Leadership and Change Management in Nursing - Article Example

Running Headers: Leadership and change management in nursing Your Name: Instructor’s name: Course: Institution: Date: Introduction The rate of change organizations are undergoing has continued to accelerate over the last years and there is no evidence to suppose that this trend will cease. The intensifying demand for higher organizational performances and the increased competition are pressing organizations to become more results- focused, faster acting and more flexible. Most organizations are finding that achieving such initiatives requires effective leadership (Tourangeau, 2003). As the mounting customer demands, competitive pressures and regulatory pressures impact utilities globally, change is becoming the custom rather than an exception. It is now becoming significant for utility managers to work not only on their traditional managerial roles but also as transitional leaders; leaders who can effect change to an organization. This poses great challenges for managers throughout organizations and especially to those having a responsibility for staff, because they have an extra role that centres on guiding the staff throughout the changes inherent in our contemporary society. Nursing, a section of the healthcare system, is one of the critical areas that require change. The frightening rise in mortality and morbidity among hospitalized patients globally intensifies concerns about professional experience. Healthcare professionals as well as nurses require increased scrutiny for them to provide effective and safe care. This therefore means that the contemporary healthcare systems and specifically the nursing sector have to undergo some changes in order to guarantee effective service delivery. In this essay, the concept of leadership and change management will be explored and how it can be applied to manage change in the nursing handover from traditional to modern handover. This will be achieved through a review of some literature related to the topic and the application of the Quinn’s theory (Piderit, 2000). Change Change often seems new and moving faster all the time, yet history is full of stories of non-stop change. The precise definition of change remains controversial among different authors. Leana and Barry (2000) define change as a never-ending process of readjustment and re-adaptation, as man responds to the ever-changing circumstances behaviourally. On the other hand, Conger, Spreitzer and Lawler (1999) argue out that change is a continuous process of transformation and it is not necessary that man re-adjust to adapt to this change. Research studies articulate that change is often difficult to embrace as it is bound to face some resistance. For instance, in history, the Roman Centurions complained about it. The Ludites also rebelled over mechanization and rioted in the streets of Paris over the first calculating machine invented by Pascal. Numerous wars have also been hotbeds of change. Innovations, both good and destructive, often thrive. Organizations, firms and companies are broken apart. Whole populations are changed forever. However, change does not stop when people stop rioting in the streets, but such battles just move to the offices and boardrooms. Whatever the case, the bottom line remains; change goes on, whether real or imaginary, and continues to have an effect in our lives. Science and technology continue to make our work easier and such changes though costly, are the main cause of constant strikes at the workplaces and even in our societies today. In order to effect change in any aspect, there has to be effective leadership. A leader is a person who guides and influences others, takes risks and moves forward before the others. They challenge the process, enable others to act, and inspire a shared vision (Tourangeau, 2003). However, change is always bound to face some rejection or resistance as many people may find their old systems more effective than the intended change. Failure of many change initiatives come as a result of many reasons (Maurer, 1996). Resistance to change brings in delays and costs into the change process, which are hard to anticipate but have to be considered (Lorenzo, 2000). Resistance to change considered an important element in the change process since it helps generate information that can be used to develop more successful change processes. The leaders can assess the previous change process that failed to achieve the needed change and use it to develop a new change process (Piderit, 2000). However, general objective of introducing change is to become adapted to the changing environment or improve the present state of the situation to a better state (Boeker, 1997). Lewin (1951) created the first practical model of change that characterized change as a condition of imbalance between the restraining forces and the driving forces. Therefore, if these forces are balanced, change cannot take place. In every aspect of our daily lives, change flows and fades in recurring cycles that can be chartered and thus predictable and managed (Nadler and Nadler, 1998). Change processes entail structures and methods of doing tasks as well as performance, expectations and perceptions of the concerned parties. Prosci (1996) came up with a model known as the ADKAR, a model that has placed an influence in change management. In this model, five stages have to be realized for an organization to successfully change. The first stage is the awareness stage, which involves making sure the organization is aware of the reasons why change is needed. The second stage, desire, involves motivating the organization’s members to have the desire to participate in changing the organization. The third stage, which is knowledge, rules out that awareness about the necessity to change is not enough but the organization has to know how to change. The fourth stage, refereed to as ability, requires the organization to implement new behaviours and skills in order to realize change. The final stage is known as reinforcement and calls for organizational reinforcement to sustain the changes. Practice application- managing change in the nursing handover form traditional to modern handover The transformation of the nursing practices from the old system, traditional handover, to the modern system is a necessary step towards the improvement of life in the society. This is because the transformations will lead to an increase in the people’s lifespan. The shift handover is an essential part of the communication process, taking place almost twice a day in the gynaecological ward within the nurses’ working day. Indeed, nurses in the society today make an important profession and possess advanced skills, cognitive knowledge, self-motivated creativity and systems understanding (Quinn, 1996). In addition, they also have technical and scientific knowledge, decision making skills and critical thinking skills which they use to provide holistic care to the society. Quinn’s theory of change Quinn (2000) highlights that when change is introduced to an organization, the organization experiences a period of slow death, which is also referred to as deep change. This experience often occurs when the organization considers its present state as competent and more satisfying, and therefore sees no need of adopting the intended change. The organization is more contented acknowledging its status quo and thus not ready to change. Pesut (2001) notes that slow death in an organization takes place when self interests prevail over collective responsibilities. In order to cope with slow death, Quinn suggests that the first alternative is for the leaders to walk out of the situation. They can also consider finding a way out of the problem or a way around the problem, in the hope that slow death may not result to major tribulations. However, the two suggested ways of coping with slow death in the organization are both negative responses and often tend to make the situation worse since the organization will adapt the needed change. Therefore, the best coping approach Quinn suggests is engaging in the process of slow death or deep change. This is the method a transitional leader can take to effect change into his organization. However, this approach requires that the need for change is accepted and well understood by all people in the organization and that adjustments are made to respond to this change (Piderit, 2000). Need for change Bedside handovers give immediate solutions to numerous problems associated to the traditional handover system. Moreover, bedside handovers emphasize on individualized patients care and puts patients at the core of all care activities. Bedside handovers rely on bedside reporting systems to unlike the traditional handovers that purely rely on verbal information. Patients engaged in the handovers have a speedy recovery since they have access to information and can discuss their health concerns with the nurses. Also, bedside reporting allows nurses starting their shift to acquire an improved insight into the care required by each patient. In summary, bedside handover is comprehensive, personal, informative and shorter, thus bedside handover system should be adopted. The process of change This study focuses on the process suggested by Dessler (2000), in which he describes the process of organizational change in eight steps. He highlights that after an organization goes through the eight steps, change can then be experienced at all levels. An analysis of the present situation reveals dissatisfaction with the old system of handover since it had led to a boost in the quantity of critical incidents and protest form doctors, patients and relatives. Some of the restraining forces that may lead to rejection of the change process include fear of accountability, more work for the nurses and lack of confidence. The change process will incorporate the following eight steps. Creating a sense of urgency This involves the application of unfreezing, a concept that implies, encouraging people to realize the need for change, considering their current situation. Initiation of change requires a considerable power of leadership and a sense of direction. The first move therefore is to create awareness through communicating the intended change to all people who will be affected by the new system. These are the patients, ward managers and the nurses, so that they all have a shared vision of a new handover system. This will also include using case studies and some literature demonstrating has been successful. This will allow the nurses to identify and analyse constraints and benefits of the proposed system in the context of the old one. For instance handover overlap with the emergency situations. The application of urgency in this step enables the nurses to overcome their traditional reasons for refusing to give in to change and bump them out from their contentment (Dessler, 2002). Create a guiding coalition and mobilize commitment One of the important elements in the change process is the change agent. These are the people who are expected to embrace the change and in our case, the change agents are the nurses, ward manager and the patients who simply work to bring about the intended change. However, this process does not only require focusing on the change agent, but selecting a task force that can help drive the change forward. The role of developing a shared understanding is often played by the task forces (Quinn, 1996). It is important to note that discussion is an important factor because from the many suggestions and ideas, an effective solution can be achieved (Gebelein, et al. 2000). Coalition also helps to ensure commitment to achieving the intended changes. Develop and communicate a shared vision Development of a shared vision gives the direction to the intended change. The shared vision here concerns the importance of the intended change, bedside handover, which has been agreed on as the best option for change. They should then concur on what the outcome of their vision should be, with regard to the future of their work environment (Leana and Barry 2000) and identify specific objectives that can be used to attain the change. However, choosing a strategy for the change process is determined by different factors. A critical factor is good interpersonal relationship. In our case, excellent communication and strong leadership are some of the strategies that can be applied to achieve this change. Therefore the change has to be announced to the patients and the nurses in advance in order to offer the opportunity to share the reaction concerning overlapping shifts as well as how to deal with confidentiality and accountability. Empower employees to make the change It is impractical to attain change without the empowerment of the people involved in the change process. This empowers the team to actively participate in all steps of the change process without oversights and is a strategy for lasting and effective transformation. This strategy can be applied to convince others to accept change using some of the documented evidence of the positive impacts of bedside handovers such as increased patient satisfaction. Some of the nurses in the ring of informal leaders can take the responsibilities of being role models and encourage others to accept change. According to Tappen (1995), empowerment means that an individual is able to act as well as being encouraged and expected to act. It actually encourages the team to be more committed to attaining change. Generate short-term wins A change process should not only focus on the long term outcomes, as this may make the people to lose morale along the way, but should generate short term goals that can be achieved within a short time span. They have to feel that they are achieving something as the process is going on (Leana and Barry, 2000). Installing the modern handover system may require some financial investment. Therefore, they can start by installing the bedside handovers to some wards so that people see there is something being achieved before installing the whole wards with the new system. Discovering short term goals and assessing them after they are achieved helps both the leaders and the staff feel motivated that they can actually achieve and manage the process to the end point. It actually helps build a sense of success and boost the people’s morale. They simply act as benchmarks to maintain the process of change on target. Consolidate and produce more change Contentment returns at this stage as the patients and hospital staff tends to think that after installing handovers to certain wards things are all right and that there is no need to proceed with the change process. At this point therefore, it is important to remind the patients and staff that the change process has to go on until the long term goals are attained. In most organizations, the leaders accept the need to change, come up with plans on how change can be achieved, the plans are then implemented, but they fail to attain the intended change due lack of maintenance. Anchor the new ways of doing things in the organizational culture It is important that the organization maintains shared values. The shared mission agreed can be that all handovers will be carried out at the beds side of the patients between the outgoing and the incoming nursing staff and the patients. However, as changes take place, there may be need to have this mission changed too, in order to have a match between the organizational culture and the mission of change. The organizational value may be maintaining respect for the patients; therefore in effecting this change, the organizational culture should be maintained. Challenging these values may make the patients and the nursing staff to feel insecure. Some employees may even disregard the whole process of change due to paying no attention to their shared values (Leana and Barry, 2000). Monitor progress and adjust the vision as required Appraisal has to be done at each stage of the change process. Evaluation of the implementation of the bedside handover system can be carried in two different phases. These phases can involve a protocol, which can be filled after every shift handover, and divided into two parts in a day. They then have to monitor each step of the change process to ensure the objectives are achieved (Conger, et al, 1999). Conclusion Managing change in a hospital environment is a difficult task since it involves changing the behaviour and attitude of the employees, in order to gain their cooperation, in a complicated environment. The change process is often bound to face some resistance, which if not carefully considered, may lead to rejection of the whole process. However, different scholars have come up with various processes that can be implemented to effect change in an organization (Ansoff, 1990). This study illustrates the process that was devised by Quinn. The eight steps, if implemented correctly can actually help the organization achieve a change strategy. This is because this process incorporates both the management and the staff in achieving its targets unlike other processes that only include the staff at the implementation stage. It is true that leaders are expected to take the leading role when it comes to effecting change. However, the perspectives of the employees have also to be taken into consideration (Piderit, 2000). Change has to be accepted in the organization, as it determines the success of the organization and the people within it. References: Ansoff, I.H. 1990. Implanting Strategic Management, London: Prentice Hall International, Ltd. Boeker, W. 1997. Strategic change: The influence of managerial characteristics and Organizational growth, Academy of Management Journal, 40 (1), pp. 152-170. Conger, J.A., Spreitzer, G.M. & Lawler, III, E.E. (eds.) 1999. The leader's change handbook: An essential guide to setting direction and taking action. San Francisco: Jossey-Bass. Dessler, G. 2002. Management, pp. 302-306. Upper Saddle River, NJ: Prentice Hall. Lawrence, P.R. 1954. How to Deal with Resistance to Change, Harvard Business Review, (May/June), pp. 49-57 Leana, C.R. and Barry, B. 2000. Stability and Change as Simultaneous Experiences in Organizational Life. Academy of Management Review, 25 (4), pp. 753-759. Lewin, K. 1951. Field Theory in Social Science. New York: Harper & Row Nadler, D. A. 1998. Champions of change: How CEOs and their companies are mastering the skills of radical change. San Francisco: Jossey-Bass. Piderit, S.K. 2000. Rethinking resistance and recognizing ambivalence: a multidimensional view of attitudes toward an organizational change. Academy of Management Review, 25 (4), pp. 783-794. Quinn, R.E. 1996. Deep Change: Discovering the leader within. San Francisco: Jossey-Bass. Read More