Did you ever why you chose to do certain things in life? Why do you choose to brush your teeth or have your cholesterol checked? I would hope it is because you believe in it and not because you were told to. Think about it, kids do things sometimes because their parents tell them too. What happens when mom does not tell you to brush your teeth when you moved out? Hopefully, for the sake of the person you kiss or talk to, you continue this. Do you keep doing it because mom told you or because you have a good understanding of why you do it in the first place? Maybe in this situation a little of both, but what I am getting at is understanding the why behind what we do. This is an extremely important concept when implementing changes in healthcare.
If you do not understand why you are doing something, chances are you will not buy into the action and fail to do it. This is true for brushing your teeth and just about every hospital protocol that exists. I like to share my favorite change theory with my peers in hopes they will adopt the conceptual beliefs before just implementing change to their team.
John Kotter is a transformational leader and creator of the 8-step change model. Webster explains the three phases of this model as: creating a climate for change, engaging and enabling the team, and implementing and sustaining the change (2016). I have observed and participated in many initiatives where the bulk of energy is placed in telling staff the intervention, deadlines, dates, new processes, you name it. What I see very rarely is the bulk of energy used to help the team understand the current culture or climate in a way that makes the team stand up and say, “we need to do something about this!” You see, when the bulk of energy is used in creating an urgent need for change, the rest of the process is much smoother.
I took this approach when I identified a situation on a unit that was experiencing multiple patient falls. The approach I used involved helping the team come to the conclusion that they had a problem, their current interventions were not working, and they wanted their results to be better. They understood that they needed guidance and support to make their unit much safer from falls. We planned out what the new vision would look like and began creating a new way of thinking. Slowly, but surely, we implemented evidence based initiatives for fall prevention. Each intervention added followed a real patient story to help the team understand why the intervention was so critical. For example, the why behind using a gait belt with ambulation was an actual patient who fell as the nurse held his gown. This is a real situation that staff understood, related to, and felt did not want to happen again on the unit. Next was the EGRESS test to help the team understand basic principles for when they should and should not ambulate a patient. Again, a real story behind why I taught them this initiative created a new sense of urgency for, “why haven’t we been doing this yesterday?”
Setting the vision and buy-in creates a new culture and climate for the change. Interventions act as layers, where success is only achieved when staff believe in following them and critically thinking thru new situations. Providing the education and tools is important, however, empowering the staff to take action in what they now believe in is critical. We knew as a unit we were not going to be fall free for a year. That was not the goal, although it would be great! You see, we embrace and celebrate the small wins on the unit. Recognizing a nurse who assessed a patient using EGRESS or when we saw a tech ambulating a patient with a gait belt. These little wins are what keeps the team motivated to continue their efforts. Once you are there, you simply do not let go of the reins. You need leaders who are going to create a just culture where feedback is shared in real time to help those who may not buy-in, get on board. This takes a little more energy than, “because the manager said so.” This requires energy in explaining why we do it, what our vision is, and how it is working.
The goal here is to make the change stick and become a part of a new culture. This culture of fall prevention nurses become contagious to anyone who walks onto the unit. As I watch the tech explain to a nurse who floated to our unit, why we use a gait belt and yellow socks, I feel exhilarated. This is truly the best part of my job! Transforming nursing staff into change agents because they believe in what they do.
The next time you brush your teeth, thank your mom for making you do this simple task. Now you know it was because your teeth and gums depended on it. If she never taught you why you do it and provided you with the tools to do it, chances are you could paying for it now in adulthood. Something to think about the next time you want to make change stick.
Webster, M. (2016). Successful change management -kotter’s 8-step change model. Retrieved from http://www.leadershipthoughs.com/kotters-8-step-change-model/