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13.05.2015

Managing change by empowering staff,what do subconscious thoughts mean,really healthy breakfast meals,your gift of love they crucified - Good Point

Perhaps one of the most distressing images to emerge from the Francis report into care failings at Mid Staffordshire NHS Trust in 2013 was the image of patients so thirsty that they were drinking dirty water out of flower vases. Chris Ham presents presents the findings and evidence around the review he chaired into staff engagement and devolved decision-making for the Department of Health.
This perception does little to empower them to own changes occurring and to adapt behaviours to sustain practice improvements.When managing change it is important to identify with people and reduce the possible resistances they will have in accepting new ways of practising (Holbeche, 2006). He stresses the need for a culture of high staff engagement and devolved decision-making, due to compelling evidence suggesting this increases quality of care. Baulcomb (2003) found that successfully leading change means helping people to embrace the challenges to the point where they positively accept and psychologically own new ways of practising.This article examines how a team of community nurses was supported as the nurses adapted to using an electronic patient caseload tool.
Rather than being expected to adjust to a management-led change, the team was encouraged to own this new way of working through a structured change management process (Lewin, 1951).Reason for changeThe team of seven community nurses sees housebound patients, many of whom have complex nursing needs. Change, particularly when it is unexpected, can undermine confidence and threaten sense of purpose (Holbeche, 2006).
Before the change, each patient’s personal details and planned visit dates were held in a handwritten visit folder. It took an average of 40 minutes each day – not an effective use of busy nurses’ time.About a month before making the changes, we looked at alternative options. Any specific future interventions, such as changing a wound treatment, can be added electronically as a comment attached to the next scheduled visit.


This was mainly due to staff changes within the team; when staff moved on, fewer members of the team were comfortable using the electronic system, so nurses went back to the old, familiar paper systems.
They said that, for change to be embraced and sustained, people must identify with, and value, the new ways of working.To bring about a sustainable change in using an electronic caseload system, the whole team needed to own the change in their practice.
Lewin (1951) offered a three-step approach to implementing structured changes in the workplace. Adopting this enabled the whole team to psychologically identify with and sustain the change.Lewin proposed that bringing about meaningful structured change meant supporting employees in psychologically “unfreezing” from a point of comfort with the current state of affairs. Nurses often talk of “change fatigue”, viewing their professional life as being subject to unremitting changes.For change to be embraced, it needs to be planned and implemented in a way that responds sensitively to people’s emotional reactions (Curtis and White, 2002). Lewin’s change model lends itself to healthcare practice – its three stages are comparable to the processes of planning, implementing and evaluating care.Unfreezing changeLewin’s “force field” analysis offers a way of analysing and predicting how people will react to a given change during the unfreezing period (Cook et al, 2004). The assessment makes it possible to identify the driving forces for the change and the likely resisting forces against it (Fig 1).Lewin (1951) found that ensuring staff actively participated in analysing opportunities was vital to identifying and compensating for resistant behaviours. However, everyone recognised the system would help communication and reduce duplication.Although the process of discussing the proposed change was time consuming, it proved indispensable in involving everyone and respecting any concerns (Cook et al, 2004). This reduced uncertainty about what the change would involve (Curtis and White, 2002).One common concern was that staff would need support in learning how to use the spreadsheet as a caseload management tool.
As Holbeche (2006) suggests, change can only be sustained while the driving forces propelling it outweigh the resistant forces against it.The team had previously reverted to using handwritten caseload management tools because the driving forces behind the change had subsided, while the resisting forces had continued.


Not everyone had been trained to use the system confidently and, once most of the individuals skilled in using the electronic caseload had moved on, the team no longer had a critical mass of people able to use the system.Getting everyone to participate in and shape ongoing change is essential to reducing resistance (Curtis and White, 2002). If these concerns about change had not been addressed, we would have had an ineffective caseload management tool in place –an unsustainable system relying on a few individuals to maintain it.The single biggest reason technology-related healthcare projects fail is because users lack the suitable IT skills and experience (Warm et al, 2008). Supporting all members of the team as they learnt to use the system has taken time and the commitment of everyone to support their colleagues (Cook et al, 2004).Within four weeks of instigating the change, every nurse in the team felt confident enough to update the electronic caseload independently. While all of us can forget to update comments from time to time, we support each other constructively to ensure the system is updated.Refreezing changeThrough open communication and team involvement, everyone has been empowered to embrace and embed the change. Allocating patient visits now takes an average of 10 minutes a day, freeing up a substantial amount of nurses’ time.ConclusionThis experience has been positive and change has been sustainable because we engaged the team and worked as a team (Baulcomb, 2003).
If behavioural resistance is not identified and worked with, they can reverse even the best-intended change projects. Equally, they may resist change because it can damage care.Open discussions are needed to identify if change is realistic and will benefit patients and staff. Lewin’s process of managing structured change is one way in which busy leaders and practitioners can mentally step back and identify how sustainable changes can be achieved (Lewin, 1951).



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