Chapter 14
Creating a Vision and Motivating a Change to Evidence-Based Practice in Individuals, Teams, and Organizations
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Implementing EBP
Among the most important elements that need to be present for change to be accomplished successfully are:
1. Vision: Developing a clear and exciting vision of what is to be accomplished can unify stakeholders
2. Belief: Belief that the change to EBP is beneficial can lead to behavior change and foster the ability to successfully make the change
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Implementing EBP—(cont.)
3. Strategic planning: Goals are established with deadline dates; a well-defined strategic plan is written. Use of a SCOT (Strengths, Challenges, Opportunities, and Threats) analysis will assist in the planning process:
Assess and identify system Strengths that will facilitate the success of a new project
Assess and identify Challenges that may hinder the initiative
Outline the Opportunities for success
Delineate the Threats to project completion, with strategies to overcome them
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Implementing EBP—(cont.)
4. Action: Putting the strategic plan with its actionable objectives into motion
5. Persistence: Continuing to move forward despite of unforeseen barriers; being nimble and open to revising approaches to allow continued progress
6. Patience: Allows for continued progress even when results of actions are not yet seen
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: Basic Assumptions of the Change Curve Model
Changing an organization is a highly emotional process
Group change requires individual change
No fundamental change takes place without strong leadership
The leader must be willing to change before others are expected to change
The larger and more drastic the change, the more difficult the change
The greater the number of individuals involved, the tougher the change will be to make (Duck, 2002)
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: Stages of the Change Curve Model
Stage I: Stagnation: Characteristics include lack of effective leadership, failed initiatives, and too few resources; depression occurs and/or hyperactivity exists; individuals may feel stressed and exhausted
Stage II: Preparation: Emotional climate is anxiety mixed with hopefulness; possibly reduced productivity; buy-in is essential; opportunity exists of getting people excited, but may fail if preparation is too long or too short
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: Stages of the Change Curve Model—(cont.)
Stage III: Implementation: Individuals must see “what is in it for me?”; it is essential to assess readiness for change and increase confidence in making the change
Stage IV: Determination: The highest chance of failure is in this stage; if results are not as expected, change fatigue may set in if determination to see the change through is not firm; highlighting small successes is crucial
Stage V: Fruition: Positive outcomes are seen; reward and celebration for effort is important; danger in this stage is that organization reverts back to complacency and begins stagnation
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: Kotter and Cohen’s Model of Change
Step 1: Create a sense of urgency: Create the emotional feeling that “we need to move NOW,” which is especially important when individuals are complacent
Step 2: Form a team: Select members who possess the needed knowledge and skills, the respect and trust of others, and enthusiasm and commitment; opinion leaders are particularly important
Step 3: Vision and strategy: Create a clear vision and workable strategy with reasonable timeline
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: Kotter and Cohen’s Model of Change—(cont.)
Step 4: Communicating the vision: Communicate the vision and strategies with “heartfelt messages” that appeal to the emotions, which will motivate change; repeating the message will make the strategies clearer
Step 5: Empowerment: Remove barriers that inhibit successful change
Step 6: Interim successes: Establish short-term successes to celebrate
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: Kotter and Cohen’s Model of Change—(cont.)
Step 7: Ongoing persistence: Cultivate ongoing persistence; giving up too early will doom the project
Step 8: Nourishment: Encourage and feed the new culture to make the change permanent through celebration and planting meaningful infrastructures
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: Roger’s Theory of Diffusion of Innovations
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: The Transtheoretical Model of Health Behavior Change
Originally conceptualized to explain the process of changes in health behaviors, but also is applicable to organizational change
Stages:
Precontemplation: The individual is not intending to take action in the next 6 months (40% of an organization)
Contemplation: The individual is intending to take action within the next 6 months (40% of an organization)
Preparation: The individual plans to take action in the next 30 days (20% of organization)
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Organizational Change Models: The Transtheoretical Model of Health Behavior Change—(cont.)
Stages—(cont.):
Action: Overt changes were made less than 6 months ago
Maintenance: Overt changes were made more than 6 months ago
By matching intervention strategies to the stage in which individuals are currently engaged, the model proposes that resistance, stress, and the time needed to implement the change will diminish
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Strategies to Overcome Barriers to Implementing EBP
Allow individuals to express their skepticism, fears, and anxieties in order to clarify misconceptions
Educate clinicians about EBP in a way that appeals to their emotions; this enhances their beliefs about their ability to implement it
Know the personality types of the individuals involved
Produce a written strategic plan
Develop SMART (i.e., Specific, Measurable, Attainable, Relevant, and Time bound) goals to be achieved
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Strategies to Overcome Barriers to Implementing EBP—(cont.)
Communicate the plan clearly and often; use several media modes (e.g., written, visual/graphic, and video) if possible
Acknowledge that the team-building process is dynamic and requires creativity and flexibility
Match organizational resources and administrative support closely to the diffusion of EBP
Enlist leaders and managers early in the change
Create a critical mass of EBP adopters within leadership and individual clinicians to sustain the change
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
“Knowing and Working with Personality Types”: Rohm’s Taxonomy (the DISC Model)
Type Characteristics Strategy
Drivers Like to take charge and are highly task oriented Give them opportunities to lead specific tasks
Inspired Are socially oriented and like to have fun Show them that the change can be fun and exciting; have them assist in celebrations of success
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
“Knowing and Working with Personality Types”: Rohm’s Taxonomy (the DISC Model)—(cont.)
Type Characteristics Strategy
Supportive and steady Typically reserved and like to be led Emphasize that they are important to the project, but do not have to lead
Contemplators Very analytical and detail oriented Show them all of the details; consider giving them a leadership role in tracking processes and outcomes
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Stages of Team Formation
Stage Stage Characteristics
Forming Anxiety, excitement, testing, dependence, exploration, and trust
Storming Resistance to different approaches; competitiveness and defensiveness; tension and disunity
Norming Trust and respect develops; satisfaction increases; feedback is provided to others; responsibilities are shared; decisions are made
Performing Level of interaction is high; performance increases; team members are comfortable with one another; there is optimism and confidence
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
According to Roger’s theory of diffusion of innovation, the minimum percentage (critical mass) of people who “adopt” to the change that would signal that a change has begun to take hold is:
a. 5%
b. 15%
c. 40%
d. 60%
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
b. 15%
Rationale: According to the theory, there needs to be a critical mass of 15% to 20% of a combination of innovators, early adopters, and early majority before it can be assumed that an innovative change really begins to take hold.
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
What model of organizational change would be most likely to give priority to changing nurses’ feelings about EBP over presenting them with new information?
The transtheoretical model of health behavior change
The Change Curve model
Diffusion of innovations model
Kotter and Cohen’s model of change
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
d. Kotter and Cohen’s model of change
Rationale: Kotter and Cohen propose that the key to organizational change lies in helping people to feel differently (i.e., appealing to their emotions). They assert that individuals change their behavior less when they are given facts or analyses than when they are shown evidence that influences their feelings.
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
According to Rohm’s taxonomy (the DISC model), individuals with which of the following personality styles are most likely to be comfortable in a leadership role?
Driver
Inspired
Supportive and steady
Contemplator
*
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
a. Driver
Individuals with “D” (Driver) personality styles like to take charge of projects and are highly task oriented, making them well suited to positions of leadership
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*
*