Riding the waves of change: Strategies for success Lucia D. - - PDF document

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10/3/2018 Riding the waves of change: Strategies for success Lucia D. Wocial, PhD, RN, FAAN 2018 Annual Meeting MN NACNS October 5, 2018, Burnsville, MN Objectives Describe characteristics of successful change agents. Identify skills

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10/3/2018 1

Riding the waves of change: Strategies for success

Lucia D. Wocial, PhD, RN, FAAN 2018 Annual Meeting MN NACNS October 5, 2018, Burnsville, MN

Objectives

2

  • Describe characteristics of successful

change agents.

  • Identify skills necessary to cope with

change.

  • Identify tools to help the Advanced

Practice Nurse navigate change.

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Diffusion of Innovation Curve

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innovators resisters late majority early majority early adopters 15%

2%

34% 17% 34% length of time to adopt innovation number of people

Rogers, 2005

4

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Change vs Transition

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  • Change
  • Transition

Transition Modal

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Ending Neutral Zone Beginning

Bridges, 1995

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The Change Agent: Characteristics

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Personal Characteristics

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  • Persistence
  • Sense of Humor
  • Tough Skin
  • Patience
  • optimism
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Resilience

  • A dynamic capability which can allow

people to thrive on challenges given appropriate social and personal contexts.

Howe, Smajdor & Stockl, 2012

  • “the ability to recover or healthfully

adapt to challenges, stress, adversity,

  • r trauma: to be buoyant in adverse

circumstances.”

Rushton, 2016

Features of resilience

  • Self-efficacy
  • Self-control
  • Ability to engage support and help
  • Learning from difficulties
  • Persistence despite blocks to

progress

Howe, Smajdor & Stockl, 2012

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Enhancing personal resilience

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  • Accept change
  • Continue learning
  • Sense of purpose
  • Personal identity
  • Networking
  • Reflection
  • Learn new skills

Code of Ethics for Nurses

12

1.

Practice with compassion and respect.

2.

Primary commitment is to patient.

3.

Advocate for individuals.

4.

Accountable for individual nursing practice

5. 5.

The nurse se owe

  • wes

s the same e duty ty to self

6.

Establish and improves health care environments.

7.

Advance the profession through development.

8.

Collaborate with others to meet health needs.

9.

Articulate values and maintain integrity of nursing

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13

The Change Agent: Skills and Resources

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The Change Agent: Job Description

  • Coach
  • Role Model
  • Navigator

Teamwork: Cast of Characters

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  • Sponsor
  • Advocate
  • Change Agent
  • The Team
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Leadership Characteristics

  • Character
  • Commitment
  • Connectedness
  • Compassion
  • Confidence

Cooperation

Accommodating Collaborating

Compromising

Avoiding Competing

Assertiveness

Five Modes of Conflict Management

http://www.foundationcoalition.org/teams

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Silence is not golden

19

  • Silence Kills. The Seven Crucial

Conversations for Healthcare. 2005

  • The Silent Treatment: Safety tools

and checklists aren’t enough, 2010

Crucial Conversations

  • Broken rules (shortcuts)
  • Disrespect
  • Incompetence
  • Lack of support
  • Micromanagement
  • Mistakes
  • Poor teamwork

Patterson, Grenny, McMillin, and Switzler, (2002)

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Accountability Ladder

Making Things Happen Planning Problem Solving Curious/Learning Moaning and Groaning Blaming Avoiding Denial Sabotage

21

Unhealthy Healthy

Tools to Navigate Change

22

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Eight Steps of Successful Change

2 3

  • 8. Create a New Culture
  • 7. Don’t Let Up
  • 6. Produce Short-Term Wins
  • 5. Empower Others to Act
  • 4. Communicate for Understanding & Buy-In

3. Develop the Change Vision and Strategy

  • 2. Pull Together the Guiding Team
  • 1. Create a Sense of Urgency

focus

Kotter, 2007

Universal Precautions

  • Gloves: set realistic expectations
  • Gown: seek help when necessary
  • Goggles: explore excuses
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Checklist for staying on track

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Change Compo ponents Outcome Vision Confusion Skills Anxiety Incentives Gradual Change Resources Frustration Action Plan False Starts ALL Change Lippitt, 1987

Riding the wave

  • Focus on shared SMART goals
  • Specific, measurable, achievable,

relevant, time-based

  • Start small
  • prioritize often
  • Give positive feedback
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3 Communication Channels

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Channel el Meanin ing Tool

  • l

Affective Emotion NURSE Cognitive Facts Ask-Tell-Ask Meaning What matters I wish, I worry

Listening: An Exercise

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I’m fed up with this. I can’t get my work done on the new computer

  • system. I know we can’t go back to
  • ur old system (which is a shame) but

there’s got to be a better way. I’ve got some ideas about how to make this thing work, but I’m not sure it’s worth investing my time and energy.

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PAUSE

29

  • Breathe
  • Smile
  • Stand up straight
  • Release muscle tension
  • focus

Mental Training

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  • Identify the central issue
  • Validate your reaction
  • Weigh the importance
  • What can YOU do about it?
  • Say what?
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How to Survive

  • Self-care
  • Support network
  • Safe space
  • Acceptance
  • Lighten up
  • Seek inspiration

Riding the wave…

  • Nurture supportive relationships
  • Manage conflict
  • Engage in difficult conversations
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33

Comments/Questions?

lwocial@iuhealth.org

34

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References

35

  • Bridges, W., & Mitchell, S. (2000). Leading transition: A new model for change. Leader to leader, 16(3), 30-

36.

  • Crownover, B. (2003). Why did that idea flop?. Family practice management, 10(8), 39.
  • Howe A1, Smajdor A, Stöckl A. Towards an understanding of resilience and its relevance to medical training.

Med Educ. 2012 Apr;46(4):349-56. doi: 10.1111/j.1365-2923.2011.04188.x.

  • Hutton, D. W. (1994). The change agents' handbook: A survival guide for quality improvement champions.

ASQ Quality Press.

  • Kaminski, J. (2011). Diffusion of innovation theory. Canadian Journal of Nursing Informatics, 6(2), 1-6.
  • Kotier, J. P. (1995). Leading change: why transformation efforts fail. Harvard Business Review, 73(2), 59-67.
  • Lippitt, M. (1987). Leading Complex Change. Enterprise Management, Ltd.
  • Peter, E and Liaschenko, J. “Moral Distress Reexamined: A Feminist Interpretation of Nurses’ Identities,

Relationships, and Responsibilities,” Journal of Bioethical Inquiry 10, no. 3 (2013): 337-45.

  • Pulley, M. L., & Wakefield, M. (2001). Building resiliency: How to thrive in times of change. Center for

Creative Leadership.

  • Rogers, E. (2003). Diffusion of Innovations. Fifth edition. Free Press: New York.
  • Rushton CH, Carse A. Towards a New Narrative of Moral Distress: Realizing the Potential of Resilience. J

Clin Ethics. 2016 Fall;27(3):214-218.

  • Silence kills: The seven crucial conversations for healthcare. (2005). VitalSmarts. Retrieved from

http://www.aacn.org/WD/Practice/Docs/PublicPolicy/SilenceKills.pdf

  • The silent treatment: Why safety tools and checklists aren’t enough to save lives. (2011). VitalSmarts.

http://silenttreatmentstudy.com/