PEER RESPONSES FOR Patient Outcomes and Sustainable Change

Reflect on the "IHI Module QI 201: Planning for Spread: From Local Improvements to System-Wide Change." Describe how change spreads according to Kurt Lewin and Everett Rogers. Using the IHI Framework for Spread, assess the current culture of your organization or practice site and explain how likely a new idea will spread. Provided rationale and support for your explanation.

Veronica Montemayor

Jan 13, 2023, 7:36 AM

This week the "IHI Module QI 201" discussed the theories of Kurt Lewin and Everett Rogers. Memon et al. (2021) noted that employee readiness for change means the employee's initiative to participate actively in the execution of the change process, Lewin's three-step change process is a well-chosen theory for these types of change. Employee engagement cannot be formed within a day; it actually is a procedure that needs to be developed, and effective organizations place methods to make sure employee engagement increases through planning, employee input and satisfaction, strong communication, and an understanding of what motivates employees (Memon et al., 2021). The authors further noted Kurt Lewin's change management theory defines three stages of change management unfreezing, moving, and re-freezing. This theory is essential during the implementation of change, and the organization needs to change the current culture within the organization. The literature has shown that staff within the organization must buy into the proposed change in practice to improve patient outcomes. Utilizing the IHI framework for this change is another resource we may use to help implement changes in the current processes.

Everett Roger's theory detailed numerous innovation process models and frameworks for organizations, systems, and individuals. His innovation process comprised of: an innovation, as an idea, practice, or object that is perceived as new by an individual or other unit of adoption; communication channels, as the means by which messages about the innovation move from one individual to another; time, a unit that measures the duration of the innovation-decision process itself, how long it takes for the innovation to be adopted by an individual or group, and the innovation's rate of adoption; and, social system, a set of interrelated units that are engaged in joint problem solving to accomplish a common goal (Beausoleil, 2019). As I become more familiar with Roger's theory, I see how it can be utilized for a quality improvement project in the organization. Having multiple options for change theories is essential to nursing leaders and other interdisciplinary teams who are implementing changes in their current practice. These theories may also be used throughout organizations to sustain the desired outcomes.

References

Beausoleil, A. M. (2019). Revisiting Rogers: the diffusion of his innovation development process as a normative framework for innovation managers, students, and scholars.  Journal of Innovation Management,  6(4), 73–97. https://doi-org.lopes.idm.oclc.org/10.24840/2183-0606_006.004_0006

Memon, F. A., Shah, S., & Khoso, I. U. (2021). Improving Employee’s Engagement in Change: Reassessing Kurt Lewin’s Model.  City University Research Journal (CURJ),  11(1), 144–164. https://search-ebscohost-com.lopes.idm.oclc.org/login.aspx?direct=true&db=bth&AN=150058778&site=eds-live&scope=site

Bonnie Flores

Jan 12, 2023, 7:25 AM(edited)

This week’s Institute for Healthcare Improvement (IHI) Module provided an excellent example of spreading change, which is relevant and can be used for our direct practice improvement (DPI) projects. Two theorists were discussed, Kurt Lewin and Everett Rogers. Kurt Lewin’s model states that change can happen in three steps: unfreezing, change or movement, and refreezing (Burnes, 2020). During the first phase the reason for change will need to be communicated to the staff, the second phase is perhaps the most difficult as this is when barriers to change occur (Burnes, 2020). People will resist the change, tests will be done, learning will occur, and the transition can be challenging. The third and final stage is when the change is solidified, and the new practice becomes the standard, refreezing occurs at this point (Burnes, 2020). Follow-up will need to be ongoing, and policies, procedures, and new protocols will be implemented during this time (Institute for Healthcare Improvement (IHI), 2020).

Everett Rogers's Diffusion of Innovations theory discusses how change and adoption rates occur over time. His theory identifies that change will continue until the most resistant people (i.e., the laggards) finally succumb and adopt the changes (IHI, 2020). Along the bell curve, people fall into many categories, the innovators and early adopters are to the left of the curve and encompass 16% of the people (IHI, 2020). Most people either fall into the early or late majority, both of which account for 34%, followed by the people on the right side of the curve, the laggards, which encompass another 16% of the people (IHI, 2020). The theory gives change agents a good idea of how successful they can expect their spread project to be.

Unit change is more readily adopted within my healthcare organization than organizational change. The staff in the Intensive Care Unit (ICU) where I work loves to examine the evidence behind why we are doing things and make changes that will benefit the patients and the staff. However, within the organization, change is not as well received when senior leaders tell us that we have a new policy or procedure. This is because they do not get buy-in from the staff. They are reactive rather than proactive or generative and merely tell us that we must make a change without any education on why. The IHI Framework for Spread is an excellent model that would go over well if followed in my facility. For example, in the IHI model, the leadership is responsible for setting the agenda and assigning responsibility for the spread (IHI, 2020). The senior leaders may be doing this within their own leadership meetings, but they are not doing a good job of disseminating this information to the people who will be making the changes. However, to give them credit, they are very good at receiving input on where staff feels changes need to occur. For example, if I were to bring an idea to the leadership, they would be supportive if it didn’t cost them money. They would be even more receptive if I could make a case on how it would save money. The main areas where I think the leadership lacks are the set-up and communication. The set-up identifies key partners, and a spread strategy and communication need to occur at all steps in the process (IHI, 2020). Communication is a vital factor in ensuring that a change occurs. As an advanced practice nurse who will be enacting a change project soon, I now have a better idea of what works and why and will do my best to ensure that I am acting as an effective leader. Some staff is likely to be resistant, but if I can do a good job with the communication and education piece, then I am confident I will be able to get buy-in from the staff. I will also keep in mind that not all staff will be receptive, but eventually, even the laggards are bound to change once the old way is gone.

References

Burnes, B. (2020). The origins of Lewin’s three-step model of change.  The Journal of Applied Behavioral Science,  56(1), 32-59.