Shirey, Maria R. PhD, MBA, RN, NEA-BC, FACHE, FAAN
Author Affiliations: Associate Professor, Doctor of Nursing Practice Program, University of Southern Indiana, College of Nursing and Health Professions, Evansville.
Correspondence: Dr Shirey, University of Southern Indiana, College of Nursing and Health Professions, 8600 University Blvd, HP-2044, Evansville, IN 47712 (firstname.lastname@example.org).
Organizational change is a constant in today's dynamic healthcare systems. Given that maintaining the status quo is not a desired strategic option, nurse leaders must proactively scan the competitive environment to formulate needed change initiatives. Many viable change initiatives, however, fail to gain approval and thus never go beyond the drawing board. Why does this happen? One explanation is that nurse leaders may not always create the sense of urgency needed to make change happen.
Overview of Change Framework
In 1996, John Kotter,1 then a professor of leadership at the Harvard Business School, published a seminal book entitled Leading Change. In this book, Kotter1 proposes an 8-step framework for leading transformational change (Table 1). The framework views change as a process that includes 3 groupings of steps: defrosting the status quo, introducing new practices, and grounding change in corporate culture.
Kotter's1 first grouping of steps 1 to 4 collectively defrosts a hardened status quo. Steps 1 to 4 include establishing a sense of urgency, creating the guiding coalition, developing a vision and strategy, and communicating the change vision. Collectively, steps 1 to 4 prime the landscape for successfully implementing change. Of all the steps within Kotter's framework,1 step 1, establishing a sense of urgency, is the most important step because it requires tackling inertia.
The second grouping of steps 5 to 7 introduces new change practices and initiatives. Steps 5 to 7 include empowering broad-based action, generating short-term wins, and consolidating gains. To facilitate change requires leaders to eliminate obstacles interfering with the desired vision. This grouping of steps may require structural, process, and system changes that allow for new performance approaches. Planning for quick gains facilitates momentum and excitement for change.
Last, the third grouping of steps, which includes step 8, involves anchoring new approaches in the culture. According to Kotter,1 cultural change occurs because new methods yield desirable behavioral change and superior performance. Sustaining cultural change requires communicating ongoing results and "routinizing" organizational practices. Examples of routinizing or embedding change into everyday practices may involve creating new job descriptions, employee orientation programs, in-service educational offerings, and performance evaluations. Leadership development and sustainable change capacity are also needed to perpetuate new business practices. Meyer and Stensaker2 argue that organizations with sustainable change capacity must be ambidextrous. That is, organizations seeking sustainable change must be able to implement radical change yet simultaneously maintain daily operations.
According to Kotter,1 the 8-step change framework takes time and must be sequential. Jumping to step 5 without mastering steps 1 to 4 sets up leaders for failure and thus is counterproductive for sustainable change. Reaching step 8 is necessary to complete a planned change process and to observe rooted outcomes of transformation. Kotter1 argues that critical mistakes in any of the 8 steps have devastating impact, slowing momentum and negating gains.
Tactics for Establishing a Sense of Urgency
Establishing a sense of urgency is the first and most difficult step in Kotter's framework and one needed to advance any major change. Kotter3 defines true urgency as actions needed on critical issues that are of pressing importance and must be addressed now, not eventually. Establishing a sense of urgency involves scanning the environmental landscape to identify market and competitive realities. Through this strategic surveillance approach, nurse leaders identify major opportunities as well as potential crises. Kotter3 identifies 4 tactics needed to establish a sense of urgency: bring the outside in, behave with urgency every day, find opportunity in crises, and deal with no-nos (Table 2). Tactics are tools that leaders use to tailor the change implementation plan and diminish identified barriers.4
Bring the Outside in
Bringing the outside in involves connecting the organization's internal reality with external opportunities. Organizations that focus too much on their internal situation and ignore external forces create a disconnect that reduces the organization's sense of urgency. Believing that one's organization has such a strong product or successful track record that it cannot fail breeds arrogance and complacency (the opposite of urgency). To create a sense of urgency, organizations and their leaders need to remain vigilant and hungry for new opportunities. Bringing the outside in or monitoring the external environment to isolate then trial or design best practices is a way of keeping organizations and their leaders fresh and receptive. Creating a business case for change is a way to align internal realities and capabilities with external opportunities consistent with organizational goals.
Ways in which the external environment can be brought inside include listening to customers both using and providing the organization's services. Frontline personnel engage with customers on a daily basis and are in a key position to convey the customer's voice. Listening directly to customers also provides a vehicle for understanding a need for change. Sometimes the customer's messages become more compelling when recorded and shared. Kotter3 argues for the value of recorded messages (ie, video) to bring the outside in, suggesting that "material that is emotionally and intellectually honest, shown at the right time to the right group, can be surprisingly influential."3(p75)
Kotter3 advocates openly sharing troubling data. Although the inclination might be to only circulate concerning information among senior leaders, mobilizing the full workforce for improvement necessitates shared knowledge. Not knowing about impending problems fosters complacency, wastes precious time, and undermines the organization's future.
Sending employees out of the organization to learn new information and "scout" potential opportunities and partnerships contributes to creating the need for change. Equally important is the need to bring outside people inside one's organization to provide different perspectives that could galvanize performance improvement. In times of financial constraints, organizations become shortsighted, often not sending employees to industry conferences or bringing external experts into the organization. These supposedly cost-cutting measures interfere with establishing a sense of urgency and are not long-term focused.
Behave With Urgency Every Day
Behaving with urgency every day involves leaders being alert and engaged as well as cognizant of tone, attitude, and time. According to Kotter,3 leaders behaving with urgency stay ahead of the competition (alert), respond to requests with passion (engaged), speak with a steady nonthreatening voice (tone), incorporate a "yes we can" approach (attitude), and deliver work sooner than expected (time). Behaving with urgency means not resting on past laurels or taking for granted that yesterday's success could represent tomorrow's failure.
Behaving with urgency requires the ability to clear the decks, a practice Kotter3 suggests, involves purging calendars and delegating as needed. Leaders going from meeting to meeting without time to complete follow-up activities or reflect on their work become fatigued and lose their sense of urgency. To combat exhaustion and enhance responsiveness, behaving with urgency would entail eliminating low-priority and unnecessary meetings or projects (purging) and empowering others to solve their own problems (delegate).
Find Opportunity in Crises
Kotter's3 framework suggests that "crises are not necessarily bad and may, under certain conditions, actually be required to succeed in an increasingly changing world."3(p120) This statement supports the notion that leaders should stay alert for opportunities that come from crises. Although structures, processes, and rules should be in place to avert crises, if a crisis does actually occur, leaders should not let that perfectly good crisis go to waste.5 Crises can increase an organization's sense of urgency mobilizing needed action leading to vital progress.
Deal With the No-Nos
No-nos are individuals within organizations who are highly skilled urgency killers.3 No-nos are not thoughtful skeptics; rather, they are disruptive, closed minded, and potentially dangerous. To cultivate a sense of urgency for change necessitates removing or neutralizing urgency killers. There are 3 effective ways to deal with no-nos. First, a no-no can be given a faraway assignment, keeping them from creating mischief that could interfere with increasing urgency. Second, counseling no-nos out of the organization is a way to remove these urgency killers. Third, no-nos who undermine progress may be immobilized using social pressure. Peers calling peers on unacceptable behavior sometimes have a more powerful effect than managers counseling these no-nos.
Leading change is an essential strategic nursing leadership competency. To facilitate organizational change, however, nurse leaders must first use persuasive messages and tactics that create a sense of urgency and mobilize others to action. Sustaining a high sense of urgency over time interferes with complacency, thus positioning leaders and organizations for reaching high performance levels and achieving desirable outcomes. Understanding Kotter's3 8-step change framework1 and the 4 key tactics for establishing a sense of urgency are crucial for implementing successful transformation and sustainable change.
© 2011 Lippincott Williams & Wilkins, Inc.