NORMA GOMEZ, MBA, MSN, RN, CNN

Unique Challenges for the Nephrology Professional in

Managing Change

CHANGE

CHANGE

THE CHANGE PROCESS

Figure 1

MODELS OF CHANGE

Lewin Lippitt Havelock Nursing ProcessUnfreezing Diagnose the

problemBuilding a relationship

Assessment

Moving Assess the motivation and resources

Diagnosing the problem

Diagnosis

Refreezing Select progressive change objects

Acquiring resources

Outcomes identification

Choose change agent role

Choosing the solution

Planning

Maintain change

Gaining acceptance

Implementation

Terminate helping relationship

Stabilization and self-renewal

Evaluation

RESPONSES TO CHANGE

Opportunity Oh no!

Involve the teamCommunicate ConstantlyPlanDon’t let up

Poor planningEnd user’s not consultedPoor follow up

CHALLENGES TO CHANGE

IMPLEMENTATION

PROJECT MANAGEMENT

The ideal process for implementing change is to organize and manage the work.

This is the definition of project management.

TERMS

A project is a temporary endeavor with a defined beginning and end undertaken to meet unique goals and objectives to bring about beneficial change or added value.

Specific people or groups who have a stake in the outcome of the project are stakeholders.

The project manager is responsible for the processes used to manage the project.

TERMS

The project team consists of the full-time and part-time resources assigned to work on the deliverables of the project.

Scope is the way you describe the boundaries of the project. It defines what the project will deliver and what it will not deliver.

TERMS

A deliverable is any tangible outcome that is produced by the project. All projects create deliverables.

The implementation plan tells an observer how the project team will complete the project.

ORGANIZATIONAL STEPS

Defining the workBegin the process by brainstorming

potential goals, objectives, and activities for the project.

Consider what strategies will be used, as well as resources (including staff, budget, equipment, and technical assistance) needed to carry out the plan.

Before creating a new plan of action the team should first consider whether there is an existing plan that can be modified.

ORGANIZATIONAL STEPS

The first task in formulating your plan is to identify the project team. Identify the needed skills to ensure the

project is a success. Form a team that is representative of

the stakeholders. Team members must make a

commitment to make time in their workday to attend meetings and submit reports as determined by the team.

TEAM COMPOSITIONTEAM COMPOSITION

Project Name ESA Conversion

Project Leader Jeanne Smith

Core Skills Skills

Required Team

Representative Team Status

Department Represented

Development of educational tools Jane Brown Core team Nursing

Policy development Susie Mills Core Medical Clinical/ Operations

Protocol Development Jerry White Core Medical Clinical

Implementation Gary Green Core Operations

Patient education Norma Long Core Social Services

Physician education Dr. Smith Core Physicians

Technical expertise Joe Roberts Core Chief Tech/Machine Techs

Stakeholder Interests Processes Included

Team Representative

Team Status

Team Member Liaison

IT Linda Jones PT Jerry White

Marketing Debbie Flores PT Gary Green

Processes or

Projects Affected Team

Representative Team Status

Team Member Liaison

Logistics

Toolkit

ORGANIZATIONAL STEPS

Establishing TimelinesDepending on the size and scope of change needed, the time frame may extend from weeks to months and at times possibly years.

It is important to recognize that this is a complex process, but a project has a beginning and an end.

ORGANIZATIONAL STEPS

Managing the plan Develop a preliminary plan that outlines each step.

Include who is responsible for each step and how long it will take to accomplish.

IMPLEMENTATION PLAN

It describes the activities required, the sequence of the work, who is assigned to the work, an estimate of how much effort is required, when the work is due, and other information of interest.

Once the plan is in place, it guides the team and they perform the work according to the plan.

Implementation Plan

Project Name: Machine Conversion Target 5/1/12

Project Lead: Jeanne Smith

Task/Activity Priority Action Start Date Due Date Completion Date % complete Responsible

person Notes

Clinical policies and procedures

High 2 -4 weeks prior to start date begin reviewing all policies and procedures and implement change for new machines

3/17/2012 3/22/2012 3/22/2012 100% J. Smith, Clinic Manager

Machine set-up, priming, fluid removal calculations, transducer protectors, termination of treatment, recirculation, policies and procedures revised and approved by approving body.

Staff Education High Set up educational meetings for nurses and staff MD's

3/22/2012 4/15/2012 J. Smith, Clinic Manager

Utilize Manufacturer's education materials and Clinical Representatives

Forms Medium Change forms: •Incident report form •Treatment flow sheet

• Plan of care • Reuse logs• Disinfection logs

3/22/2012 4/10/2012 B. Gomez, Adm. Assistant

Review all forms that may be impacted by this change. Need to get approving body to appove. Contact printer

ORGANZATIONAL STEPS

Execution phase The execution phase is typically the longest

phase of the project. It is the phase within which the deliverables

are physically constructed and presented for approval.

It is very important to develop a system to identify and maintain contact with individuals who have been assigned specific responsibilities within the plan. Communication Plan

ORGANIZATIONAL STEPS

Closure Following the completion of all project

deliverables, a successful project will have met its objectives and be ready for formal closure.

Once your team has planned, created, implemented, and the change has become part of your daily work (standard operating procedure), you are ready to evaluate the process Evaluation process

CASE STUDY

Consider the complexities of implementing the following

changes in a dialysis facility: Acquiring a facility of near equal size Changing to a different dialysis delivery system Changing medication from every treatment to once

per month Changing staff schedule from 12 hour shifts to 10

hour shiftsChange is clearly warranted, but where do you start?Whom do you involve? How do you see it through tocompletion?

KEY POINTS

Nurses need to participate in or lead change management projects

The first step is to identify what exactly needs to change and why

Several tools exist to help this process, including root cause analysis and process mapping

Stakeholders need to be identified and involved in the process of change for it to be successful

Communication throughout the process is essential

Identify and utilize outside resources to facilitate the change

SUMMARY

Select a change theoryCreate awarenessManage resistanceInitiate the changeEvaluate the changed environmentDisseminate the change through the

organization

QUESTIONS