I just came across the 35-year-old book Implementing Change in Nursing while spring cleaning a bookshelf. In this time of healthcare turmoil, change is certainly on my mind. It's probably on yours, too, as we're faced with it every single day in our leadership practice. So much so that the concept of change fatigue now appears in the nursing literature. In 1971, David Bowie exhorted us to “turn and face the strange ch-ch-changes.” Are you embracing “the strange” and leading your followers through change?
In a quick search on nurses leading change, I found a 2013 editorial on change from our late Editor-in-Chief Emeritus Richard Hader. He urged us to understand staff members' reactions to change and be prepared to help them. Have the past 6 years, or 35 years in the case of my old book, given us a new perspective?
Surprisingly not. As normal as change is, it's still difficult and requires a process from assessment through evaluation and maintenance. Unfortunately, a recent article in the Journal of Nursing Administration on “innovativeness” found that a large percentage of frontline managers were resistant to implementing change. And an American Nurse Today article about pursuing leadership positions asked the following question of its readers: “Are you comfortable with change?” The author concluded that an individual considering a leadership role may encounter problems if he or she is uncomfortable with change. Ch-ch-changes are always there.
Change can be driven by regulators, bosses, yourself, clinical nurse-led projects, and every department from human resources to supply management to quality and more. How can you “face the strange” and succeed? We've seen that the old theories still hold true, such as Lewin's three-stage change management model of unfreezing, changing, and refreezing. What else?
Change is about process at every single step—the what and how. And, most important, it's about people—the who and why. If you don't address people, sustaining change is doomed. The Institute for Healthcare Improvement published its Psychology of Change Framework last year, encouraging us to focus on the human side of change by involving people, tapping into intrinsic motivation, sharing power (aka shared governance), and being authentic with stakeholders. Refreshing and much harder! This takes a lot of time and effort to work through as opposed to writing a policy and expecting compliance. To me, compliance is a dreaded word in relation to professional practice. Nursing practice has to be more than rote obedience.
Nurses are driving safety improvements in all our organizations. What makes them successful? Addressing process AND people. In the ADKAR (awareness, desire, knowledge, action, and reinforcement) change model, we also see a focus on people. Anecdotally, desire is the biggest hurdle but when we wrap our heads around a reasonable why that resonates with our values and beliefs, the fear and loathing of change dissipates. When stakeholders are involved with a voice, they're enabled and engaged, leading to sustained change. This was basically Rich Hader's message: listening to and helping staff.
The need for change is omnipresent. Let's “turn and face the strange” with a dual focus on process and people. That's leadership.