NSG 601 Identify two barriers to change in your organization that are also prevalent in the research literature on change management
NSG 601 Identify two barriers to change in your organization that are also prevalent in the research literature on change management
In any healthcare facility, when implementing quality healthcare initiatives, change typically occurs. Barriers to change are often faced and must be overcome with certain strategies to better the organization. Two barriers in my organization that are prevalent in literature on change management are staff resistance, and lack of planning. In trying to promote the use of standardized hand off communication tool, there may be barriers to the changes that will be implemented. For example, upon the implementation of a standardized hand off communication tool, some nurses may be hesitant to consistently use the hand off tool. Nurses often have a set way of doing things and completing tasks and thus may be resistant to using a standardized hand off communication tool. Miller (2021) found that nurses recognized that they should be using the IPASS method but were still hesitant to use it. Miller (2021) recommends certain strategies to assist staff in areas of resistance. For example, celebrating successes with staff using the hand off tool correctly, continued education on the importance of the hand off tool, and empowering staff to lead the patient safety initiative (Miller, 2021). These are all strategies that could aid staff in properly accepting the quality healthcare initiative of using a standardized hand off communication tool.
In addition, the lack of planning may pose a barrier to this quality healthcare initiative. Because the ultimate goal and aim of this quality healthcare initiative is to improve patient safety, it would be important for the initiative to be planned accordingly. Miller (2021) used a PDSA framework to implement the use of IPASS. This framework could be used in this initiative to better plan and implement the use of a standardized hand off communication tool. The strategic planning of the implementation is important to reach the goal of having 75% of nurses use the standardized hand off communication tool within 6 months.
In order to promote enthusiasm regarding the use of a standardized hand off communication tool, it would be important to use a tagline to promote the project. The tagline for this initative could be “Patient safety through communication”. The rationale of this choice would be that it is easily understood in a language that everybody can understand. Every staff member has the main goal of promoting patient safety and this tagline recognizes that. This tagline promotes the change by encouraging patient safety.
Below is a graphic that could be used to support this healthcare initiative and tagline.
Miller, D. (2021). I-PASS as a Nursing Communication Tool. Pediatric Nursing, 47(1), 30–37.
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When it comes to change in any organization it can be met with both opposition and acceptance. What’s important is that management is open to collectively working together through good communication while taking the time to walk the opposition through the change process. Uncertainty and insecurity can hinder change at any institution. In my organization, I have noticed two barriers to change in the area of psychiatry, a technological barrier and mental illness-related stigma.
During the COVID-19 pandemic, many organizations were thrown into telemedicine for the first time and not all institutions were technologically equipped to perform telehealth visits appropriately. Lack of physician “preparedness and readiness, reimbursement was a key issue” as coding for the services was also difficult to navigate for providers (Ojha & Syed, 2020, p. 2). The reluctance grew through providers’ unwillingness and lack of acceptance, but through education and adequate training, the clinicians could find understanding in the incorporation of telehealth as there is supportive evidence that the intervention benefits the treatment of the patients.
Mental illness-related stigma is in our healthcare culture. Even providers with extensive education at times falter by allowing interpersonal stigma to alter how they conduct themselves while providing care to patients. Patient-provider interactions are crucial as the patient can be made to feel “devalued, dismissed, and dehumanized” during these interactions (Knaak et al., 2017, p. 111). It has a negative impact on the patients, as patients will be reluctant to receive any care in the future, overall affecting the quality of care these patients deserve. Much emphasis needs to be placed on a better awareness of their unconscious biases, so the leadership can tackle these barriers head-on to lead to better outcomes for the patients. The institution needs to show providers how their decisions do have an impact on their recovery (Knaak et al., 2017).
The tagline “treat the illness, not the stigma” employs that providers at times unknowingly allow their stigma to get in the way of providing quality care to the psychiatric population. Sometimes the patient’s physical problems will go unmet as a provider’s bias comes between providing quality patient care. This delay in treatment can be life-altering and could cause unwarranted trauma to the psychiatric patient population as they may personally stop seeking help altogether. The tagline promotes providers to “stop and think” allowing awareness of one’s own bias to be out in the open. This skill can create the change in behavior that is needed when approaching psychiatric patients and meeting their care needs.
Knaak, S., Mantler, E., & Szeto, A. (2017). Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. The Canadian College of Health Leaders, 30(2), 111–116.
Ojha, R., & Syed, S. (2020). Challenges faced by mental health providers and patients during the coronavirus 2019 pandemic due to technological barriers. Internet Interventions, 21, 1–4. https://doi.org/10.1016/j.invent.2020.100330 (Links to an external site.)
In order to implement change successfully in a healthcare setting, we need to be aware of what common barriers are perceived by nursing staff that prevent change. Two of these barriers that I have noticed include inadequate resources/support and the need for an entire workplace culture change. When a new policy or piece of equipment is being initiated on my unit, there is inevitably resistance, as nurses are busy and do not want to take time out of their day to learn how to perform a new task. However, once resources such as a sales rep who stays on the floor when a product is being rolled is offered or the unit as a whole begins partaking in a new policy, everybody will come together to implement change. For example, when the unit was introduced to the female external catheter (PureWick) everybody was resistant to this foreign concept – even with the knowledge that it would decrease the incidence of needing indwelling catheters and therefore decrease risk of CAUTIs. However, when we were offered teaching daily by the PureWick rep and the unit began talking about how convenient these devices were, they became a staple product in our workplace. This demonstrated the importance of resources and culture change.
A 2020 study by Le-Dao et al. found that these two barriers are among four common themes in change management within healthcare. These researchers also found that insufficient leadership and improper use of a change management model such as PROSCI contribute to unsuccessful change (Le-dao et al., 2020). By identifying these themes we have a starting point for how to implement interventions in healthcare that will actually bring about change.
A main intervention within my project is to post signage around my unit that emphasizes the importance of remembering to make follow up appointments for patients before discharge. A possible tagline for my project that could be written into this signage is “follow through with the follow up!” This tagline encompasses the importance of making follow up appointments while acknowledging the fact that nurses know they are in part responsible for these appointments and should follow through with making them. This tagline employs a strategy of being catchy enough to stick into the minds of nurses, hopefully to keep them thinking about discharge.
I have attached a visual I designed that could be used as signage around my unit to emphasize the importance of making a follow up appointment to at least the PCP office of patients.
Le-Dao, H., Chauhan, A., Walpola, R., Fischer, S., Schwarz, G., Minbashian, A., Munro, A., D’Arcy, E., Allan, J., & Harrison, R. (2020). Managing complex healthcare change: A qualitative exploration of current practice in New South Wales, Australia. Journal of Healthcare Leadership, 12, 143. https://doi-org.rivier.idm.oclc.org/10.2147/JHL.S274958
We have in some way all become aware of telemedicine during this pandemic. However, it has been present in healthcare for some time. There are patients that have embraced this change, and others that can not bring themselves to appreciate this advancement. This is also a fact with healthcare organizations. This is present with nurses and physicians. In my organization, we use telemedicine for specialty consults and neurological assessments when addressing stroke symptoms. At times it has benefits. These benefits correlate with the enthusiasm and comfortability of the physician and/or the nurse.
With the development of the telemedicine program initiated for stroke alerts, its purpose was to function as a complimentary adjunct with bedside consults. However, many physicians do not feel they are getting a “full picture” without being at the bedside. This complaint is more common with older physicians. There are also physicians that are just not comfortable with this new form of technology. These two issues are also present with the nursing staff. Nurses feel as if they did not receive enough education on how to correctly work the telemedicine device and physicians are looking to them as guidance. As with any new technology, there is a learning curve and the nursing staff feels this is an added responsibility. This has limited the positive response. Ogrinc et al. (2018) discussed the different type of responders. With this lack of education prior to initiation, the majority of nurses are laggards and look to the past ways of performance rather than future advances.
The nursing response is involved around a critical component of change management – preparation for change and the understanding of use (Kho et al., 2020). The organization could have implemented a more structured and diverse education program. Providing a more intense education program to a few nurses would have allowed for a “super user” program. This could have helped a few assist many leading to a positive response to change.
Kho, J., Gillespie, N., & Martin-Khan, M. (2020). A systematic scoping review of change management practices used for telemedicine service implementations. BMC Health Services Research, 20, 1-16. Https://doi.org/10.1186/s12913-020-05657 (Links to an external site.)
Ogrinc, G. S., Headrick, L. A., Barton, A. J., Dolansky, M. A., Madigosky, W. S., & Miltner, R. S. (2018). Fundamentals of health care improvement: A guide to improving your patients’ care. Institute of Healthcare Improvement
Fortunately, in my current setting, there are no real barriers or resistance for improving or changing practice, likely due to the newness of the clinic and the ongoing expectation that change will be continuous and expected in these early years. However, in my previous practice setting there were constant barriers to change which included some that I personally experienced with my own barriers, and those that I witnessed from other healthcare providers.
In my previous setting there were multiple quality improvement processes going on at any given time, and staff were encouraged to either participate or identify and create areas where improvements could be implemented. The success of a project could directly lead to a significant increase in one’s base salary, and so there was a lot of motivation for staff to find ways to improve processes. Process improvements require teams and team members to work collaboratively and most of the time the team was created based on a shared desire and vision of the end-goal. However, on occasion those that were considered “higher level” staff and who had real or perceived oversight over other staff would initiate a process improvement project and choose their team members and identify the level of participation that was expected, (i.e., you had no choice). There are multiple problems with this approach, and there should be no surprise when I say that forcing people to participate, even with a great idea, leads to a lack of commitment from the staff, and as important – resistance to participating and this sometimes led to further resistance to collaboratively working with the individual altogether.
A quality improvement initiative that was met with a significant amount of resistance and lack of commitment was instituting a three-minute mindfulness moment prior to patient rounding, and then between patient rooms to improve patient satisfaction. The thought being that if the providers were being “mindful” the patients would recognize the full engagement of their medical team and patient satisfaction would increase. The team was resistant due to the lack of shared decision making on the entire project including the time the mindfulness moments were to occur. Not only did the “leader” meet resistance to implementing the mindfulness moments, but there was also a lack of commitment and staff would make excuses to opt out on most days of the week.
One of the greatest attributes of change agents is their ability to lead others however, even those who are transformational leaders can meet resistance to change if the culture promotes a hierarchy where people are not perceived as equal. In my example, barriers to change can be explained by the culture setting, whereby the identification of one’s importance is based on their level of education or job title and the higher the education the greater control over others in their setting and practice. In the article Change Management in Health Care and Mental Health Nursing, the authors identify these same problems with an organizational cultures that can impede change, create resistance, and increase stress on staff that ultimately lowers their commitment (Cleary, RN, PhD, West, RN, PhD, Arthur, RN, PhD, & Kornhaber, RN, PhD, 2019).
If I were to go back in time and discuss this initiative with the project designer, I would recommend a more novel approach that creates intrigue and excitement to participate in what really was a great idea. I would possibly recommend a tagline such as “Mind your Mind: Achieve Satisfaction in Everyday Interactions”, and maybe a second line “Be there or be Mindless”, and then I would have posted it on the unit requesting team members to join, (verse picking them myself).
Cleary, RN, PhD, M., West, RN, PhD, S., Arthur, RN, PhD, D., & Kornhaber, RN, PhD, R. (2019). Change management in health care and mental health nursing. Issues in Mental Health Nursing, 40(11), pp. 966-972.
Ogrinc, MD, MS, G. S., Headrick, MD, MS, FACP, L. A., Barton, PhD, RN, FAAN, ANEF, A. J., Dolansky, PhD, RN, FAAN, M. A., & Miltner, PhD, RN, CNL, NEA-BC, R. S. (2018). Fundamentals of health care improvements: a guide to improving your patient’s care. Joint Commission Recources.