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Change

Advances in Skin & Wound Care: December 2018 - Volume 31 - Issue 12 - p 533
doi: 10.1097/01.ASW.0000547844.39931.b6
DEPARTMENTS: EDITORIAL

Elizabeth A. Ayello, PhD, RN, CWON, ETN, MAPWCA, FAAN, is the co–Editor-in-Chief of Advances in Skin & Wound Care; Faculty, Excelsior College School of Nursing, Albany, New York; and President, World Council of Enterostomal Therapists, President, Ayello Harris & Associates, Inc, Copake, New York, President (1999) National Pressure Ulcer Advisory Panel. R. Gary Sibbald, MD, DSc (Hons), MEd, BSc, FRCPC (Med Derm), FAAD, MAPWCA, JM, is the co–Editor-in-Chief of Advances in Skin & Wound Care; Professor, Medicine and Public Health, University of Toronto, Toronto, Ontario, Canada; Director, International Interprofessional Wound Care Course & Masters of Science in Community Health (Prevention & Wound Care), Dalla Lana Faculty of Public Health, University of Toronto; and President (2008-2012), World Union of Wound Healing Societies.

The end of the calendar year can be a time to reflect on what the past year has brought and what the new year may bring. This past year has brought change to Advances. This includes Dr Salcido transitioning to Editor Emeritus, as well as the addition of new members to the Editorial Advisory Board and Peer Review Panel. Just as we say farewell to the old year, we have said goodbye to some Board members who are retiring from their volunteer service to the journal. We thank them for their many contributions and thoughtful reviews of submitted manuscripts.

For us personally, becoming co–editors-in-chief and working with the Wolters Kluwer editorial team have provided an opportunity to revisit the concept of change, which has many elements that we can examine. For example, some journal readers may not be aware that in this digital age there are online exclusives available on our website, www.woundcarejournal.com. In 2018, we published three articles online that highlight wound care around the world:

  • Preventive Effect of a Microclimate-Regulating System on Pressure Ulcer Development: A Prospective, Randomized Controlled Trial in Dutch Nursing Homes (The Netherlands, January)
  • Developing a Mobile App for Prevention and Treatment of Pressure Injuries (Brazil, February)
  • Pressure Injury Prevention: Knowledge and Attitudes of Iranian Intensive Care Nurses (Iran, April)

Change can be exciting. For some people, accepting change and dealing with the change process is challenging. Barriers to change exist, but when skillfully managed, change can bring effective results. E. M. Rogers’s1 1962 diffusion of innovation theory can be used to explain how change in ideas and technology, coupled with adoption of new ways of doing things, can be disseminated. Rogers2 describes five groups of people based on how they react to change. What group do you belong to?

  • Innovators (2.5% of the population) are risk takers who are the first to accept change but also have the resources and stature to accommodate failure.
  • Early adopters (13.5% of the population) are key opinion leaders, respected by their peers, who judiciously communicate change.
  • The early majority (34% of the population) follows innovator lead with a more general introduction of change into practice.
  • The late majority (34% of the population) only follow a new adoption to practice after it is clear that the majority of practitioners have accepted the change.
  • Laggards (16% of the population) focus their activities on tradition with no or minimal connection to early adopters or the majority of colleagues.

One of the innovations in healthcare delivery that could improve patient outcomes is the Integrated Practice Unit.3 Originally designed as a tool for analyzing competition in business, it can be adapted for healthcare; the idea is to arrange teams around patient medical problems and not medical specialties. The Porter model emphasizes value, or best patient outcomes for the lowest healthcare dollar.3 The five stakeholders of healthcare are patients, professionals, payers, policy makers, and politicians. Healthcare professionals, along with the payers and policy makers, need to be the innovators and early adopters of value-based care, integrating care across the continuum. Outcomes and costs should be measured for every patient, facilitating a move toward bundled payments. Expanded services could be amortized across institutions that comprise multiple sites using technology as a platform.

For example, comprehensive diabetes services may link foot care to eye and kidney care. This realignment would create an integrated care model with doctors, nurses, and allied health professionals working in concert with support staff to coordinate patient-centered care for improved outcomes. Early adopters could provide measurable outcomes for a more general rollout to the late adopters and laggards.

Dan Millman4 wrote that “the secret of change is to focus all of your energy not on fighting the old, but on building the new.” You, the readers of Advances, can make change in your practice. We wish you the best in your endeavors in 2019.

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Elizabeth A. Ayello, PhD, RN, CWON, ETN, MAPWCA, FAAN

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R. Gary Sibbald, BSc, MD, DSc (Hons), MEd, FRCPC (Med Derm), FAAD, MAPWCA, JM

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REFERENCES

1. Rogers EM. Diffusion of Innovations. 1st ed. New York, NY: Free Press of Glencoe: 1962.
2. Rogers EM. Diffusion of Innovations. 5th ed. New York, NY: Free Press of Glencoe: 2003.
3. Porter ME. Lee TH. The strategy that will fix health care. Harvard Business Review. 2013. https://hbr.org/2013/10/the-strategy-that-will-fix-health-care. Last accessed October 22, 2018.
4. Millman D. Way of the Peaceful Warrior: A Book That Changes Lives. Novato, CA: HJ Kramer; 2006.
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