Innovation and Change in Nursing - Essay Example

? Section a. In any professional organization, as well as the healthcare setting as it pertains to nursing, organizational change will occasionallybe required. Moreover, healthcare professionals must cultivate an awareness not only of technological innovation itself, but of the need for ongoing change. Healthcare organizations best serve themselves, and their patients by looking towards an operational model that incorporates the assumption of change. Such a structural paradigm will likely prove increasingly useful as a preemptive strategy to adapt to ever-changing technology, and the demands this places for an ever changing healthcare profession. Cultivating an understanding of the process of professional change can also prove essential towards the objective of increasing workplace diversity. (Friday & Friday, 2003) There are many phases to the process of change, considerable research on the process having been described by Lewin, (1951) who elucidated in a psychological context of the stages of change, of which the movement phase is the second one. Which follows unfreezing, and is then in turn is followed by a phase of a re-freezing. (Lewin, 1951) Complexities and pitfalls exist both in terms of operational behavior as well as personal beliefs. During the implementation of organizational change a critical phase in the process is what is described as the movement phase. The goal of this phase in a professional organization is to enable and encourage the employees to find ways to embrace a new vision that the organization will need to develop. Each nurse, or employee in general must look within themselves and find ways that they can make the new direction of the organization work for them, in their specific situation and job description. A series of short term limited steps may be required to facilitate the transition between older modes of operation. Short term goals should be set to encourage the replacement of outdated methods in favor of movement towards the higher objective of an effective organizational transition. Kotter and associates have also proposed an explanation of the step-wise change process, by which the three overarching objectives can be translated into smaller steps for a smoother transition. (Kotter, 1996), (MLDC, 2010) Adequate planning and goal-setting are essential to coordinate the changes occurring within the organization, and how all personnel will be required to implement their part of the changes. Short-term goals will include accommodation for likely sources of resistance, as well as tactics necessary to overcome those sources. Among these short-term goals to facilitate the movement phase, it is important to remove psychological barriers. (Kotter, 1996) Objects and artifacts that may symbolize the older operational process, or tools that are specifically applicable to prior goals and values should be removed without delay, unless such articles are essential in the hospital's new operational strategy. Anything that can function as a psychological 'anchor', reminding nurses and other employees of prior goals and outdated standards must be replaced. All employees should be reminded of the potential of the new recommendations and their promise for the future. This transition can be assisted by the implementation of 'short-term wins', to demonstrate ongoing progress towards the ultimate goal. Target dates for measurable changes are helpful. Short-term steps in the right direction must clearly communicated throughout the hospital, and higher staff should be made available to assist employees with the implementation, and modification of benchmarks, if necessary. The medical employees responsible for implementing the changes should certainly be included in planning meetings; if those operational changes would affect them, or make additional demands. These objectives must be readily achievable. They should clearly contribute to the new direction of the organization. The exact structuring of these benchmarks may be eased by looking at prior instances in which the organization needed to implement changes; and copying the forms if not the substance of the changes. b. On an individual level, as mentioned above - the individual may be supported during the change process by instituting a familiar process of change. (MLDC, 2010) Within the hospital, or other professional organization; there must be recognition of the need for change - yet the institution will function more efficiently if a pre-existing system of change is already in place, and ready to roll out when new policies are required. Change itself becomes familiar, through the implementation of an amendment-like process by which operational changes can be made. An expectation must exist within the high-tech world of professional healthcare, and similar professions that effective service requires modernization. And modernization is an ongoing process. Thus, a process should exist for the incorporation of new diagnostic equipment, when available, and the ways this intersects with the work of each individual nurse. When new technology is introduced; it is a virtual certainty that some new procedure, or modification of procedure will be required to accommodate it. By establishing a predictable process by which new processes are incorporated; change itself can become both comfortable and familiar to each employee. Efficient hospital leadership, both from higher-ranked nurses as well as administration will be essential for smoothly processing change; and ensuring that each employee learns to function through them. c. It is also necessary to discuss resistance to change, and to analyze theories concerning ways in which this resistance can be overcome. Most psychological researchers categorize resistance to change just as one might categorize the process of change itself as it pertains to values and beliefs. Resistance to change can be categorized in cognitive, affective, and behavioral issues that limit the individual's ability to adjust in the face of needed transitions. (Oreg, 2003) Other sociologists and discuss limitations pertaining to a change implementation process. (Jaffe, 1994) (Judson, 1991) An important point that can be gleaned from the research on resistance is a feeling of personal justice, on the part of individual nurses, or employees. Some nurses may feel that operational changes in patient policy, or treatment regimens may be targeted directly against them; or that some other segment of the hospital staff is being favored at their expense; in a way that feels like a personal slight. (Colquitt, 2001) Personal treatment during the Change process can lead to the outgrowth of resistance, even if only in a covert way. Still more researchers, (Herscovitch & Meyer, 2002) have devised schemes that measure normative and affective commitment to change among employees. There is general agreement that much of the work available on resistance to change, and the process of psychological change ultimately stems from Lewin's three-phase conceptualization work, and his seminal study. (Lewin, 1951) This has set the foundation for the subject, and a variety of subsequent researcher build upon this foundation. (Armenakis & Bedeian, 1999) Resistance to change can ultimately be understood as a component to the first dimension in the process; that of unfreezing. Perceptions of justice/injustice towards the individual is associated with the movement phase. But the other side of resistance is commitment, which is part of the third, refreezing phase. (Foster, 2008) But in essence; organizational change research tends to recapitulate Lewin's original work. Section 2 a. Strategies for implementing change require an intelligent, systematized process. Sweeping alterations to hospital procedures can produce considerable confusion if handled improperly. Springing reforms on employees in any institution is likely to result in confusion, incomplete compliance, or outright resistance at best. The process implementation must be stepwise. As mentioned above, Lewin (1951) described the three fundamental phases of organizational change; but Kotter organizes them into discrete steps for easier implementation. Within the phase of Unfreezing, there are benchmarks that can ease the process by which old standards are released: 1.) A sense of urgency is necessary; in response to a crisis or pressing need felt by the hospital; this must be communicated to all personnel. Or, an opportunity for improvement must be pressing; revealing a chance to radically benefit hospital performance. 2.) Build a Transitional Committee. Hospital upper-management is important not only in the instigation of the change, but in the management of the implementation. Mishandling can cause the rest of the staff to lose confidence in necessary changes. 3.) A Vision, a mission statement is needed. The hospital staff will benefit from a clear communication as to where the organization is headed. 4.) Communication of that vision is essential; failure of which can lead to misunderstandings that can derail the process. 5.) Removing Psychological obstacles is the first part of the Movement phase. Old symbols of prior operations can interfere with the transition. 6.) Short Term benchmarks; As the prior discussions demonstrate, short-term goals are necessary stepping stones. 7.) Withholding premature victory. Urgency for transitions can be lost if the motivation for the change is removed too soon. 8.) Anchor the changes. The Refreezing process must be initiated. The intrinsic motive to resist change can also be utilized to secure changes. (MLDC, 2010), (Kotter, 1996) b. Difficulties in organizational transition often involve challenges in the integration of new technology into a useful framework that would allow for meaningful change. When operational transitions have proven most effective, medical practitioners and researchers are in collaboration between disciplines to integrate new data into worthwhile innovations. (Rosswurm & Larrabee, 1999) A necessary rubric for the evaluation of any procedural change must be grounded in objective, medical realities. Clinical indicators must be employed as a method for the measurement of success for any operational initiative. Towards this purpose a clinical indicator must be defined. A clinical indicator Can be thought of as a 'quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care and support service activities.' (Idvall, et al. 1997) Clinical indicators for can be described in terms of warnings of a status change, what might be called a sentinel event. Other indicators would be those that signify the change in the rate of some relevant progression, such as heartbeat, platelet sedimentation rates, or metabolism. An ongoing objective of hospital administration must be the refinement of the means by which these indicators can be measured and communicated. It is likely there will be many more changes in the medical profession in years to come to more efficiently process these indicators. (Idvall, et al. 1997) Subsequent judgments of quality of medical care must also take into account whether or not the measures promote ongoing positive changes. It is also necessary to judge whether and to what extent unintended consequences detract from the quality of care. Also important is whether or not improvement efforts will necessitate additional effort to bring a process back into acceptable ranges. (Varkey, et al. 2007) The complexity of any healthcare system, in terms of the unpredictability in the way in which patients occasionally respond creates additional obstacles for measuring quality. What are the objectives of the transition? Were they clearly delineated for all those involved? Are there tangible objectives that are measurable, and have they all been achieved? Higher-level cognitive reasoning can yield highly divergent outcomes due to the intersect between the specific idiopathic complications unique to the life and genetics of any patient. When these factors are combined with the limited knowledge and diverse experiences of any practitioner evaluation of healthcare and new healthcare procedures are complicated. A hospital is not, certainly should not function like a factory, differences between patients combined with discretionary decision-making from different doctors and nurses complicate evaluation schemes. (Glouberman & Mintzberg, 2001.) , (Gaba, 2000) An evaluation of change must comprehensively discuss whether these, or other factors hindered the process, and how unintended consequences may have detracted from the projected gains. Observing all this, the hospital must focus on what can be learned going forward. An ongoing commitment to evidence-based practice helps in the development and evaluation of healthcare procedures. The assessment of the scientific strength underlying any procedural changes where it corresponds to peer-reviewed literature is supported by research. (McGlynn & Asch, 1998) , (McGlynn, 1998) Are the changes proposed ones that benefit from evidence-based practice? Are there other factors that facilitated the change that were not expected, and do these factors create recommendations for strategies to more fully implement or discard for the next time? Those individuals, as well as institutions with the best track records in terms of clinical outcomes are the logical candidates for the formulation of external benchmarks. Internally, it may prove useful to identify a particular nurse who is associated with the highest percentage of positive clinical outcomes as an individual standard for the evaluation of employee centered measures within the hospital. But if the entire institution is flawed looking internally will prove insufficient. Similar hospitals must be watched closely, especially those with approximate size and resources. Small-town suburban hospitals must evaluate themselves and their own policies based on the success rates of other small-town hospitals, whereas massive urban-centered medical systems must do likewise. Above all, the hospital must take a hard look at the necessities that lead to the change, and how its vision for the future was developed. The ideas that shaped this vision must be weighed carefully, with an eye towards the fulfillment of realistic, tangible objectives. REFERENCES Armenakis, A. A. Bedeian, A.G. (1999) Organizational change: A review of theory and research in the 1990's. Journal of Management, 25(3), 293-315. Colquitt, J.A. (2001). On the dimensionality of organizational justice: A construct validity of a measure. Journal of Applied Psychology. 86, 386-400. Foster, R. D., 2008. Individual resistance, organizational justice, and employee commitment to planned organizational change. ProQuest, 2008.UMI Number: 3291987.Proform Information and Learning Company. 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