NURS 6241: Strategic Planning in Health Care Organizations | Week 10

At Jones Memorial, a well-known trauma center in a densely populated urban area, administrators and the rest of the strategic planning team are considering adopting a new health information technology system. They anticipate this will help to monitor health care quality and patient safety, improve communication, and streamline patient flow from intake through discharge and billing.

As the strategic planning team at Jones Memorial prepares for this change, what potential barriers should they anticipate? Whom should they include in the planning process, and how can they use team building to facilitate positive outcomes?

This week, you examine barriers to planned change. You explore how to predict and work with these barriers—from the normal, to-be-expected challenges, such as resistance to change and role adjustments, to those that arise as a result of having an overly complex plan or failure to engage in proper resource management.

Learning Objectives

Students will:

• Analyze strategies for overcoming barriers to change
• Analyze strategies for identifying a team of change champions**This Learning Objective is also assessed in Week 11.

Learning Resources

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Required Readings NURS 6241:Week 10: Barriers to Planned Change and Implementing Planned Change

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.

• Chapter 8, “Planned Change”(Note: You may have read this in a previous course.)

Sare, M. V., & Ogilvie, L. (2010). Strategic planning for nurses: Change management in health care. Sudbury, MA: Jones and Bartlett.

• • Review Chapter 7, “The Three Key Elements of the Strategic Planning Process: A Vision That Guides Nursing’s Future Action”
    • “The Architect, Change Agent, and Communicator: Three Crucial Roles in Strategic Planning” section (pp. 135–136)

• • Chapter 9, “Understanding Change Theory: Strategic Planning Change Agents” (pp. 171–194)

• • Chapter 10, “Communicating the Strategic Plan” (pp. 195–212)

• Chapter 11, “Eight Cautionary Tales of Strategic Planning” (pp. 215–226)Chapter 9 examines change theories and how these theories can be applied in strategic planning. Chapter 10 explores the importance of communication throughout the strategic planning process and how strong communication and reduce barriers to change. Chapter 11 provides examples from the field of strategic planning efforts.

Gerrish, K., McDonnell, A., Nolan, M., Guillaume, L., Kirshbaum, M., & Tod, A. (2011). The role of advanced practice nurses in knowledge brokering as a means of promoting evidence-based practice among clinical nurses. Journal of Advanced Nursing, 67(9), 2004–2014.

This article describes some of the barriers to change (in this case, implementing evidence-based practices) that nurses encounter and examines knowledge brokering to facilitate change.

McMurray, A., Chaboyer W., Wallis, M., & Fetherston, C. (2010). Implementing bedside handover: Strategies for change management. Journal of Clinical Nursing, 19(17/18), 2580–2589.

This article examines a change in nursing handover practices to analyze change management with attention to individuals’ attitudes, motivations, and concerns. See Figure 2 for example of unfreezing, moving, and freezing.

Nesse, R. E., Kutcher, G., Wood, D., & Rummans, T. (2010). Framing change for high-value healthcare systems. Journal for Healthcare Quality, 32(1), 23–28.

The authors address factors that impede change and discuss change management principles, including the value of team investment for facilitating change.

Required Media

Laureate Education (Producer). (2013c). Challenges of implementation [Video file]. Retrieved from https://class.waldenu.edu

Note: The approximate length of this media piece is 3 minutes.

Dr. Carol Huston discusses some of the challenges faced when implementing a strategic plan and strategies for addressing those challenges.

Discussion: Team Building and Addressing Barriers to Planned Change

Planning and implementing change can be quite challenging, especially in a complex health care environment. No matter what kind of change is undertaken, there are likely to be some obstacles. Yet, wise leader-managers, and those with whom they work, recognize that change is necessary and revitalizing; they see that planned change can not only contribute to organizational sustainability but also promote high-quality care and positively impact patient outcomes. These leader-managers harness a larger vision and engage in forethought and analysis to minimize and address barriers to planned change.

Based on what you have learned about the change process and strategic planning, what barriers do you think may arise related to the change you are proposing through your Course Project? How would you cultivate stakeholder involvement and promote team building for your planned change?

As you think about these questions, consider the following statement: “The system will evolve based on changes in the behavior of the people in the system” (Nesse, Kutcher, Wood, & Rummans, 2010, p. 27).

Do you agree? Why or why not? How does this relate to the specifics of your strategic plan?

To prepare:

• Review the information presented in the Learning Resources, including Dr. Carol Huston’s comments on addressing barriers to implementing a strategic plan change. Consider insights related to change theory, common barriers to change, and strategies for addressing these barriers that relate to the implementation of your proposed change.
• Identify specific barriers you are likely to encounter with your proposed change, including resistance to change. Evaluate strategies that may be used to minimize or address these barriers.
• Think about the value of stakeholder involvement in planned change, as well as the specifics of stakeholder participation in your strategic plan to champion the change. Who should be involved in strategic planning and at what point? How could they serve as change champions?

By Day 3

Post an explanation of strategies you would use to minimize or address barriers, including resistance to change, related to your strategic plan. Explain how you would promote stakeholder involvement for your proposed change, and encourage them to become change champions.

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days using one or more of the following approaches:

• Provide feedback on their strategies for addressing barriers to change.
• Suggest additional strategies for addressing barriers or resistance.
• Offer additional insights for identifying appropriate stakeholders.
• Suggest additional stakeholders or change champions to be involved. NURS 6241:Week 10: Barriers to Planned Change and Implementing Planned Change

ADDITIONAL INFORMATION 

Barriers to Planned Change and Implementing Planned Change in Nursing

Introduction

Planned change is a process that can be used to help improve the quality of nursing care. It involves identifying areas where change is needed, developing a plan for change and then implementing it. The plan should be based on evidence and research about how best to deliver care in your organization, but it’s also important that you understand what barriers may exist for people wanting to implement planned change.

A general lack of knowledge about planned change among nurses.

The first barrier to planned change is a general lack of knowledge about planned change among nurses. Change is a process, not an event; it’s not just about technology, but also about people and how they work together. If you don’t understand why your hospital wants to implement this new system, then it might be difficult for you to support its implementation in any way.

There are different types of planned changes: structural (such as redesigning nursing homes), operational (such as implementing bedside charting), or administrative (such as restructuring departments). Each type requires different skillsets from those involved in implementing them—and that can make things more challenging when trying out new ideas! In addition, there needs to be buy-in from leadership at all levels within healthcare organizations if they want their staff members’ involvement with these processes going smoothly down the line too.”

A fear of loss of power and authority by line staff.

• A fear of loss of power and authority by line staff.

• A fear of losing control of their work.

• A fear that technology will replace them, not just in the hospital, but also across other sectors such as health care or education.

In some cases this can be a valid concern as many nurses have been laid off due to budget cuts or outsourcing opportunities at other organizations which have resulted in fewer jobs available for new graduates entering the workforce (or even those who don’t want to go into nursing).

Different perceptions about what should be changed.

The first step to implementing planned change is understanding the problem. What is it that you want to change? Why does this matter, and how will your efforts improve patient outcomes?

Once you have identified the problem and its solution, consider how you can measure success. How do we know when it’s working? Is there a way for us to tell if patients are benefiting from these changes or not?

The need for change agents to go slowly and establish a foundation before beginning any real change.

You have to start with the basics and get a foundation before you can build anything else.

There are many ways to develop your foundation. Some examples include:

• Establishing protocols, or standard operating procedures, for your unit or department. These protocols should be communicated clearly to all employees so they can understand what is expected of them in each situation that arises during their workday (e.g., eating lunch). They also need to know when certain things are not allowed (e.g., bringing food into an exam room).

• Conducting focus groups with patients and family members who have been involved in nurses’ care for several years so that staff members can learn about how people really feel about various aspects of nursing care (such as communication with doctors).

The natural resistance of people to change and the need to reduce resistance.

• People are resistant to change because it is different.

• People are resistant to change because it is unfamiliar.

• People are resistant to change because it is uncertain.

• People are resistant to change because it is uncomfortable or inconvenient

Understand that there are challenges to planned change and know strategies for overcoming them.

You are not going to get anywhere in your career without change. In fact, if you want to stay on top of the latest trends and keep up with what’s happening in your field—and make progress toward those goals that were set for yourself—then you need planned change.

You may feel tempted at times to think of planned change as something other than an ongoing process; it can feel like one big event instead of an ongoing journey. But this is another way that we are all too familiar with: We tend not to view our lives as moving forward over time but rather as a series of discrete events separated by gaps where we’re not doing anything at all! This kind of thinking leads us down paths where we have no sense of direction or purpose because there’s nothing happening around us except sitting still while waiting for something else (or someone else) else happens first… and then next thing I know I’m sick again!

Planned change requires patience and commitment; both things seem obvious enough but often aren’t realized until they’ve already been lost somewhere along the line due perhaps most importantly having unrealistic expectations about how quickly things will happen given adequate preparation time before implementation occurs.”

Conclusion

Our research has identified a number of barriers to planned change in nursing. Each of these can be overcome using a variety of methods. The most important thing is to keep an eye on the big picture, acknowledge the challenges and work together with your colleagues to find solutions that work for everyone!