Why is Change so Hard?

Change Everyone thinks of changing the world, but no one thinks of changing himself”   Leo Tolstoy

Many nurse leaders today will readily admit that one of their most significant challenges is dealing with the rapid changes occurring in the health care environment.  This change is happening on many levels.  Organizations are introducing new technologies and electronic medical records that are forcing a change in practice.  Insurers are moving to reimbursement models that are based on pay for performance on a wide variety of measures, many of which are nursing sensitive.  The workforce is comprised of four generations with different values, attitudes and beliefs – and some tried and true approaches in human resource management are no longer working well.  The level of uncertainty during these difficult economic times makes future planning difficult.  We know that the future will require that we take some bold action but resistance to change in times of uncertainty can be challenging.

Accepting Change

In most situations where we are asked to change, we are substituting new and unfamiliar behaviors or practices for old comfortable ones.  This can make us feel insecure about our work and is often personally exhausting.  That is why the reaction to change can be quite emotional.  A good example of this is what is happening with in many institutions with the introduction of the electronic medical record.  Seasoned nurses who have worked their entire careers with paper charts are now being asked to do their charting electronically.  Some are not secure with their technology skills and are having difficulty mastering the new systems that are purchased by their health care agencies.  Initially, their work is taking much longer because of their lack of proficiency with these new systems.  They feel like novices in clinical environments where they once felt quite proficient.  In contrast, many younger nurses who are part of the digital age are quite happy with the transition to electronic medical records.  They have always had technology as part of their life.  Their clinical patterns of working are not as well established because they are early in their careers.  It is important to keep in mind that resistance to change is often a manifestation of insecurity.

The Role of the Nurse Leader in the Change Process

As a leader, reflecting on your own reaction to the change and what you are projecting to others is an important first step.  You may be demonstrating resistance yourself in subtle ways that are both verbal and nonverbal.  Leaders play a key role in framing the context of change for their staff.  This is especially true in uncertain environments.  You must help to manage change in a way that employees can cope with it.  To be successful, change cannot be imposed but rather the leader should look for ways to enable and involve staff.  John P. Kotter, a Harvard Business Professor, is a highly regarded expert in the field of change management.  He proposes the following 8 step model that leaders can use to understand and manage change:

  1. Create a sense of urgency about the need for change– inspire staff to see the need for the change and make the change objectives real and relevant.
  2. Build a team to help guide the change–  get the right people in place (skills, abilities and attitude) to make the change happen.
  3. Develop and communicate the change vision– a simple, clear strategy of what the change is and how the change will occur.
  4. Communicate for buy-In-involve as many people as possible, keep them informed and respond to their needs.
  5. Empower action– remove obstacles, provide feedback and reward progress.
  6. Create short-term wins– establish some easy to reach goals – manage the change in bite-size chunks.
  7. Don’t let up– build and encourage determination and persistence – report on the progress.
  8. Make the change stick– this is the most challenging part of change -weave the change into the culture and practice in tangible ways.

Change can be hard but altering the pace of change in our environments is not likely to be a leadership option now or in the future.  What is within our control is how we personally respond to change, and how we frame and facilitate change for our followers.


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