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Change Happens Successfully With Positive Transitions

Pirrung, Joan Marie MSN, APRN, ACNS-BC

doi: 10.1097/JTN.0000000000000253

Correspondence: Joan Marie Pirrung, MSN, APRN, ACNS-BC, Christiana Care Health System, 4755 Ogletown-Stanton Rd, Room 1320, Newark, DE 19718 (

The author declares no conflicts of interest.



The health care world is rapidly changing. These changes are sometimes mandated from an accrediting organization, guided by financial implications, a desire to improve patient satisfaction scores, or a direct result of a performance improvement initiative. Health care centers and systems across the nation are restructuring services and personnel to create an environment that is financially sound while seeking to provide safe and effective care. Employee engagement and satisfaction must be factored into the implementation of change, and we must personally understand how to navigate through the changes. We need to gain knowledge on how to let go of the old way in order to be happy in the new environment. Shea and Gunther (2009) stated, “Change. It's your job. It just won't stop. It's relentless. It keeps coming at you like never-ending rapids in a permanent whitewater river. Change will burn you out if you don't learn how to handle it.” Why is “change” so difficult at times? The phrase “change is good' is commonly heard, yet we find ourselves floundering to adapt to certain changes.

It isn't the changes that do us in, but the transitions that take a toll, as each term has its own definition (Bridges, 1991). Change is external and situational. The transition is the internal process that we go through to accept the new situation. Bridges goes on to say that transition is not the outcome of the change “but the ending that you will have to make to leave the old situation behind.” We face the ending first of whatever the change may be and transition into the new approach, culture, process, and so forth. With that said, how do we get through transitions to ensure change is successful? How do we ensure our performance improvement plan will be successful? For example, what strategies should I develop to accept the change and ensure a smooth transition into the new electronic world of documentation and billing?

There are two forces to an effective change strategy: the leader(s) who plan(s) the change, and the staff members who move through the change. Each player should understand his or her role as a change agent and collaborate on how to make the process successful. To be successful in leading and managing change, you must design, execute, and communicate a plan that is strategic to meet the overall goal and thoughtful enough to rein in the barriers or negative behaviors before they are faced. As the leader of a change, consider the following five factors that affect acceptance of a change prior to implementation:

  • Believe your staff will gain an advantage or benefit personally from the change and include the gains in the plan.
  • Compare the change with the current state and identify similarities. Staff will accept change more readily if the plan includes relatable facts.
  • Understand the change despite its complexity. If the change requires multiple transition steps, take it slow. Some staff members need to clearly see small successes before accepting the larger goal.
  • Test the change by organizing a pilot group.
  • Learn of others who have had success with the change and share the positives and negatives of the transition. These findings can help form the rollout plan and perhaps mitigate barriers before they are met.

As the change agent who is moving through the transition, what can you do to make yourself more resilient to change and help your leaders in implementing the change? Dr. Spencer Johnson outlined seven ways to move through the transition phase of change. The story is very simplistic and can apply to both your work and personal experiences. The story emphasis is on how to deal with change in a less stressful and more successful way by following the tips as follows (Johnson, 1999):

  • Change happens: Ask questions. Understand the reason for the change.
  • Anticipate the change: Keep yourself prepared at all times for a change and work with your team on planning and implementing the change. This creates a sense of self-empowerment so that you successfully transition through the change. You are in control.
  • Monitor change: Reassess the situation often. Make suggestions on perhaps a better way to accomplish the plan and meet the overall goal.
  • Adapt to change quickly: Accept the change; otherwise, you will remain in denial and not be able to move forward.
  • Change: Change is not successful without the transition phase. Move with the change.
  • Enjoy change: Mourn what you feel you may have lost but quickly move forward and enjoy the new adventure.
  • Be ready to quickly change and enjoy it, again: During the transition phase to the change, be prepared to redirect the designed path. The first plan to implementation may need editing.

The lesson is that we need to recognize and accept that we are working in a constantly changing health care environment. However, for those of us who have been in the trauma specialty for many years, we know that the foundation of an optimal trauma center and system is based on the willingness to change. There needs to be an eagerness to consistently monitor the care provided in anticipation of altering a pathway or algorithm to ensure improved outcomes. This is the exact reason why I truly embrace being a leader within a trauma center and ensuring that we are providing evidenced-based care to all trauma patients at all times. It is often said that the only thing constant in life is change. Health care is changing, and we are part of the change. As we embark on a new year, make transitions to changes smooth and understand your role on the team. Know what you bring to your team. Understand how you can impact the change through the transition phase and help lead your trauma team to a successful goal.

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Bridges W. (1991). Managing transitions: Making the most of change. New York, NY: Perseus Books.
Johnson S. (1999). Who moved my cheese? New York, NY: Putnam Adult.
Shea G., Gunther R. (2009). Your job survival guide: A manual for thriving in change. Upper Saddle River, NJ: Pearson Education.
Copyright © 2017 by the Society of Trauma Nurses.