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The Future of Nursing LEADING CHANGE , ADVANCING HEALTH. The report from the Future of Nursing is ALL about change. http://www.thefutureofnursing.org/IOM-Report.
The report from the Future of Nursing is ALL about change.
Leadership Program is divided into 4 main areas. Communication is foundational for learning and understanding about systems. Knowledge of how systems function is necessary to institute change. The ability to accept and engage in change is necessary to be an advocate for health policy.All nurses are expected to lead!
To be more effective leaders and full partners, nurses need to possess two critical sets of competencies: a common set that can serve as the foundation for any leadership opportunity and a more specific set tailored to a particular context, time, and place.
The former set includes, among others:
Change Theories: There are many theories for change. Click on the link below to familiarize yourself with some of the many theories. http://changingminds.org/explanations/theories/a_alphabetic.htm
Nurses have long used this model when interacting with patients. It is often applied when trying to change patient behaviors.
Click on this link for a review of this model.
When engaging in system changes we need a body of knowledge and skills that includes the individual and the system.
Changing a system requires knowledge of both individual and system wide theories. You will need to consider how the individual comes to making changes and you will need to consider how making a change within and between systems occurs.
Kurt Lewin's Force Field Analysis is a powerful strategic tool used to understand what's needed for change in both corporate and personal environments. It helps you understand the system in which you are attempting to initiate a change.
As you consider making changes in healthcare remember the concepts related to systems.
You must assess your system when you are proposing and planning for changes.
Appreciative Inquiry: A positive revolution in change (Cooperrider & Whitney)
Open Space Technology (Harrison Owen)
The whole systems approach: Using the entire system to change and run the business (Adams & Adams)
Rapid Results (Murphy, Kriwan, & Ashkenas)
Six Sigma Approach
Holma, P, Devane, T., & Cady, S. (2007). The change handbook, (2nd ed.). San Francisco, CA: Berrett Koehler Publishing.
Felgen, J. (2007). I2E2: Leading lasting change. Minneapolis, MN: Creative Health Care Management.
Guanci, G. (2007). Feel the pull: Creating a culture of nursing excellence. Minneapolis, MN: Creative Health Care Management.
WILL NEED TO WATCH THIS AND UPDATE THE LINK AS THE WEBSITE WILL BE UPDATED OVER THE SUMMER
Click on the link below to read an overview of common barriers nurses encounter when managing change and innovation. Structural Barriers to Change and Innovation in Nursing by:Beatrice J. Kalisch, Ph.D., RN, FAAN, Titus Professor of Nursing, University of MichiganSuzanne Begeny, MS, RN, Ph.D. Applicant, University of Michigan
You may be asking: How do I become more innovative? How do I become more creative?How do I explore ideas or technology and come up with new ways to use them?
From: A kick in the seat of the pants by Roger von Oech
Read the following article for an overview of innovation in nursing. Unlocking the Power of InnovationBarbara A. Blakeney, RN, MSPenny Ford Carleton, RN, MS, MPA, MScChris McCarthy, MPH, MBAEdward Coakley, RN, MSN, MA, Med
Why is change so hard?People tend to like things just the way they are… and we are a creature of habits. To change habits. . . .wouldn’t it be simple if this is all it took →
In fact many of us are excellent at tamping down change, holding off chaos, or flat out deflating any wild ideas…. Often we are the obstacle that prevents ourselves and others from changing even when outside motivation is positive.
Events occur… (if we notice), and we make meaning of those events.
Meaning making nearly always triggers an emotional response…feelings.
At a fundamental level humans tend to ask “Is what just occurred safe?”
(Communication with ourselves)
Once we decide we may be threatened (real or imagined), our response to that threat is to maintain our safety.
If we stay safe because of our response, we tend to repeat that behavior because we perceive it keeps us safe.
The danger is this response could become a habit.
Sometimes it becomes an addiction.
King, B. E. (2012). How the brain forms new habits: why willpower is not enough. Conference: Institute for Brain Potential.
Habits tend to help us guard against any ‘perceived changes’ that may affect the present state one enjoys in the here and now.
We tend to like things just way they are. We resist changing our behavior. Long term consequences are usually not factored into this way of thinking.
If we think a change could impact our present state of well-being we may repeat past behaviors that we perceived kept us safe.
Many of us simply resist change.
The goal for facilitating change is to avoid building resistance.
Learning activity: Read the article Fable of Roasted Pigs
Consider what situations you have experienced that are similar to this story.
Write your thoughts in your reflective journal. (You should have a reflective journal from the Communication Module).
Judy is a staff nurse in the dialysis unit. She has noticed the patient flow on some days is especially congested. She wonders “is there a better way to move patients through the unit while preserving safety and quality?”
Now that she has formed a question what will she do next?
Talk to other staff members? Investigate how other dialysis units structure their patient flow and assignments?
If Judy uses I2E2after developing her vision she gathers evidence from multiple resources, she assesses then creates or modifies the infrastructure.These pieces include: defining roles, practices, standards, aligning with mission vision.For maximum success she engages all stakeholders in this process. It is the action plan.
Next to provide necessary education Judy and her team must consider the various domains of clinical/technical, interpersonal relationships, critical/ creative thinking, and leadership. Because for the change to stick, one must include not just a change in one’s skill set but a change in behavior.
Again the overall success of the change is evaluated by collection of evidence. The operational definition of success should align with the vision and be measureable. Outcomes assist the team to refine and address any gaps in success.
Csikszentmihalyi, M. (1996). Creativity: Flow and the psychology of discovery and invention. New York; Harper Collins Publishing.
Von Oech, R. (1990). A whack on the side of the head: How you can be more creative. Stamford, CT: U.S. Games Systems, Inc.
Gladwell, M. (2005). Blink: The power of thinking without thinking. New York: Little, Brown and Company.
Gelb, M. (1998). How to think like Leonardo da Vinci: Seven steps to genius every day. New York: Bantam Dell.
Thompson, C. (1992). What a great idea! New York: HarperPerennial.
Healthcare Kaizen http://leanhealthcareperformance.com/lean/kaizen.php
Graban, M., & Swartz, J. E. (2012). Healthcare Kaizen: Engaging front line staff in sustainable continuous improvements. Boca Raton, FL: CRC Press.
How innovations catch and spread…
Rogers, E.M. (1995). Diffusions of Innovations, (4th ed.). New York: The Free Press.
Marciano, P.L. (2010). Carrots and sticks don’t work: Build a culture of employee engagement with the principles of RESPECT. New York: McGraw Hill. (This resource is an excellent overview for both employers and employees).
Kegan, R. & Lahey, L. L. (2009). Immunity to change: How to overcome it and unlock the potential in yourself and your organization. Boston, MA: Harvard Business Press.