this project, Lewin’s Three-Step Model for Change and the Lean Systems Approach. The description of the bedside shift report project methods demonstrates that multiple disciplines are able to utilize a common framework for leading and sustaining change to support outcomes of high quality and safe care, and capitalize on the opportunities of multiple views and discipline-specific approaches.

The conclusion discusses outcomes, future initiatives, and implications for nursing practice. Key words: Outcomes, quality improvement, interprofessional collaboration, Lewin, Lean, crosswalk, case review, outcomes Providing today’s healthcare requires professional collaboration among disciplines to address complex problems and implement new practices, processes, and workflows.

Providing today’s healthcare requires professional collaboration among disciplines to address complex problems and implement new practices, processes, and workflows ( AACN, 2011 ; Bridges, Davidson, Odegard, Maki, &Tomkowski, 2011 ; IOM, 2011 ). Often this collaboration magnifies competing or alternative discipline specific theories, language, and strategies to lead and sustain change management and to implement and support Continuous Quality Improvement (CQI) projects.

Initially, professionals may perceive these differing views as mutually exclusive. Lewin’s Three-Step Model Change Management is highlighted throughout the nursing literature as a framework to transform care at the bedside ( Shirey, 2013 ). One criticism of Lewin’s theory is that it is not fluid and does not account for the dynamic healthcare environment in which nurses function today ( Shirey, 2013 ).

With the need to streamline resources and provide quality and safe healthcare, nurse leaders have focused on a rapid cycle approach to lead and sustain quality improvement changes at the bedside. One specific approach that is gaining rapid attention in healthcare is the “Lean System” for transformation.

Experts assert that Lewin’s theory provides the fundamental principles for change, while the Lean system also provides the particular elements to develop and implement change, including accountability, communication, employee engagement, and transparency. The purpose of this case review is to describe how one large, Midwestern, rehabilitation facility used a crosswalk methodology to promote interprofessional collaboration and to design an intervention model comes to implement and sustain bedside shift reporting.

Founded in the mid-1950s, this 182-bed, acute, inpatient rehabilitation facility (IRF) is located in a large Midwestern city and known for its commitment to promoting interprofessional and collaborative patient care. Rehabilitation is an interprofessional practice by nature that requires physiatrists, nurses, occupational therapists, speech therapists, physical therapists, and ancillary departments to collaborate to identify and achieve patient goals and outcomes.

In early spring of 2017, the IRF will open a new research hospital to replace the current building. The new research hospital, a private, not-for-profit acute in-patient and outpatient rehabilitation facility, will expand patient care and combine research activities that translate directly to patient care in real time to improve patient outcomes.

This evolving research hospital environment requires that nurse executives demonstrate collaborative problem solving across the spectrum of care. Nurse leaders and executives’ formal training supports frequent use of Lewin’s Three-Step Model for Change Management.

Meanwhile, healthcare institutions’ performance improvement departments often institute the Lean Systems Approach to quality improvement ( Toussaint & Berry, 2013 ; Toussaint & Gerad, 2010 ). Integrating language from the Lean model within the theoretical basis of change theories used by the IRF healthcare culture would likely be a key factor for success continuous quality improvement activities.

The IRF executive leadership team identified that the organization was reliable in initiating improvements, but was challenged to sustain and spread improvements throughout the organization. The Lean model had been adapted as the improvement system for the IRF.

Integrating language from the Lean model within the theoretical basis of change theories used by the IRF healthcare culture would likely be a key factor for success continuous quality improvement activities. The Director of Performance Improvement gained leadership team approval to lead an effort to connect the Lean System tools with concepts that were common to several change management theories or frameworks, such as Diffusion of Innovations Theory; Donabedian’s Structure, Process, and Outcomes Framework; and the Institute for Healthcare Improvement (IHI) Rapid Cycle Improvement Model, including Lewin ( Donabedian, 2003 ; IHI, 2001 ; Lewin, 1951 ; Rogers, 2003 ).

Concurrently, the manager of nursing outcomes met with her clinical nursing team to plan a pilot project for bedside shift reporting (BSR). Ultimately, this project serves to coalesce the aforementioned simultaneous events of the new research environment of the facility and the combination of change theory and Lean model concepts into a workable framework for interprofessional collaboration.

• While the BSR is not the focus of this case review, this project served as a catalyst for the interprofessional collaboration among executives; mid-level and staff nurses; performance improvement professionals; the patient-family education resource center; and director of ethics.
• The purpose of this article is to discuss an interprofessional collaboration that sought consensus among members of different disciplines who typically utilized different theoretical approaches to problem solving.

We selected the crosswalk method to further collaboration and to create an intervention model for BSR. As BSR happened to be a substantive topic of interest to the organization, a natural opportunity emerged to display the utility of a crosswalk method as a tool to developing an intervention model.

• Inherent in interprofessional collaboration is a requisite that each discipline shares an understanding of the similarities and a common language of the change process.
• With the current emphasis on interprofessional problem-solving approaches for CQI in mind, collaboration becomes an essential part in delivering quality care and leading CQI projects ( AACN, 2011 ; Bridges et al., 2011 ; IOM, 2011 ).

Inherent in interprofessional collaboration is a requisite that each discipline shares an understanding of the similarities and a common language of the change process it proposes to use to develop an intervention model. Because the language and perspectives differ, professionals often struggle to find common ground for understanding so that each discipline maintains an influence.

Historically, many nurses have subscribed to Lewin’s Three-Step Model for Change ( Shirley 2013 ). For the past 10 years, the Lean System Approach has been at the forefront of efforts to implement and sustain change in healthcare delivery organizations (D’Andreamatteo, Lappi, Lega, & Sargiacomo, 2015 ).

This section provides a brief overview of Lewin’s Three-Step Model for Change and the Lean System Approach to change. Lewin’s Three-Step Model for Change Healthcare organizations are complex adaptive systems where change is a complex process with varying degrees of complexity and agreement among disciplines.

• The Change Model.
• Complex adaptive systems require that, in order for organizations to maintain equilibrium and survive, the organizations must respond to an ever-changing environment.
• Healthcare organizations are complex adaptive systems where change is a complex process with varying degrees of complexity and agreement among disciplines ( Plsek & Greenhalgh, 2001 ; Porter-O’Grady & Malloch, 2011 ).

Lewin’s Change Management Theory ( Lewin, 1951 ) is a common change theory used by nurses across specialty areas for various quality improvement projects to transform care at the bedside ( Chaboyer, McMurray, & Wallis, 2010 ; McGarry, Cashin & Fowler, 2012 ; Shirey, 2013 ; Suc, Prokosch & Ganslandt, 2009 ; Vines, Dupler, Van Son, & Guido, 2014 ).

• Lewin’s theory proposes that individuals and groups of individuals are influenced by restraining forces, or obstacles that counter driving forces aimed at keeping the status quo, and driving forces, or positive forces for change that push in the direction that causes change to happen.
• The tension between the driving and restraining maintains equilibrium.

Changing the status quo requires organizations to execute planned change activities using his three-step model. This model consists of the following steps ( Lewin 1951 ; Manchester, et al., 2014 ; Vines, et al., 2104 ).

1. Unfreezing, or creating problem awareness, making it possible for people to let go of old ways/patterns and undoing the current equilibrium (e.g., educating, challenging status quo, demonstrating issues or problems)
2. Changing/moving, which is seeking alternatives, demonstrating benefits of change, and decreasing forces that affect change negatively (e.g., brainstorming, role modeling new ways, coaching, training)
3. Refreezing, which is integrating and stabilizing a new equilibrium into the system so it becomes habit and resists further change (e.g., celebrating success, re-training, and monitoring Key Performance Indicators )

Other Considerations, Criticisms of Lewin’s change theory are lack of accountability for the interaction of the individual, groups, organization, and society; and failure to address the complex and iterative process of change ( Burnes, 2004 ). Figure 1 depicts this change model as a linear process. Figure 1. Lewin’s Three-Step Model for Planned Change However, in addition to change theory, healthcare has also shifted to a robust system for change called the Lean Systems Approach. Lean Systems Approach The Lean Model. The Lean Systems Approach (Lean) is a people-based system, focusing on improving the process and supporting the people through standardized work to create process predictability, improved process flow, and ways to make defects and inefficiencies visible to empower staff to take action at all levels ( Liker, 2004 ; Toussaint & Gerard, 2010 ).

To that end, Lean creates value for internal and external customers through eliminating waste (e.g., time, defects, motion, inventory, overproduction, transportation, processing). To create value and meet customer needs, Lean resources are provided in a robust toolkit. Value stream mapping is a tool to identify process relating to material and information and people flow.

It is useful to identify value added and non-value added actions. Value stream mapping is then used to create a plan to eliminate waste, create transparency (visual management), implement standard work, improve flow, and sustain change.Lean is a way of thinking about improvement as a never-ending journey.

• Overall, Lean is a way of thinking about improvement as a never-ending journey.
• Lean starts as a top-down, bottom-up approach, requiring leadership support.
• Over time, the goal is for all staff to contribute to problem solving and designing improvements to add value as defined by the customer.
• Value is defined as the services that the customer is willing to purchase ( Toussaint &Gerard, 2010 ).

In healthcare, adding value or meeting the customer or patient needs often occurs at the bedside, and nurses who provide care are closest to the bedside. Lean offers a common system, philosophy, language, and tool kit for improvement. Many quality improvement approaches have parallels and one well known is Deming’s Improvement Model of Plan, Do, Check, Act ( Deming Institute, 2015 ).

Deming’s model is also utilized in the Lean approach as a structure to make and sustain improvements. The IHI refers to this as Plan, Do, Study, Act-Rapid Cycle Improvement Model ( Scoville & Little, 2014 ). Both models, like Lean, strive for structure, methods, and improvement that never ends – continuous improvement, or Kaizen, in Lean terms.

For an organization to reap the full benefit of the Lean approach, it is necessary to integrate a system-wide approach ( D’Andreamatteo et al., 2015 ; Liker, 2004 ; Toussaint, 2015 ). Lean tools are designed to work together to maximize improvements within an organization and create a culture that embraces the journey of continuous quality improvement.the Lean System exemplifies a culture where each staff member is empowered to make change.

1. To this end, the Lean System exemplifies a culture where each staff member is empowered to make change.
2. This culture focuses on creating value, supporting staff, and improving process flow to increase quality, reduce costs, and increase efficiency.
3. Interprofessional collaboration is a necessary component to make improvements that involve going to the gemba (i.e., where the work is done or patient floor), to observe with our own eyes, ask questions, and learn.

Other aspects of Lean are the importance of utilizing data and identifying root cause (5 Why’s, or asking why five times). Becoming a learning organization by creating a safe environment to make mistakes (taking into account patient safety) is key in Lean; it is better to try, fail, learn, adjust, than to not try at all ( Simon & Canacari, 2012 ).

1. The Lean tools provide a medium for staff to break down problems, eliminate non-value added activities, and not only implement a new standard process, but sustain it as well ( Kimsey, 2010 ; Liker, 2004 ; Mann, 2010 ).
2. Aizen, or continuous improvement, means adjusting how healthcare organizations operate to create value.

Other Considerations, Incorporating Lean into the healthcare industry has been met with barriers. A common reaction to Lean within healthcare is that it only applies to manufacturing cars (e.g., the Toyota Production System) ( Liker, 2004 ; Toussaint & Gerad, 2010 ; Toussaint & Berry, 2013 ).

This reaction, in itself, becomes a barrier to apply and incorporate Lean into the healthcare industry. The interpretation of standard work being inflexible is also a barrier within healthcare. Standard work can be made flexible to adjust to unique patient scenarios and change according to changes in the healthcare environment, technology, and patient needs.

Kaizen, or continuous improvement, means adjusting how healthcare organizations operate to create value. Many hospitals have been applying Lean, such as Virginia Mason Medical Center, ThedaCare, Mayo Clinic, and Seattle Children’s Hospital ( Toussaint & Berry, 2013 ).

Furthermore, regulatory changes, such as those from the Centers for Medicare & Medicaid Services (CMS), and pressure on healthcare organizations to deliver high quality, safe and cost-effective care ( Toussaint & Berry, 2013 ). creates an environment whereby any member(s) of the organization can take action to improve performance and outcomes.

Healthcare can often be a shame and blame culture, which is very different than Lean ( Simon & Canacari, 2012 ; Toussaint & Gerad, 2010 ). A fundamental principle of Lean is that it attacks the process rather than the person or people to create a no-blame culture.

The Lean Systems Approach is designed to build trust, engage staff to trystorm (try ideas rapidly to see if they work), measure improvement, and implement and sustain. The Lean System is designed for problems to rise to the surface and become transparent so that they can be addressed. This transparency (visual management), along with clear measures and coaching, keeps important concerns in view of staff.

This creates an environment whereby any member(s) of the organization can take action to improve performance and outcomes ( Mann, 2010 ). Considering concepts from both Lewin’s Three-Step Model for change and the Lean Systems Approach opens the possibility of using the best of each of these models to facilitate interprofessional collaboration and a problem-solving approach.

• Through interprofessional collaboration, nursing and other disciplines can continue to improve processes and outcomes for the greater good of patient outcomes and the healthcare industry ( Brooks, Rhodes & Tefft, 2014 ).
• The next section offers a short explanation of the concept of interprofessional collaboration, which served as the problem-solving basis of our project to develop an intervention model for bedside shift reporting.collaboration can enhance collegial relationships and collapse professional silos, as well as improve patient outcomes.

In one of the more widely-cited definitions of collaboration, Gray ( 1989 ) describes “a process through which parties who see different aspects of a problem can constructively explore their differences and search for solutions that go beyond their own limited vision of what is possible” ( p.5 ).

• Collaboration involves multiple disciplines that span across individual professional silos, hence the term interprofessional is used for this case review.
• Collaboration is based on a naturalistic inquiry process, whereby each party takes on the teacher role, educating others, and the learner role, an openness and willingness to receive information from others, relinquishing power and control to move beyond their own perspectives for benefit of change ( Denzin & Lincoln, 2011 ; Gray, 1989 ).

Communication serves as a mechanism for sharing knowledge and is the hallmark for improving working relationships ( Gray, 1989 ). Collaborative efforts create spaces where connections are made, ideas are shared, opportunities for innovation flourish, and strategies for change to transpire ( London, 2012 ).

Today, healthcare associations and committees work diligently to ensure that interprofessional collaboration is part of their educational curriculum and practice standards. The American Nurses Association ( ANA, 2009 ) lists “collaboration” as a standard of practice for nursing administration. Similarly, the Institute of Medicine ( IOM, 2011 ) recommends that “nurses should be full partners, with physicians and other health professionals, in redesigning healthcare in the United States” ( p.32 ).

Nursing driven improvement projects and change initiatives that require interprofessional collaboration are common in redesigning healthcare delivery. However, simply grouping healthcare professionals from differing disciplines together to work on a project does not always cultivate collaboration ( Kotecha et al., 2015 ).

Effective interprofessional collaboration is a blending of professional cultures that arises from sharing knowledge and skills to improve patient care, and exhibits accountability, coordination, communication, cooperation, and mutual respect among its members ( Bridges et al., 2011 ; Reber, et al., 2011 ).

Such collaboration can enhance collegial relationships and collapse professional silos, as well as improve patient outcomes ( Kotecha et al., 2015,). There are facilitating and hindering factors for interprofessional collaboration associated with nursing driven projects ( Tviet, Belew, & Noble, 2015 ).

• Facilitating factors cited include: identifying key roles and individuals; soliciting early involvement and commitment from individuals and the group; and continuing to monitor progress and compliance well after implementation, including follow up with staff whose compliance is low.
• Hindering factors cited include: difficulty coordinating meeting times among multiple professions; bias of each profession as to what would work for them; discipline specific professional jargon; and the ability of one person or group to resist change and stop the project from moving forward ( Ellison, 2014 ).

Interprofessional collaboration lessens discipline-specific perspectives, thus improving quality of care and patient outcomes, and increasing efficiency and reducing healthcare resources. Interprofessional collaboration lessens discipline-specific perspectives, thus improving quality of care and patient outcomes, and increasing efficiency and reducing healthcare resources ( Patton, Lim, Ramlow, & White, 2015 ).

• An initial effort by all parties to visually display alignments and confront differences may minimize frustration and miscommunication among professionals.
• As we considered the synergy of concepts from both the Lewin Three-Step Model for Change and Lean Systems Approach, our idea was to use crosswalk methodology to begin collaboration with an interprofessional perspective.

The crosswalk is a robust qualitative method, often associated with theory building and inductive reasoning, which provides a compressed display or visual of meaningful information ( Miles & Huberman, 1994 ). Table 1 demonstrates the utility of the crosswalk method across domains, with examples from various domains to make comparative evaluations among programs, assessment tools, and theories to determine alignments and misalignments.

• Advantages of conducting a crosswalk are that it elucidates key connections and critical opportunities for growth and knowledge expansion, equitable resource allocation, and inquiry; and it depicts a large amount of information in a clear and concise manner.
• Disadvantages of the crosswalk method are that it often lacks the rigor and depth necessary to make causal links or provide generalizable information ( Miles & Huberman, 1994 ).

However, since the goals of qualitative methods are not causal links or generalizability, crosswalks can offer an intentional, systematic method to consider complex information in a meaningful way. Table 1. Examples: Utility of Crosswalk Across Domains

Domain	Reference	Purpose
Academia	American Association of Colleges of Nursing, 2011	To show interface between the nine master’s essentials against themes in the IOM’s report ( 2011 ).
Administration- Healthcare	Rudisill & Thompson, 2012	To conduct a gap analysis between required skills for nurse executives and competency assessment.
Clinical	Brandenburg, Worrall, Rodgriguez, & Bagraith, 2015	To delineate self-report measures using two aphasia tools.
Clinical	Sink, et al., 2015	To compare the findings of two mental state exams in the African Americans for accurate interpretation.
Public Policy, & Accreditation	Kamoie & Borzi, 2001	To confirm congruency between the final HIPAA privacy rule and federal substance abuse policy.
Public Health Surveillance	Parsons, Enewold, Banks, Barrett & Warren, 2015	To link unique physician identifiers from two national directories so that Medicare data can be used for research.
Public Health & Performance Management	Gorenflo, Klater, Mason, Russo, & Rivera, 2014; Kamoie & Borzi, 2001	To demonstrate the robust congruencies between two performance management programs.
Research	Lai, Cella, Yanez, & Stone, 2014	To further refine the psychometric properties of two fatigue scales.

Through a case review, we will describe how this IRF implemented a CQI process that integrated theory into practice via both Lewin’s theory and a Lean Systems Approach. We used crosswalk methodology to compare Lewin’s Theory and Lean, a process that ultimately led to collaboration and the creation of an intervention model for BSR.

1. For this case, the crosswalk was used to visually examine the relationships, concepts, and language used within two approaches to change and quality improvement.
2. Team members visualized the similarities and dissimilarities and adopted the teacher and learner role necessary to move the BSR project forward.

Our Team Initially, an interprofessional team of six consisting of executives; mid-level and staff nurses; performance improvement professionals; the patient-family education and resource center; and director of ethics convened through semi-monthly work sessions from early spring 2015 to early fall 2015 for the purpose of BSR.

• During interprofessional work sessions, the language used among team members when discussing the improvement process differed, which resulted in confusion among members and became a barrier to collaboration.
• What the team experienced was similar to what Andersen and Rovik ( 2015 ) described as the many interpretations of lean thinking.

Different definitions or interpretations of concepts were being made, prolonging the improvement and sustaining process. D’Andreamatteo et al. ( 2015 ) suggested that “.a common definition should be established to distinguish what is Lean and what is not” ( p.10 ).

The team wanted all participants of the various disciplines to see the commonalities of approach, to create a better known definition of each concept, and to continue to build collaboration and understanding for better outcomes. Visually showing theoretical connections helped improve the understanding of all team members and thus our process became more adoptable to the group.

Team members identified the translation barrier very early when they conducted a crosswalk of concepts and language from Lewin’s Change Theory to the language of Lean tools and principles. Lean, being both a system and a way of thinking, and not just a quick process to make point improvements, was linked with Lewin’s, three-step model of planned change.

1. Convened an interprofessional working group consisting of executive, mid-level and staff nursing, performance improvement, the patient-family education resource center, and director of ethics;
2. Reviewed literature on BSR to familiarize team with evidence-based practice for BSR;
3. Reviewed Lewin Three-Step Model for Planned Change;
4. Reviewed Lean System Approach for CQI;
5. Created a crosswalk;
6. Refined crosswalk based on team feedback;
7. Finalized crosswalk ( See Table 2 );
8. Presented to nursing staff-at-large to spread understanding.

The final crosswalk led to two outcomes, described below. Table 2. Crosswalk: Lewin Change Theory and Lean Concepts

Lewin (Stages) Examples of Concepts & Processes	Lean System (Not all inclusive)
Unfreezing Educating (showing data) Communicating Setting the scene Challenging Creating project guidelines Scoping the project Demonstrating issues Asking—what are mental models? (stakeholder analysis)	Plan (Ask why is this a focus; collect data & information to tell story; define baseline) Value streams/process flows (what is the current state?) Employee engagement Gemba walks Observations Data, pareto charts, visual displays, analysis 5 whys, root cause analysis 5S Evaluation (Sort, Simplify, Shine, Standardize & Sustain) Define customer demand (takt time) Evaluate 7 wastes & flows Targets & goals (current & future) Challenges/obstacles
Moving Brainstorming Presenting ideas Training Role modeling Coaching and mentoring Implementation Stakeholder engagement	Do Employee engagement Trystorm ideas Data: Re-measure against targets, goals & desired future state Problem Solving: Eliminate waste, maximize flows Gemba walks Observations Just In Time (JIT) – Just What is Needed The Right Amount Where it is Needed When it is Needed Develop standard work sequence Test & define new process flow Mistake proof (jidoka & poke-yoke) safety & quality built in Implement 5s (see above) Communicate Educate Coach Develop feedback loops Develop visual management (transparency)
Lewin (Stages) Examples of Concepts & Processes	Lean System (Not all inclusive)
Re-freezing-sustaining Communicate Re-train Reward Realize benefit >costs Evaluate Monitor Use Key Performance Indicators (KPIs) Socialize new employees/members	Check/Act (Sustain, stabilize, show improvement) Employee engagement Gemba walks Observations Accountability (expectations) Coaching (educating) Stabilize process Introduce countermeasures Re-measure; data, targets, goals Visual management

Our Outcomes This case review illustrates two outcomes. The first outcome of our project was enriched interprofessional collaboration and the second outcome was an intervention model BSR ( see Figure 2 ). These are briefly described below. The rich interprofessional collaboration that resulted in our final crosswalk illustrated the compatibility between Lewin’s Theory and Lean, operationalized the stages of change, and provided tangible strategies and tools to implement and sustain a BSR project.

1. This project will be implemented in 2016.
2. During a debriefing, the primary author (E.W) asked team members to comment about their experience with this CQI project.
3. Anecdotal information illustrates furthered collaboration within this IRF.
4. Team members verified the accuracy of the anecdotal information by reviewing its written form and gave permission for publication in this article.

The following remarks display three themes related to collaboration: the teacher-learner process where members move between educating others, and gaining knowledge by being open and willing to understand others; I came to the team with one idea about how to change systems for the benefit of patient care.

Initially, I felt the team was polarized due to their differing ways of thinking or points of view about change. Once we conducted the crosswalk between Lean and Lewin, I could visualize how we were saying similar things, but in a different way. I learned from my team members and I believe they learned from me.

I listened and I also felt heard. loved this experience and would use the crosswalk early in any interprofesssional project. the opportunity for innovative problem solving that transpired above your own world view for the common good; Nurses first came to the team with the feeling that Lean was just a passing fancy that would attempt to improve sustaining change and would fail and soon be forgotten.

1. They came away with useful tools to support their on-going challenges to continually improve patient care and nursing outcomes.
2. The promotion for enhanced partnerships among professionals.
3. Finding commonality in the Lewin and Lean languages and approach provided a way for our broader group to connect and discuss improvements in a proactive way.

Recognizing we were not against one another but working towards the same goal for quality of care. Since this took crosswalk took place, our partnerships are tighter due to a better understanding of each other’s disciplines and perspective. We have a point of reference to go back to for discussion.

Mutual respect was enhanced allowing us to have different conversations now with better focus on solutions. As noted previously, the manager of nursing quality and her clinical staff had done preliminary work on BSR. The second outcome of our subsequent team work, the intervention model in Figure 2, assimilated and utilized Lean and Lewin tools and principles that comprise the Standard Work Sequence (i.e, the BSR protocol).

Examples of this protocol included:

• The design and target population of intervention
• Process measures, such as measures of the intended delivery of the intervention (e.g., survey assessing on thoroughness, accuracy and efficiency of the BSR, patient interviews, and staff coaching and feedback tool)
• Outcome measures, which included measures for the intended response or results of the intervention (e.g., pain control, patient falls, pressure ulcers, availability of RNs, staff addressing concerns, and staff keeping patient informed)

Figure 2. Intervention Model for Beside Shift Reporting This article describes the two outcomes resulting from our interprofessional collaborative team effort to address the topic of interest using an intentional theoretical approach. As the intervention model is implemented, baseline and follow-up data will be obtained on the process and outcomes measures listed above.

1. Developing and utilizing our crosswalk to educate nurses on the Lean philosophy and tools adopted by this organization for CQI also familiarized non-nursing members of the interprofessional team with Lewin’s work and the common nursing culture and language for change.
2. It was the “aha” moment for all team members.

This breakthrough led to further collaboration and demonstrated the commonalities between Lewin’s Three-Step Model for Change and the Lean Systems Approach philosophy for CQI. Collaboration enhanced nursing buy-in to this process and a better understanding of the application of Lean principles.

Critical to collaboration is that parties realize that talking about and planning collaboration does not mean that it will happen quickly and easily. Barriers to communicating and understanding the process were greatly reduced. At the conclusion, nurses could quickly and easily see the benefits of using this adaptive model to implement and sustain change.

Critical to collaboration is that parties realize that talking about and planning collaboration does not mean that it will happen quickly and easily. Ultimately, the crosswalk offered two positive outcomes. The first was that it furthered interprofessional collaboration by engaging team members to clarify language and mental models of management approaches.

The second outcome was the development of the intervention model for BSR project, taking preliminary work on a project by the Manager of Nursing Outcomes and her team to the next level, with an end product that is being implemented in 2016. Future directions for our team are to determine the usefulness of the crosswalk for multi-discipline initiatives, such as the “patient up and ready” program, a joint initiative between nursing and allied health to ensure that patients are available and ready for each scheduled therapy session.

In sum, the initial outcomes of this case review demonstrate willingness among providers in multiple disciplines to seek consensus in understanding and utilize a shared framework to lead and sustain change for high quality and safe patient care. Doing so capitalizes on the expanded knowledge and expertise of multiple views and discipline-specific approaches to change management.

Elizabeth Wojciechowski, PhD, PMHCNS-BC Email: [email protected] Elizabeth Wojciechowski is a doctorally prepared APN in mental health nursing with 25 years of experience in clinical management, strategic planning, graduate-level education, and qualitative and quantitative research. Her most recent professional experience as Education Program Manager and Project Consultant includes collaborating with professionals on hospital-wide change management projects; developing a website and hospital-wide patient and family education system; project lead for strategic planning for a new cancer rehabilitation center; and leading the inception of the nursing research committee.

Former experience as an associate professor of nursing and a nurse manager includes serving on a university IRB board; teaching epidemiology, research, leadership and management at the graduate school level; developing and administering an outpatient dual-diagnosis program servicing children and families; and securing outside funding to pursue clinical research projects that resulted in publications in peer-reviewed journals and awards.

Tabitha Pearsall, AAB, Lean Certification Email: [email protected] Tabitha Pearsall received a business degree in Seattle, WA and has 25 years operations experience, 11 years of experience utilizing Lean or Six Sigma improvement methodologies, with the last eight years focused in healthcare. She is Lean Certified through John Black & Associates, whose method is modeled after the Toyota Production System.

She has implemented improvement programs in three organizations, two of which are in healthcare focused on Lean. Currently, Director of Performance Improvement at a large acute rehabilitation hospital, creating structure and implementing plan for integrating Lean methods and facilitating improvements hospital wide.

• Patricia Murphy, MSN, RN, NEA-BC Email: [email protected] Patricia J.
• Murphy has over 30 years of experience in nursing leadership and education.
• She currently is the Associate Chief Nurse at a large acute inpatient rehabilitation institute where she is responsible for the operations of seven inpatient-nursing units, the nursing supervisors, radiology, respiratory therapy, laboratory services, dialysis, and chaplaincy.

In this leadership role, she identifies, facilitates, implements, supports, and monitors evidence based nursing practices, projects and nursing development initiatives in order to improve nurse sensitive patient outcomes and add to the body of knowledge of rehabilitation nursing practice.

Former experience includes Director of Oncology Services and Hospice; strategic planning of a new cancer center; leading quality projects in oncology and within the stem cell transplant unit; designing and implementing an oncology support program; and developing and implementing a complementary therapy program to support inpatients, outpatients, and the community.

Eileen French, MSN, RN, CRRN Email: [email protected] Eileen French received a BSN from Northern Illinois University and an MSN from Loyola University. She is certified in rehabilitation nursing and has worked for over 30 years at a large acute inpatient rehabilitation institute, as a direct care nurse, clinical educator, clinical nurse consultant, and nurse manager.

• She is currently Manager of Nursing Outcomes, and has led a group of nurses responsible for planning and initiating bedside shift report in this rehabilitation setting.
• Brooks, V., Rhodes, B., & Tefft, N. (2014).
• When opposites don’t attract: One rehabilitation hospital’s journey to improve communication and collaboration between nurses and therapists.

Creative Nursing, 20(2), 90-94. Burnes, B. (2004). Kurt Lewin and complexity theories: back to the future? Journal of Change Mnagement, 4 (4), 309-325. doi: 10.1080/1469701042000303811 Ellison, D. (2014). Communication Skills. Nursing Clinics of North America, 50(1), 45-57.

How do you define digital transformation?

Digital transformation is the process of using digital technologies to create new — or modify existing — business processes, culture, and customer experiences to meet changing business and market requirements. This reimagining of business in the digital age is digital transformation.

1. It transcends traditional roles like sales, marketing, and customer service.
2. Instead, digital transformation begins and ends with how you think about, and engage with, customers.
3. As we move from paper to spreadsheets to smart applications for managing our business, we have the chance to reimagine how we do business — how we engage our customers — with digital technology on our side.

For small businesses just getting started, there’s no need to set up your business processes and transform them later. You can future-proof your organization from the word go. Building a 21st-century business on stickies and handwritten ledgers just isn’t sustainable. ” Every digital transformation is going to begin and end with the customer, and I can see that in the minds of every CEO I talk to.” Before looking at the hows and what’s of transforming your business, we first need to answer a fundamental question: How did we get from paper and pencil record-keeping to world-changing businesses built on the backs of digital technologies? Not so long ago, businesses kept records on paper.

Whether handwritten in ledgers or typed into documents, business data was analog. If you wanted to gather or share information, you dealt with physical documents — papers and binders, xeroxes, and faxes. Then computers went mainstream, and most businesses started converting all of those ink-on-paper records to digital computer files.

This is called digitization: the process of converting information from analog to digital. Learn what your peers think and know about digital transformation and find links to resources in this survey report. Finding and sharing information became much easier once it had been digitized, but the ways in which businesses used their new digital records largely mimicked the old analog methods.

Computer operating systems were even designed around icons of file folders to feel familiar and less intimidating to new users. Digital data was exponentially more efficient for businesses than analog had been, but business systems and processes were still largely designed around analog-era ideas about how to find, share, and use information.

The process of using digitized information to make established ways of working simpler and more efficient is called digitalization. Note the word established in that definition: Digitalization isn’t about changing how you do business, or creating new types of businesses.

1. It’s about keeping on keeping on, but faster and better now that your data is instantly accessible and not trapped in a file cabinet somewhere in a dusty archive.
2. Think of customer service, whether in retail, field ops, or a call center.
3. Digitalization changed service forever by making customer records easily and quickly retrievable via computer.

The basic methodology of customer service didn’t change, but the process of fielding an inquiry, looking up the relevant data, and offering a resolution became much more efficient when searching paper ledgers was replaced by entering a few keystrokes on a computer screen or mobile device.

As digital technology evolved, people started generating ideas for using business technology in new ways, and not just to do the old things faster. This is when the idea of digital transformation began to take shape. With new technologies, new things — and new ways of doing them — were suddenly possible.

Digital transformation is changing the way business gets done and, in some cases, creating entirely new classes of businesses. With digital transformation, companies are taking a step back and revisiting everything they do, from internal systems to customer interactions both online and in person.

They’re asking big questions like “Can we change our processes in a way that will enable better decision-making, game-changing efficiencies, or a better customer experience with more personalization?” Now we’re firmly entrenched in the digital age, and businesses of all sorts are creating clever, effective, and disruptive ways of leveraging technology.

Netflix is a great example. It started out as a mail order service and disrupted the brick-and-mortar video rental business. Then digital innovations made wide-scale streaming video possible. Today, Netflix takes on traditional broadcast and cable television networks and production studios all at once by offering a growing library of on-demand content at ultracompetitive prices.

Digitization gave Netflix the ability not only to stream video content directly to customers, but also to gain unprecedented insight into viewing habits and preferences. It uses that data to inform everything from the design of its user experience to the development of first-run shows and movies at in-house studios.

That’s digital transformation in action: taking advantage of available technologies to inform how a business runs. A key element of digital transformation is understanding the potential of your technology. Again, that doesn’t mean asking “How much faster can we do things the same way?” It means asking “What is our technology really capable of, and how can we adapt our business and processes to make the most of our technology investments?” Before Netflix, people chose movies to rent by going to stores and combing through shelves of tapes and discs in search of something that looked good.

Now, libraries of digital content are served up on personal devices, complete with recommendations and reviews based on user preferences. Streaming subscription-based content directly to people’s TVs, computers, and mobile devices was an obvious disruption to the brick-and-mortar video rental business.

Embracing streaming also led to Netflix looking at what else it could do with the available technology. That led to innovations like a content recommendation system driven by artificial intelligence. Talk about making the most out of your IT department! Similarly, digital transformations have reshaped how companies approach customer service. Explore trends causing companies to transform their products and customer relationships. Making call centers and in-store service desks run more efficiently with digital technology is of course great. But real transformation comes when you look at all available technologies and consider how adapting your business to them can give customers a better experience.

1. Social media wasn’t invented to take the place of call centers, but it’s become an additional channel (and opportunity) to offer better customer service.
2. Adapting your service offerings to embrace social media is another good example of a digital transformation.
3. But why stop there? As we mentioned earlier, digital transformation encourages businesses to reconsider everything, including traditional ideas of teams and departments.

That doesn’t necessarily mean tapping your service reps to run marketing campaigns, but it can mean knocking down walls between departments. Your social media presence can encompass service and marketing, tied together by a digital platform that captures customer information, creates personalized journeys, and routes customer queries to your service agents.

What is the difference between digitization and digitalization?

What is digitalization? – In digitization, physical objects or information are stored in computers, but the process where this data is used may not be changed. This is the key difference between digitization and digitalization. Through digitalization, digital technologies and digitized data are utilized to enable or improve processes.

What are the 4 pillars of transformational change?

Transformational Leadership – To use this approach in the workforce, one must first understand exactly what transformational leadership is. In the simplest terms, transformational leadership is a process that changes and transforms individuals (Northouse 2001).

1. In other words, transformational leadership is the ability to get people to want to change, to improve, and to be led.
2. It involves assessing associates’ motives, satisfying their needs, and valuing them (Northouse 2001).
3. Therefore, a transformational leader could make the company more successful by valuing its associates.

One successful transformational leader was Sam Walton, founder of Wal-Mart, who often visited Wal-Mart stores across the country to meet with associates to show his appreciation for what they did for the company. Walton gave “rules for success” in his autobiography, one of which was to appreciate associates with praise (Walton 1996).

Idealized influence describes managers who are exemplary role models for associates. Managers with idealized influence can be trusted and respected by associates to make good decisions for the organization. Inspirational motivation describes managers who motivate associates to commit to the vision of the organization. Managers with inspirational motivation encourage team spirit to reach goals of increased revenue and market growth for the organization. Intellectual stimulation describes managers who encourage innovation and creativity through challenging the normal beliefs or views of a group. Managers with intellectual stimulation promote critical thinking and problem solving in an effort to make the organization better. Individual consideration describes managers who act as coaches and advisors to the associates. Managers with individual consideration encourage associates to reach goals that help both the associates and the organization.

Effective transformational leadership results in performances that exceed organizational expectations. Figure 1 illustrates the additive effect of transformational leadership because managers must pull together the components to reach “performance beyond expectations” (Northouse 2001). Figure 1. Additive effect of transformational leadership Each of the four components describes characteristics that are valuable to the “transformation” process. When managers are strong role models, encouragers, innovators, and coaches, they are utilizing the “four I’s” to help “transform” their associates into better, more productive and successful individuals.

What are the 5 stages of transformational change?

Five stages of change have been conceptualized for a variety of problem behaviors. The five stages of change are precontemplation, contemplation, preparation, action, and maintenance. Precontemplation is the stage at which there is no intention to change behavior in the foreseeable future.

Many individuals in this stage are unaware or underaware of their problems. Contemplation is the stage in which people are aware that a problem exists and are seriously thinking about overcoming it but have not yet made a commitment to take action. Preparation is a stage that combines intention and behavioral criteria.

Individuals in this stage are intending to take action in the next month and have unsuccessfully taken action in the past year. Action is the stage in which individuals modify their behavior, experiences, or environment in order to overcome their problems. The Academic Health Collaborative provides interdisciplinary teaching and learning spaces, and access to experts, for all of URI’s health disciplines. Learn More

What are the four stages of transformational change?

The stages are shock, anger, acceptance and commitment. People’s initial reaction to the change will likely be shock or denial as they refuse to accept that change is happening. Once the reality sinks in and people accept the change is happening, they tend to react negatively.

What are examples of transformational change?

McDonald’s –

McDonald’s is an excellent example of relevant transformational change. In the year 2006, McDonald’s faced a severe backlash from multiple health activists and critics. The backlash resulted in huge losses and unfavorable reviews. The CEO John skinner tackled the criticism by adding healthier items to the menu. Furthermore, he improved the customer service methodology. The result of this transformation was a friendly environment and outlook that prevented the company from collapsing.

Transformational Change Example – McDonald’s

What is the goal of transformational change?

How to manage transformational change – When it comes to change, there are two types: transformational and transactional. Transformational change is about evolving the organization as a whole and developing new processes and ways of working that make the company more successful.

1. Establish a clear goal for the change initiative.
2. Get everyone on board with the vision for the future.
3. Create a roadmap for how to get there.
4. Put in place mechanisms to track progress and ensure success.

What is an example of transformational leadership in healthcare?

Transformational leaders are leaders who employ a distinct management style. The style is just as the title suggests – the leader seeks to transform a workplace to promote success. In other words, the leader goes above and beyond daily operations, motivates staff, and sets goals for the workplace. Transformational leaders should:

Serve as role models Motivate the team Demonstrate concern for individual follower’s needs Challenge followers to be creative

Nurse leaders can also demonstrate this style of leadership. They motivate staff to reach goals that align with a healthcare organization or facility’s vision or mission. An example would be a facility’s goal to increase patient satisfaction. The nurse leader would set goals to improve customer service, collaboratively develop an initiative or initiatives, and measure results (i.e., a patient survey) – engaging staff along the way.

Is There Friction Between Nurse Managers and Staff Nurses? Nurse Manager Leadership Recommendations for Staff Engagement and Success What Leadership Positions Are Available for ADN Nurses?

Keeping this example in mind, we can break it down further to illustrate the transformational model of leadership. Beginning with goal setting in the example above, the nurse leader could hold a staff meeting and include all staff in a department. He or she would then identify the reason for the goal; for example, patient satisfaction has dropped as evidenced by an increase in patient complaints.

1. The nurse leader may provide specific examples, such as in the increased number of complaints from patients that state they are waiting too long after they press the call light to receive assistance from staff.
2. The nurse leader may then engage the staff and brainstorm ways to respond to call lights faster, thereby increasing patient satisfaction.

He or she must encourage ideas, listen to staff, and acknowledge their concerns. They should interact respectfully with staff and remain positive throughout the brainstorming session. Once the group develops a goal and an initiative, the nurse leader may choose to pilot it.

• Using the prior example, let’s say the group came up with an initiative to have staff spread out around the nursing unit as opposed to them being assembled at the nursing station.
• Being spread out may reduce the time it takes to respond.
• The nurse leader may choose to pilot for a few weeks or a few months and see if the number of patient complaints drops.

He or she may call a follow-up meeting to present results and engage staff in their thoughts about the pilot, including how it worked and what may not have worked as well as expected. One of the benefits of transformational-style leadership is that it builds a professional, respectful relationship between a leader and staff.

Clinical Nurse Leader Programs Master’s in Nursing Administration Programs Dual MSN/MBA Degree Programs

Why is change needed in the NHS?

NHS England » Change is the key to NHS survival The NHS must change if it is to survive and remain sustainable. That was the blunt message from NHS England’s chief executive Sir David Nicholson to the today. “We need to put systems in place that make change happen,” he told a packed audience.

“This is a matter of survival for the NHS. “We are at a fork in the road. Those who say we can muddle through for two or three more years as we are and sustain the NHS are wrong. The old ways will not sustain it and we will only see a managed decline.” Sir David was joined on the Community Stage at Manchester Central by MP Stephen Dorrell, the chairman of the Health Select Committee, and Dame Ruth Carnall, the former chief executive of NHS London and healthcare consultant, to debate ‘Is reconfiguration a luxury or a necessity?’ Sir David said several major changes had to be put in place including empowering people to take charge and make decisions about their own health and care.

“Changes are about organising services around individuals and we need to make sure we have primary care services that can support 7-day working. We need to integrate services, we need to be efficient in elective services and urgent and emergency care services need to be fixed.

• All this is a significant challenge and involves a change in the way we deliver services.
• It is difficult and it is tough.
• We need to nationally make the case for the change.
• We need to be shoulder to shoulder in these changes and tackle the politics.” Stephen Dorrell said he regarded the subject of the debate as “a rhetorical question”, adding: “Reconfiguration is NHS jargon for ‘change’, and we should embrace change.

“The NHS needs to change because the demands we are being asked to meet are changing. The needs of the citizens we now provide services for are different from the needs of the citizens that the system grew up with. “Reconfiguration must be at the core of the management’s objectives as it moves forward.” Dame Ruth added: “How did we come up with a word like ‘reconfiguration’? I suspect to most of the public it means cuts and closures.

What are 4 benefits of change?

1. What is change management and why is it important – When it comes to change management, many people may be unsure of what it is exactly. Change management is the process of planning, implementing and monitoring changes in an organization, It’s important because it helps ensure that changes are implemented smoothly and without issue.

• Employees need to be prepared for changes, and the change management process should be followed in order to ensure that everyone is on the same page.
• Changes can be difficult for employees, so it’s important to have a plan in place to help them through the transition.
• There are many benefits to change management.

Some of these benefits include improved communication, increased productivity, reduced stress and improved decision making. change management can also help improve employee morale and create a more positive work environment.

Why is change important in nursing?

Managing Change in Healthcare One of the key concerns in Health care management is management of change and health care professionals are obligated both to acquire and to maintain the expertise needed to undertake their professional tasks, and all are obligated to undertake only those tasks that are within their competence.

• Moreover, change occurs continuously around us.
• We may want to support it, be indifferent to it, and be passive or participate in it.
• The pace of change has increased dramatically.
• Managing change is about handling the complexity of the process.
• It is about evaluating, planning and implementing operations, tactics and strategies and making sure that the change is worthwhile and relevant.

Managing change is a complex, dynamic and challenging process. It is never a choice between technological or people-oriented solutions but a combination of all. Effective change has been characterized as unfreezing old behaviours, introducing new ones, and re-freezing them.

– Change may be continuous, sporadic, occasional, or rare. Predictable change allows time for preparation, whereas unpredictable change is more difficult to respond to effectively. Since changes in healthcare occur so rapidly, they are less likely to be predictable. The only sustainable competitive advantage today is the ability to change, adapt, and evolve – and to do it better than the competition.

Failure rates are associated to a number of different factors such as lack of vision and commitment from senior management, limited integration with other systems and processes in the organization, and ill-conceived implementation plans. If organizations are to experience a greater level of success in their development efforts, managers and executives need to have a better framework for thinking about change and an understanding of the key issues which accompany change management.

• Even if change is endorsed, employees want to understand why change is happening and how they will be affected.
• Layoffs or other organizational changes can lead to paranoia, confusion, anger and insecurities under the auspices of change.
• Promoting change is both demanding and fatiguing.
• Bringing about change requires the manager to challenge the precedent, and requires perseverance against the habits and norms of established behaviours.

Bringing about change takes time and requires the commitment of time on the part of the manager. The manager must know the values that matter and focus on changing those as opposed to reacting to every invitation for change. She/he must be clear about what is important and develop responses and proactive actions accordingly.

1. Organisations that employ large numbers of professionals will not perform well if they become overly bureaucratic.
2. Steiner stated that organisations that are known to be bureaucratised and hierarchical are less flexible, less amenable to change and less likely to empower staff.
3. An organisation will not get full value from its professional employees if it insists that they do only what they are told.

Therefore, leaders have to learn how to manage change, rather than change manages them in order to move forward with success. Coram and Burnes argued that there is no “one best way” to manage change in an organization, and that public sector organisations need to introduce an approach to organisation change which matches their requirements and situation.

1. It has to be admitted that change in management will keep happening.
2. In addition, leaders need to understand the change process and issues that are involved with it in order to have the capability to lead and manage change and improve efforts effectively.
3. They must learn to overcome obstacles and cope with the chaos that naturally exists during the complex process of change.

Leaders should help employees and other stakeholders structure and build effective teams by developing new organizational structures and creating a shared vision that focuses on authentic employees’ output. Such inspired and informed leadership is critical and essential for organizations to be successful.

Establishing a clear vision about the direction of the change process is another key element for assuring successful change. Measuring and monitoring outcomes of the change process is essential for recognizing whether or not the change process has fulfilled its purposes. Since change is continuing to happen in organizations and associated modifications are taking place, it is important for those who are in charge of the change process to record and focus on the emerging problems due to change.

This will help avoid them in the future so that the new administration system will help to manage the change in the proper and best manner. To conclude, there are global changes happening, which drive individual organisations to change accordingly in order to proceed ahead.

• These changes have created problems within organisations concerned.
• Solutions are required to overcome any emerging problems due to the change that are continuing to happen.
• And in order to keep the organisation functioning according to plan, managers and employees’ knowledge and skills should be upgraded; necessary training on the changes in technology must be provided.

Individuals who are in charge of the change process should record all emerging problems and design an ultimate solution for better future of organisation. Changes in healthcare practice are welcome if they improve quality and safety, or save money. However, it is important to tailor health care delivery to the needs of the local population and create awareness programmes and clear communication between the public and organization is essential and highly required.

In addition, the rate of change in healthcare is accelerating, not slowing and the powerful forces that are transforming healthcare can generate vast economic potential for those who are able to employ effective survival techniques in the short term and at the same time plan for success in the long term.

To accomplish this, an organization must harness the forces driving transformation and use them to its advantage. Finally, the change in health services entails incremental improvement on existing organizational capabilities, more empowerment to the changing agents and continuous support to the changing leaders.1.

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An Aspen Publication, 1998.4. Mabey C. Mayon-White. Managing change.2nd ed. The Open University: Paul Chapman Publishing Ltd, 1993.5. Davies C, Finlay L, Bullman A. Changing Practice in health and social care. The Open University: SAGE Publication, 2000.6. Freed DH.

Please don’t shoot me: I’m only the change agent. Health Care Superv 1998. Sep; 17 ( 1 ):56-61 7. Appelbaum SH, Vecchio RP. Managing Organizational Behaviour: A Canadian Perspective. Toronto: Harcourt Brace & Company, 1995.8. Armenakis AA, Harris SG, Mossholder KW. Creating readiness for organizational change.

Hum Relat 1993; 46 :681,10.1177/001872679304600601 9. Dowd SB, Shearer R, Davidhizar R. Helping staff cope with change. Hosp Mater Manage Q 1998. Aug; 20 ( 1 ):23-28 10. Mariotti J.10 steps to positive change. Ind Week 1998; 247 :82 11. Church AH, Siegal W, Javitch M, Waclawski J, Burke WW.

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What are the 3 stages of change theory?

You get one of the most influential models in organizational psychology – Lewin’s change model. The model describes three phases that people go through as they make changes in their lives. These phases are unfreezing, changing, and refreezing.

What is transformational leadership NHS?

What is Transformational Leadership in Healthcare? – Transformational leadership in healthcare is crucial for many purposes. In the health care setting, transformational leadership involves:

Envisioning a desired outcome. Examining present reality. Recognising opportunities for improved health care

Transformational leadership in healthcare organisations is an interdisciplinary approach, This approach is taken to address the desired outcomes. And they identify the need for organisational change. This is based on health outcome data and input from staff, patients, and the community.

They collaborate and build relationships with them to assess overall community health needs. And this helps form a collective vision that aligns with those needs. Instead of giving direct orders to the employees, such leaders provide them with the tools and confidence. It’s so that they can take responsibility and make decisions as needed.

The goal of transformational leadership is to create an improved workplace. A place that is inspired, motivated, communicative and filled with people who take charge. A place that exhibits a strong commitment to the success of the organisation.

Which is a transformational change?

What is transformational change? – Transformational change is a type of change that occurs when an organization makes a fundamental change in how they operate. It’s often triggered by changes in an organization’s environment. This type of change can be challenging, but it can also lead to significant improvements in performance.

Transformational change typically requires a new vision, new goals, culture change, and new ways of doing things. It can be difficult to implement, but the rewards can be significant. The key benefits of transformational change include increased employee engagement, improved performance, and higher levels of creativity and innovation.

The role of HR in transformational change is crucial. HR professionals need to identify when a change is needed and help create a vision for the future that inspires employees and managers alike. They also need to be able to manage the transition process, ensuring that everyone is on board and that the change is executed successfully.

What is transactional and transformational leadership in the NHS?

Discussion – In this study, the four-week IMPACT leadership training was designed to increase transformational and transactional leadership skills in residents of various specialties. Transformational leadership refers to the leader’s ability to motivate team members to commit to a common goal.

Transactional leadership involves the practice of exchanging benefits for excellent performance. Taking into account that a comprehensive set of leadership skills is necessary to meet the complex demands of daily clinical practice, we based our training on the Full Range Leadership Model. Previous studies on leadership trainings have mainly been conducted in the organizational setting, primarily focusing on the transformational leadership component.

The 7 Biggest Future Trends In Healthcare

The study by Abrell et al. can be considered as one of the most comprehensive effort to train transformational leadership in a long-term study design. In their study, transformational leadership was assessed by subordinates and leadership performance was rated by leaders’ supervisors, showing a significant improvement over time.

• Abrell et al.
• Incorporated feedback mechanisms into their curriculum as well as theoretical sessions giving an in-depth review of different transformational leadership styles, such as ‘individual consideration’ or ‘inspirational motivation’.
• To the best of our knowledge, there is no program training transformational and transactional leadership alike, neither in the organizational nor in the medical field of application.

Existing leadership programs in graduate medical education, such as the one by Awad et al., focus on broader communication skills. Awad et al. implemented a leadership training for surgical residents over the course of 6 months. They aimed at improving collaborative leadership through fostering a communication style that is regarded less commanding.

Before and after completion of the training, residents assessed self-perceived alignment of the team, communication and integrity. The authors were able to demonstrate significant increases in these areas; however, training effects in terms of leadership performance such as improved team interactions have not been evaluated.

Our results go beyond prior research in different ways: First, unlike in the study by Abrell et al., we not only tested for transformational leadership skills but also for transactional leadership skills in a pre-post design. Second, for the first time, the two leadership components were trained in a group of residents, extending external validity of the proposed leadership model to the medical education area of application.

Overall, our results indicate that the FRLM is well suited for empirically testing leadership skills in residents of a wide spectrum. Third, we built upon first attempts to test the model in the medical context by providing a targeted, multimethod, structured training curriculum to improve resident leadership.

Fourth, the different evaluation data modalities we applied (self-assessment, evaluation of performance) expand existing studies that have not evaluated the behavioral component of leadership. We provided evidence that both distinct leadership components laid forth in the model are applicable for displaying significant increases in residents’ leadership performance.

• For example, at the end of the training, residents were able to show appreciation for good efforts ( transformational leadership skills ) and make clear who is responsible for specific tasks ( transactional leadership skills ).
• Interestingly, residents scored higher in self-assessed transactional leadership at baseline than in transformational leadership.

They did change significantly in both leadership components, yet remained higher mean scores for transactional leadership also after training was completed. We believe this reflects the unique requirements of the clinical setting where fostering and sustaining patient safety is among the highest of priorities.

In their everyday clinical practice, residents might feel more obliged to intervene and exert active control in order to prevent medical errors, thus exhibiting more transactional leadership behaviors. Our results further suggest that four weeks of training seem to be a good starting point to effectively train leadership skills in residents across a wide range of specialties.

A control group did not increase in self-assessed leadership skills. It is remarkable that a substantial gain in both leadership components was demonstrated by video coding of simulations from an external evaluator perspective and by subjective data, as well.

The increase in leadership skills from two different, independent perspectives supports the applicability of the leadership model for graduate medical education. We controlled for a possible confounding effect of passive leadership at baseline, as this most ineffective leadership component is considered to attenuate the effect of transformational leadership on safety.

Consistent with previous studies, mean scores for passive leadership were low in both groups.

What are examples of transformational change?

McDonald’s –

McDonald’s is an excellent example of relevant transformational change. In the year 2006, McDonald’s faced a severe backlash from multiple health activists and critics. The backlash resulted in huge losses and unfavorable reviews. The CEO John skinner tackled the criticism by adding healthier items to the menu. Furthermore, he improved the customer service methodology. The result of this transformation was a friendly environment and outlook that prevented the company from collapsing.

Transformational Change Example – McDonald’s