Estratégia de gestão da mudança em enfermagem

Portfolio: Escritos.

Liderança e Gestão de Mudanças: Navegando pela Fronteira Turbulenta.

June Kaminski, MSN PhD (c)

A mudança não é mais uma saída irregular, uma transformação inconveniente a ser realizada uma vez a cada dez anos. A mudança é algo com o qual temos que aprender a viver, estruturar e gerenciar. A mudança está aqui para ficar, e os vencedores serão os que lidam com isso. "(Bainbridge, 1996, p.4)

Introdução.

A adaptação à mudança tornou-se uma agenda comum para organizações de todos os tipos - cuidados de saúde, negócios, sociais, governamentais, educacionais e culturais. As décadas posteriores do século XX irão cair na história como uma "era de mudança perpétua". Em todas as organizações, os efeitos da mudança são multifacetados. "Novos concorrentes entram no mercado e varrem as bases de clientes estabelecidas, a tecnologia altera as regras de como as empresas podem ser empreendidas, a legislação exige mudanças na forma como os produtos e serviços são entregues, e a desregulamentação lança novos blocos comerciais e setores industriais. Atrás de tudo, as expectativas dos clientes crescem à medida que se tornam cada vez mais experientes e exigentes "(Bainbridge, 1996, p. Vii).

As formas tradicionais de fazer negócios estão rapidamente saindo pela janela. A burocracia, o controle, a rigidez e o funcionalismo tornaram-se ultrapassados ​​e são obstáculos reais ao gerenciamento de mudanças. Talvez o maior obstáculo seja a atitude das pessoas em relação à mudança, que muitas vezes são fixas e resistentes. No entanto, as empresas devem continuar a funcionar como novas capacidades e formas de lidar com a mudança após a mudança serem cultivadas. Capacidades e recursos são o coração de uma organização e são suscetíveis a mudanças: as pessoas, os sistemas de tecnologia da informação (TI), os procedimentos e as características de gerenciamento.

A mudança dentro das organizações ocorre em uma infinidade de níveis. Nova legislação internacional e nacional, clientes conscientes e exigentes, mercado global, sofisticação em desenvolvimento de TI, setores de novas indústrias, mercados e conhecimento, um movimento para uma força de trabalho flexível e de curto prazo e a incerteza sobre o futuro, todo o impacto nas organizações empresariais e sociais em todo o mundo. A combinação dessas mudanças generalizadas pode criar um ambiente de pressão-fogão dentro de organizações que se esforçam para se adaptar e prosperar.

O Fenômeno da Mudança.

Lewin (1951) produziu o primeiro modelo de mudança viável em seu modelo de campo de força. Neste modelo, a mudança foi caracterizada como um estado de desequilíbrio entre forças motrizes e forças de restrição. Se essas forças fossem equilibradas ou em equilíbrio, nenhuma mudança poderia ocorrer. A mudança é inerente em todos os contextos e é um conceito relativo. "Todo fenômeno está sujeito à mudança, por mais aparente que seja sua natureza" (Wilson, 1992, p.8). Essa mudança existe é uma noção previsível. "Em todos os setores e negócios, mude ebbs e fluxos em ciclos recorrentes que, pelo menos até certo ponto, podem ser traçados e, portanto, antecipados e gerenciados" (Nadler & Nadler, 1998, página 45).

A mudança é perigosa, desordenada e complicada. Mesmo com os melhores planos, os eventos raramente ocorrem exatamente como eles estavam previstos. "A mudança real em organizações reais é intensamente pessoal e extremamente política" (Nadler & Nadler, 1998). Os processos de mudança envolvem não apenas estruturas e formas de fazer tarefas, mas também o desempenho, expectativas e percepções de todas as partes envolvidas. A mudança tornou-se generalizada e imprevisível, mas ainda é gerenciável (Bainbridge, 1996). Uma característica inerente da mudança é que é arriscado, especialmente quando abrange muitos setores diferentes dentro de uma organização ou sociedade. A mudança também pode ser planejada ou emergente. Wilson apontou que uma mudança de modelos emergentes de mudança para planejado tem ocorrido constantemente nas últimas duas décadas. No entanto, uma mudança total não é aconselhável, uma vez que o contexto político e econômico do ambiente circundante não pode ser ignorado e também deve ser adaptado. As estratégias para lidar com mudanças não planejadas são tão necessárias quanto as planejadas.

Efeitos da mudança nas organizações.

Para se adaptar efetivamente às mudanças, a maioria das organizações estabelecidas tem uma tarefa difícil por diante em uma variedade de áreas operacionais e processuais. Os processos de negócios devem ser redefinidos e redesenhados e adaptados a configurações geográficas e culturais específicas. A força de trabalho precisa ser treinada para estar pronta para mudanças na forma como o trabalho é feito, quais habilidades e conhecimento são necessários, e como se relacionar com colaboradores globais e clientes. A própria cultura de uma organização precisa ser reformulada para suportar adequadamente os novos processos introduzidos. Estruturas, sistemas de recompensa, medições de avaliação e papéis precisam de redefinição (Bainbridge, 1996). Os estilos de liderança e os procedimentos de gerenciamento devem mudar e se adaptar, e as maneiras de se relacionar com clientes, fornecedores e outras partes interessadas precisam ser refinadas. Os avanços tecnológicos e as capacidades devem ser introduzidas e a preparação da força de trabalho para trabalhar com as novas estruturas de TI é necessária.

A adaptação bem sucedida à mudança exige "uma compreensão sobre como converter e reconstruir as complexidades e os legados dos antigos, bem como gerar designs sobre o novo" (Bainbridge, 1996, página 12). A mudança exige que as organizações movimentem-se de forma realista além de processos antiquados, capacitam e reciclam os funcionários e incorporam avanços em TI na configuração de trabalho diária. Não há mais organizações que reagem a mudanças seqüenciais ou ocasionais. Novas mudanças agora ocorrem quando as organizações estão empolgadas ao iniciar o processo de mudança. A mudança tornou-se perpétua. A fim de lidar, as organizações precisam de um processo de design com estratégias e diretrizes para prosperar entre uma infinidade de mudanças. "A mudança real é um processo integrado que se desenrola ao longo do tempo e toca todos os aspectos de uma organização" (Nadler & Nadler, 1998, p.6).

O papel e as questões dos líderes na mudança orientadora.

A criação e o design de processos de mudança dentro de uma organização são, na maioria das vezes, um papel dos líderes dentro dele. Os processos de mudança que englobam recursos humanos, adoção de TI e atualizações, ferramentas e técnicas, bem como as regras e controles básicos dentro da organização são o mandato dos líderes envolvidos na gestão da mudança (Bainbridge, 1996). Cabe aos líderes fazer com que essas iniciativas de mudança sejam tangíveis em vez de abstratas e despertem o entusiasmo e a apropriação das mudanças propostas no meio corporativo. Os líderes são responsáveis ​​por colmatar o fosso entre as decisões de estratégia e a realidade de implementar as mudanças dentro da estrutura e força de trabalho da organização. Uma infinidade de detalhes e efeitos devem ser reconhecidos e abordados para uma adaptação bem sucedida a mudanças em todos os setores de uma empresa.

"Subjacente a este princípio é o fato de que quase tudo na infra-estrutura de uma organização tem influência em alguma outra parte. O estilo de gerenciamento afeta a cultura, a tecnologia afeta a maneira pela qual a equipe interage com os clientes, os métodos de comunicação internos afetam a forma como as pessoas trabalham juntas" (Bainbridge , 1996, pág. 37). Uma abordagem holística do gerenciamento de mudanças incentiva o redesenho e a adaptação às mudanças em todos os níveis organizacionais. Em essência, o próprio processo pode se tornar a plataforma para a mudança, bem como o protetor das operações diárias existentes.

Uma imagem clara de como o negócio opera atualmente é oferecida, bem como uma imagem de como o negócio deve planejar, agendar e passar pelo processo de mudança.

Nadler e Nadler (1998) enfatizaram a importância dos líderes em organizar e manter um clima de mudança dentro das organizações. Embora a participação de todos os jogadores seja necessária, o papel do líder no processo de mudança é crucial. Apontados os "campeões da mudança" são os líderes, - os principais atores que mantêm o processo de mudança em movimento, mantendo a integridade operacional da organização. Os líderes adaptativos fornecem orientação, proteção, orientação, controle de conflitos e modelagem de normas, supervisionando o processo de mudança dentro da estrutura corporativa (Conger, Spreitzer e Lawler, 1999). É necessário estabelecer prioridades que incentivem a atenção disciplinada, mantendo um olho agudo focado em sinais de angústia dentro dos membros da empresa.

As etapas para transformar uma organização foram identificadas por Conger et al (1999). Os passos incluíram: a) estabelecer um senso de urgência; b) formar uma poderosa aliança orientadora; c) criar uma visão; d) comunicar a visão; e) capacitar outros a agir sobre a visão; f) planejar e criar ganhos a curto prazo; g) consolidar melhorias e produzir ainda mais mudanças e h) institucionalizar novas abordagens.

Um novo modelo de aprendizagem organizacional é importante para a sobrevivência e a adaptação no novo século. Aprender é um requisito fundamental tanto para os líderes quanto para os seguidores, para que ocorram mudanças efetivas e duradouras. "Sem aprender, as atitudes, habilidades e comportamentos necessários para formular e implementar uma nova tarefa estratégica não se desenvolverão, nem um novo quadro pelo qual as decisões de seleção e promoção sejam tomadas" (Conger, Spreitzer e Lawler, 1999, p. 127). Os autores propuseram um processo de aprendizagem de ações, denominado Perfil de Fitness Organizacional, para ajudar os líderes a aprender a transformar habilmente o negócio particular que estão gerenciando. Diálogos programados com seguidores fornecem informações sobre como o estilo de liderança e os comportamentos têm impacto em valores, design organizacional, estratégias e percepções de seguidores. O sucesso organizacional é um processo de adaptação mútua entre valores líderes e comportamentos, pessoas existentes, cultura e design organizacional em meio a um ambiente de mudança contínua e prolífica. Este processo de criação de perfil exige que os líderes sejam corajosos o suficiente para aprender sobre seus próprios pressupostos e valores sobre mudanças, liderança e funções e tarefas de gerenciamento. Em essência, "é necessária uma mudança de paradigma na gestão, pensando em liderança e desenvolvimento de organização" (Conger, Spreitzer & Lawler, 1999, página 158).

Tipos e Complexidades da Mudança.

De acordo com Wilson (1992), a tecnologia tornou-se o motor da mudança para muitas organizações. Nadler e Nadler (1998) creditaram o aumento da concorrência e a globalização como os fatores mais abrangentes no novo ambiente de mudança global. Eccles (1994) delineou seis contextos de mudança comuns ao mundo corporativo. Mudança de aquisição, mudança de injeção, mudança de sucessão, mudança de renovação, mudança de parceria e mudanças catalíticas foram identificadas como inerentes e desafiadoras para a maioria das organizações modernas. A mudança de aquisição implica principalmente uma mudança nos jogadores de gerenciamento. A mudança de injeção suporta uma mudança no CEO ou o alto gerente sênior. A mudança de sucessão é sentida quando a camada de gerenciamento superior é bem sucedida pelos membros atuais que se deslocam para cima da escada à medida que a administração existente se retira ou se move. A mudança de renovação implica o processo de mudança planejado definido pela administração, enquanto a mudança de parceria ocorre quando as decisões de mudança são compartilhadas em todo o espectro de jogadores organizacionais. "Finalmente, e em um estilo diferente para os outros cinco contextos, há uma mudança catalítica em que uma agência, tipicamente um conjunto de consultores ou consultores, intervém em nome de uma ou mais partes interessadas, geralmente a administração" (Eccles, 1994, pág. 88).

A mudança duradoura deve ocorrer em muitos níveis dentro de uma organização (Nadler e Nadler, 1998). As pessoas, o trabalho e a organização formal e informal são todas as facções-chave a serem consideradas e trabalhadas. Nadler e Nadler (1998) identificaram quatro tipos diferentes de mudanças organizacionais. A mudança incremental ou contínua é a seqüência ordenada de mudança que se espera como tempo e progresso do crescimento. A melhoria contínua passo a passo é a reação mais lógica à mudança incremental. A mudança descontínua ou radical é outra questão. "Mudanças complexas e abrangentes provocadas por mudanças fundamentais no ambiente externo são mudanças radicais ou descontínuas" (Nadler & Nadler, 1998, página 50). A mudança descontínua requer mudanças radicais na abordagem e estratégia, levando muitas vezes a uma revisão completa da organização.

A mudança antecipatória é feita na ausência de ameaça e na preparação para mudanças ambientais antecipadas. As mudanças reativas representam o oposto da mudança antecipada e são respostas às ameaças e à concorrência no meio ambiente. Nadler,

Shaw e Walton (1995) advertiram que a era atual está se tornando rapidamente uma mudança descontínua. "A competência central para os líderes empresariais no século XXI será o gerenciamento de mudanças" (p. 273). Os líderes precisarão de habilidades e motivação para se tornarem agentes de mudança visionária constantes. A mudança descontínua afeta profundamente três áreas-chave de qualquer organização: capacidade de liderança, arquitetura organizacional e identidade corporativa. A improvisação, a inovação e a consciência visionária serão o nome do jogo para as empresas de sucesso. A espontaneidade planejada e o oportunismo deliberado serão a chave para a sobrevivência em um ambiente global turbulento. As mudanças podem ocorrer em vários setores diferentes de uma organização simultaneamente. Estratégico, estrutural, cultural, tecnológico, fusão e aquisição, a separação e spin-off, downsizing e mudanças expansivas são comuns, complexas e desafiadoras para incorporar o meio organizacional (Nadler & Nadler, 1998).

Ferramentas e estratégias de mudança de liderança.

Bainbridge (1996) delineou um processo de cinco etapas de redesenho para organizações que estão sendo submetidas a mudanças planejadas. Os cinco passos incluem:

a) a fase de projeto para determinar os requisitos gerais;

b) a fase de definição em que o design é especificado e a documentação dos requisitos do estágio de projeto;

c) o estágio de desenvolvimento, onde as novas capacidades são cultivadas através de treinamento, educação e reestruturação;

d) o estágio de desmontagem, onde partes redundantes da organização são removidas ou convertidas em novas capacidades;

Este processo de design é realizado dentro de uma arquitetura de processo de mudança cuidadosamente organizada. "Isso inclui o link para objetivos estratégicos, a definição de medidas e a produção do próprio projeto de alto nível" (Bainbridge, 1996, p. 53). A visão de mudança deve ser expressa com a maior clareza possível e utilizada de forma consistente para liderar cada etapa do processo de mudança de projeto, incluindo a especificação dos princípios de projeto. Os princípios de design refletem o contexto e também o conteúdo dos resultados de mudanças desejados internos e externos. A especificação e a comunicação desses princípios pelos líderes são necessárias para facilitar a adoção e adaptação dentro da cultura organizacional. Pettigrew (1987) apontou a sabedoria de considerar o conteúdo, o contexto (interno e externo) eo processo de mudança dentro das organizações. Existe a necessidade de "explorar conteúdos, contextos e relacionamentos de processo ao longo do tempo" (pág. 6).

As estratégias de mudança organizacional tornaram-se um veículo viável para o sucesso dos negócios e a criação de desempenho competitivo. A capacidade de lidar com mudanças estratégicas é agora uma característica definidora das organizações pós-indústrias bem-sucedidas. "O leitmotiv da teoria da gestão moderna é o de entender, criar e lidar com a mudança. A essência da tarefa gerencial torna-se assim a criação de alguma racionalidade, ou alguma previsibilidade, do caos aparente que caracteriza os processos de mudança" (Wilson, 1992, página 7).

Uma abordagem de sistemas abertos pode facilitar processos de mudança emergentes dentro de uma organização (Wilson, 1992). As ligações e interdependências entre a organização e o ambiente externo podem ser usadas para criar um padrão de adaptação de mudanças emergentes. Galpin (1996) descreveu um processo para implementar mudanças planejadas a nível de base, usando os pontos fortes e capacidades dos recursos humanos dentro de uma organização como o centro central da mudança. Este processo incluiu etapas de a) definição de metas; b) medição de desempenho; c) fornecer feedback e coaching e d) instigar recompensas generosas e reconhecimento. Galpin também delineou os passos estratégicos que os líderes precisam empregar para iniciar o processo de mudança. Essas etapas foram:

"a) definir a necessidade de mudança; b) desenvolver uma visão do resultado da mudança; c) alavancar equipes para projetar, testar e implementar mudanças; d) abordar os aspectos culturais da organização que ajudarão e sustentam a mudança; e) desenvolver os atributos e habilidades essenciais necessários para liderar o esforço de mudança "(p. 123).

O mapeamento cognitivo e a assistência informática para o apoio à decisão em grupo são estratégias de mudança alternativa que podem ajudar a cultivar o suporte de grupo para as iniciativas planejadas (Hendry, Johnson e Newton, 1993). Os mapas cognitivos ou os sistemas de crença estratégica dos gerentes e funcionários podem ter um efeito profundo sobre a forma como a mudança é planejada e implementada. Os mapas cognitivos tornam-se uma ferramenta prática ", atuando como um dispositivo para representar a parte do sistema de construção de uma pessoa que são capazes e dispostos a tornar explícita" (p. 121). No entanto, o mapa cognitivo é "significativamente tendencioso pela interação social necessária, ou pelo olhar social, que é a base da elicitação através da entrevista" (p. 122). Ainda assim, os mapas cognitivos podem ser uma ferramenta estratégica para negociação e tomada de decisão no processo de planejamento e implementação de mudanças.

Flamholtz e Randle (1998) identificaram o planejamento de transformação estratégica como uma ferramenta chave para mudanças em uma organização. Este processo descreve o planejamento necessário para transformar uma organização no que precisa se tornar para maximizar o ajuste e reduzir as lacunas entre tamanho corporativo, ambiente, conceito de negócios e design organizacional. Flamholtz e Randle identificaram essas transformações como primeiro, segundo e terceiro tipo. Uma transformação de primeiro tipo relacionada à transformação da gestão profissional. Planejamento de revitalização ou transformação de segundo tipo relacionada a todas as camadas da pirâmide corporativa, enquanto as transformações de visão de negócios (terceiro tipo) se concentraram em mudanças necessárias para abordar novos mercados e o papel da empresa nos mercados existentes. As três dessas transformações foram abordadas usando o processo de planejamento transformacional: a) avaliação do meio ambiente; b) revisar o negócio existente; c) resolver questões de transformação fundamentais e d) desenvolver o plano de transformação estratégico escrito. Os gerentes organizacionais no topo devem mostrar liderança, compromisso e convicção para o processo de mudança e transformação (Caravatta, 1998).

A mudança incremental, muitas vezes o resultado de um processo de planejamento e análise cuidadosamente planejado, tem sido a forma mais comum de mudança planejada dentro das organizações (Quinn, 1996). Um sentimento de controle é oferecido, tempo suficiente e compromisso estão presentes, e cada etapa do processo pode ser testada e adaptada. No entanto, com o advento da tecnologia e da globalização, é necessária uma mudança profunda. "A mudança profunda difere da mudança incremental na medida em que exige novas formas de pensar e comportar-se. É uma mudança que é maior no escopo, descontínua com o passado e geralmente irreversível. A mudança profunda significa render o controle" (Quinn, 1996, p.3). ). Mudanças profundas em qualquer nível implicam risco inerente. Para se adaptar às mudanças profundas de nossos tempos, os líderes devem estar dispostos a sair em um membro, a assumir grandes riscos, afastando-se de limites bem estabelecidos.

Efeitos e Conseqüências da Mudança.

Noer (1997) advertiu os líderes a não confiarem demais em ferramentas externas para mudanças. "A busca inútil de uma ferramenta externa e objetiva é uma herança disfuncional do antigo paradigma, a conseqüência da tentativa errônea de enxertar a objetividade do método científico nos fenômenos subjetivos do espírito humano. É um desajuste fundamental," ( pág. 15). De acordo com Noer, o líder, como pessoa, é a ferramenta mais importante para a mudança. O espírito, a percepção, a sabedoria, a compaixão, os valores e as habilidades de aprendizagem do líder são todas as facetas importantes nas capacidades para levar os outros a abraçar mudanças e redesenhar.

Para durar, mudanças profundas não só devem ser feitas em meio a camadas organizacionais, mas dentro de cada um dos próprios jogadores. A mudança pessoal profunda pode ser desconfortável, mas a necessidade de cada membro de uma organização se tornar empoderada e direcionada internamente é essencial para o sucesso nesta era de mudança e evolução. Quinn adverte que se os jogadores não estão dispostos ou capazes de fazer essas profundas mudanças pessoais, então a "morte lenta" é a alternativa. Morte lenta ", uma experiência sem sentido e frustrante enredada no medo, raiva e desamparo, enquanto se move com segurança para o que é mais temido" é a conseqüência da resistência à mudança. O desgaste pode ocorrer se essa resistência à mudança persistir, resultando em perda de emprego ou até mesmo destruição da organização como um todo.

O líder que instigou a mudança dentro de uma empresa é muitas vezes sujeito a suspeita especulativa. "Porque a resistência é tão comum, aprender a superá-la é crucial para gerenciar a mudança em todos os níveis" (Nadler & Nadler, 1998, página 84). O estágio de transição em que o processo de mudança é instigado deve ser tratado com habilidade e entusiasmo. Os líderes devem possuir e alinhar as mudanças propostas, estabelecer expectativas e modelar e comunicar o raciocínio a todos os membros da organização. Os processos de ajuda envolvente e gratificante para motivar os membros, suavizando o período de transição e tentando ganhar os corações e as mentes de todos os envolvidos no processo de mudança.

Preparando-se e Prosperando na Mudança Contínua do Futuro.

Quinn (1996) entusiasmou que "Somos todos agentes de mudança potenciais. Ao disciplinar nossos talentos, aprofundamos nossas percepções sobre o que é possível. Tendo experimentado mudanças profundas em nós mesmos, podemos trazer mudanças profundas aos sistemas que nos rodeiam" (p. xiii). Os líderes que abraçaram mudanças profundas pessoalmente são capazes de projetar processos de mudança que refletem uma posição de liderança heróica e esclarecida, que transmite entusiasmo e vitalidade aos outros membros e cria uma nova perspectiva da lógica e da sabedoria de se mover com o fluxo de mudanças. Nadler e Nadler (1998) descreveram uma matriz de quatro partes de respostas para mudar: tuning, adaptação, redirecionamento e revisão. "Tuning" representa um processo de mudança antecipada em resposta a mudanças incrementais ou contínuas, enquanto a "adaptação" representa uma resposta reativa. O "Redirecionamento" é uma resposta antecipada a mudanças radicais e descontínuas, enquanto a "revisão" representa uma resposta reativa à mudança descontínua.

Para sobreviver aos efeitos da mudança contínua, os líderes precisam realizar três tarefas principais: a) moldar a dinâmica política do processo de mudança; b) motivar a mudança; e c) gerenciar o período de transição (Nadler & Nadler, 1998). Pasmore (1994) identificou a flexibilidade como um traço-chave para a implementação bem sucedida de mudanças. "Outra estratégia deve ser empregada, uma que prepara a organização para uma mudança contínua em um mundo que não oferece estabilidade e não aceita desculpas por estar despreparada, uma estratégia baseada na flexibilidade. Ser flexível significa ser capaz de mudar tudo, ao mesmo tempo "(p. 5). No mundo de hoje, essa flexibilidade se relaciona com pessoas, tecnologia, modos de pensar, formas de liderar e com o design organizacional atual. O truque parece, é perceber que, uma vez que uma mudança é alcançada, a mudança não está concluída. É contínuo e perpétuo (Hambrick, Nadler e Tushman, 1998).

"Normas, valores e princípios operacionais comuns em vez de regras e supervisão direta proporcionará a coesão necessária para fornecer direção e coordenação" (Nadler, Shaw e Walton, 1995). O líder efetivo moldará a visão e os valores da organização e passará um tempo considerável no desenvolvimento de líderes e membros da equipe. Uma cultura e uma rede fortemente desenvolvidas e integradas de indivíduos que usam seu próprio senso de liderança impulsionarão as capacidades organizacionais para a adaptação bem-sucedida a mudanças de todos os tipos e magnitudes.

Conger, Spreitzer e Lawler, (1999) alertaram que velhas formas de moldar comportamentos nos funcionários, a saber, a persuasão racional e a coerção são ultrapassadas e não funcionarão no futuro. No passado, raramente foram bem-sucedidos na perpetuação de mudanças duradouras. No futuro, eles poderiam ser mortais para qualquer organização. Em vez disso, sugere-se um estilo de mudança que remete aos comportamentos usados ​​por Martin Luther King e M. Gandhi: uma estratégia de auto-modificação de poder.

Esta técnica baseia-se mais em uma premissa moral-relacional, em vez de um paradigma político-técnico, que "exige que o agente de mudanças empregue um alto nível de complexidade cognitiva, comportamental e moral" (p. 164). Para sacudir as pessoas de posições complacentes, ou de tomar "o caminho da menor resistência", o verdadeiro empoderamento deve ser experimentado. Os membros devem se sentir desafiados e apoiados por sentimentos de capacitação para desenvolver. Com efeito, isso envolve líderes que estão dispostos a modelar os comportamentos desejados: a capacidade de caminhar à beira do caos, afastando-se da zona de conforto e deixando o controle. A disciplina interna, a visão, a expectativa e a sensibilidade do líder são aprimoradas, o que é evidente tanto para seguidores quanto para pares. "Ao libertar-se de sanções externas através de modificações pessoais, o agente de mudança obtém maior compreensão, esclarecimento ou visão sobre direção e estratégia" (Conger, Spreitzer e Lawler, 1999, p. 170).

O ambiente acelerado de hoje exige que pessoas e organizações desenvolvam a capacidade de se adaptar a mudanças e transtornos penetrantes (Conger, Spreitzer e Lawler, 1999). "A tecnologia de ponta, o triunfo do capitalismo sobre o comunismo, uma economia mundial em expansão, um bilhão de novos participantes na força de trabalho global e um excedente de produtos alimentam um ambiente altamente competitivo e em rápida mudança" (p. xxxi). A chave para a mudança organizacional bem-sucedida, é o gerenciamento de mudanças heróico e aprendido por líderes competentes e visionários. A mudança pode ser gerenciada em um estilo de cima para baixo ou como um exercício altamente participativo de todos os níveis de pessoal. A mudança é específica do contexto, o que significa que nenhum processo de mudança única é apropriado para cada situação ou entidade corporativa.

Os líderes são responsáveis ​​por definir o contexto para mudanças dentro de uma organização. Deve ser cultivada uma cultura e visão que possam suportar as mudanças planejadas e lidar com mudanças não planejadas. Envisioning, energizar e habilitar são todas as estratégias importantes para o apoio ao levantamento de iniciativas de mudança. Os líderes devem ser capazes de aconselhar, ensinar, treinar e recompensar os funcionários conforme eles adotam e se movem através do processo de mudança. Para mudanças duradouras, hábitos, atitudes e valores em todos os níveis de uma organização devem ser congruentes com a visão e os objetivos inerentes ao processo.

Os líderes transformadores compartilham características fundamentais que lhes permitem habilitar os membros organizacionais no processo de mudança (Conger, Spreitzer e Lawler, 1999). Eles são capazes de gerar a energia necessária para realizar o processo de mudança; use visão para liderar; tem uma perspectiva total do sistema; criar um processo sustentado de aprendizado organizacional incorporado em um processo de implementação de mudanças sistêmicas. "Eles devem criar uma arquitetura de processo transformador para orquestrar a passagem do estado atual para a visão" (p. 225). À medida que o sucesso no contexto de transição da mudança é experimentado, o conforto e a preparação são desenvolvidos, equipando os membros da organização com capacidades para lidar com mudanças ainda maiores. A mudança tornou-se o nome do jogo, e o líder sábio abraça-o com os braços abertos. O sucesso da entidade corporativa e as pessoas dentro dela dependem disso.

Referências.

Bainbridge, C. (1996). Projetando para a mudança: um guia prático para a transformação do negócio. Nova York: John Wiley.

Caravatta, M. (1998). Vamos trabalhar de forma mais inteligente, não mais difícil: como envolver toda a sua organização na execução da mudança. Milwaukee, WI: ASQ Quality Press.

Conger, J. A., Spreitzer, G. M. & amp; Lawler, III, E. E. (eds.) (1999). O manual de mudanças do líder: um guia essencial para definir a direção e agir. San Francisco: Jossey-Bass.

Eccles, T. (1994). Sucesso com mudanças: implementando estratégias orientadas a ações. Nova Iorque: McGraw-Hill.

Flamholtz, E. & amp; Randle, Y. (1998). Mudando o jogo: transformações organizacionais do primeiro, segundo e terceiro tipos. Nova York: Oxford University Press.

Galpin, T. J. (1996). O lado humano da mudança: um guia prático para o redesenho da organização. San Francisco: Jossey-Bass.

Hambrick, D. C., Nadler, D. A. & amp; Tushman, M. L. (1998). Mudança de navegação: como CEOs, melhores equipes e placas orientam a transformação. Boston, MA: Harvard Business School Press.

Hendry, J., Johnson, G. & amp; Newton, J. (1993). O pensamento estratégico, a liderança e a gestão da mudança. Nova York: J. Wiley.

Lewin, K. (1951). Teoria do campo em Ciências Sociais. Nova Iorque: Harper & amp; Linha.

Nadler, D. A., Shaw, R. B. & amp; Walton, A. E. (1995). Mudança descontínua: transformação organizacional líder. San Francisco: Jossey-Bass.

Nadler, D. A. (1998). Campeões de mudança: como CEOs e suas empresas dominam as habilidades de mudanças radicais. San Francisco: Jossey-Bass.

Nevis, E. C., Lancourt, J., & amp; Vassallo, H. G. (1996). Rotações intencionais: uma estratégia de sete pontos para organizações transformadoras. San Francisco: Jossey-Bass.

Noer, D. M. (1997). Breaking free: uma receita para mudanças pessoais e organizacionais. San Francisco: Jossey-Bass.

Pasmore, W. A. (1994). Criando mudanças estratégicas: projetando a organização flexível e de alto desempenho. Nova York: J. Wiley.

Pettigrew, A. M. (ed.) (1988). A gestão da mudança estratégica. Nova York: B. Blackwell.

Quinn, R. E. (1996). Mudança profunda: descobrindo o líder dentro. San Francisco: Jossey-Bass.

Wallace, B. & amp; Ridgeway, C. (1996). Liderança para mudanças estratégicas. Londres, Reino Unido: Instituto de Pessoal e Desenvolvimento.

Estratégias para gerenciar mudanças nas enfermidades.

A comunicação pode ajudar as enfermeiras a se adaptarem às mudanças organizacionais.

Artigos relacionados.

1 [Papel] | O papel de um líder de enfermeiras na comunicação 2 [Qualificações] | Qualificações para um Diretor de Enfermagem 3 [Carreiras] | Como mudar de carreira sem ir a falhar 4 [Dicas de contratação] | Entrevistando & amp; Dicas de contratação em enfermagem.

A navegação na mudança organizacional pode causar preocupação na equipe de enfermagem de uma instituição de saúde e estimular o moral dos funcionários. Ao planejar cuidadosamente estratégias para implementar as mudanças, os administradores podem alistar o apoio de seus enfermeiros e até mesmo atribuir-lhes papéis no desenvolvimento e avaliação do novo plano.

Comunicação.

Mesmo mudanças menores podem alarmar a equipe de enfermagem de uma instalação, que muitas vezes se preocupam com o significado da transição para elas. Eles podem temer que possam perder seus empregos ou que a organização reduza seus salários ou aumente seus deveres de trabalho. Comunicar com os enfermeiros durante a mudança pode aliviar a incerteza, eliminar as surpresas e fazê-las se envolver. Administrators should plan their communication strategies well in advance, designating nurse leaders to oversee the effort and determining when and how to alert nurses regarding key events. Health-care administrators can use communication strategies such as community meetings, e-mail and social media to stay connected to the nursing staff.

Teaching nurses about the planned changes and their impact on the facility and nursing staff can eliminate some of the anxiety over organizational change. In addition, offering training to help nurses adjust to new policies or procedures can give them the skills they need to successfully navigate the change. It also encourages them to take a hands-on role in the transition. Seminars and workshops prepare nurses for the impending changes and ensure they're implemented smoothly. For more intensive training, administrators can offer one-on-one coaching, assigning nurse leaders to teach nurses the skills and knowledge necessary for thriving in the new work environment.

Encourage Teamwork.

Enlisting nursing staff to offer input and assist in problem-solving can prevent resistance and offer insight from those closest to the issue. Managers can organize nurses into teams, asking them to brainstorm solutions for problems or offer recommendations for implementing the proposed changes. This can draw out valuable information from the people responsible for integrating the changes. It also demonstrates that the organization values the opinions of its nurses.

Explain Your Reasons.

To the nursing staff, planned changes may seem arbitrary or confusing, but administrators who explain the motivations behind them can turn the nurses into their biggest supporters. If nurses know the changes will enhance patient care, make employees' jobs easier or offer the facility significant financial benefits, they're more likely to champion the new structure and do whatever it takes to ensure the plan's success. It also shows them the facility's leadership doesn't expect them to accept the changes without understanding the reasons for and benefits of the new way of doing things.

Referências (3)

Créditos fotográficos.

BananaStock/BananaStock/Getty Images.

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Applying Lewin’s Change Management Theory to the Implementation of Bar-Coded Medication Administration.

by Karen Sutherland RN BScN.

MSN Student, Memorial University of Newfoundland and Labrador.

In today’s rapidly changing healthcare environment, technological advancements and computer assisted devices can challenge nurses in many ways. Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change practice. Medication errors in hospital settings lead to devastating consequences for both nurse and patient that can be reduced significantly through the use of technology that improves patient care and saves time for busy nurses. Bar-coded medication administration is one type of technology that uses a scanning device to compare bar codes on patient identification bands with bar codes on prescribed medications, electronically verifying the medications against the medication records, thereby reducing medication errors significantly. This paper will examine the applicability of using Kurt Lewin’s change management theory as a framework to introduce bar-coded medication technology at a large psychiatric facility. Lewin’s theory can lead to a better understanding of how change affects the organization, identify barriers for successful implementation and is useful for identifying opposing forces that act on human behviour during change, therefore overcoming resistance and leading to acceptance of new technologies by nurses.

Change management, Lewin change theory, Medication errors, Bar-coded Medication Administration.

Introdução.

Medication safety has been identified by the Institute for Safe Medication Practices Canada (ISMPC) as a priority among hospitals and long term care facilities since medication errors in hospitals are a serious threat to patient safety. Several studies (Carroll, 2003; Dennison, 2007; DeYoung, Vanderkooi, & Barletta, 2009) indicated that the rates of fatalities associated with medication errors in the United States were greater than 7000 deaths annually, and affected three to five percent of in-hospital patients. The ramifications of medication errors affect all healthcare organizations, resulting in consumer mistrust, increased healthcare costs, and patient injury or death (Carroll, 2003). Medication errors can occur at any stage of the dispensing and administration process but only an estimated five percent are noted in nursing documentation, suggesting that many errors that have not led to serious results are unreported (Wilkins & Shields, 2008).

Several strategies have been introduced to lessen the likelihood of error in the dispensing and/or administration process, including patient identification and electronic medication records. Bar coded medication administration is one such tool that has the potential to reduce medication errors significantly, when used correctly (Carroll, 2003; Dennison, 2007). Patient safety is one of health care’s top priorities and safe medication delivery is an important aspect of total patient care. The current system of medication delivery and administration at our facility involves old medication carts in poor repair and relies on manual checks to ensure the right drug is given to the right patient at the right time, route, site and dosage by the nurse. The psychiatric facility in question is now planning a complete overhaul of the pharmacy system and is incorporating automated dispensing machines, along with electronic medication records and bar coding of medications to modernize their care and improve patient safety. This large project will have the greatest impact on front line nurses, many of whom are skeptical of change or lack confidence in their ability to adapt to new technologies, therefore careful implementation of this project is imperative.

The purpose of this paper is to discuss how Lewin’s Change Management theory can guide the process of implementing bar-coding medication administration (BCMA) at this large psychiatric facility. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, new technologies can result in workarounds that threaten patient safety.

The Importance of Bar-Coding.

The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) defines a medication error as “any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribuição; administration; education; monitoring; and use”. Medication errors are a common occurrence in healthcare facilities around the globe, with serious consequences resulting in death or harm, increased inpatient days in hospital, erosion of trust between consumer and healthcare organizations, and a great deal of economic expense (Carroll, 2003; Dennison, 2007). The economical impact of medication errors is estimated to be around five thousand dollars per error unless there is legal litigation, when the costs can skyrocket into the millions (Dennison, 2007). No less important, but certainly less discussed, is the harm to nurse morale after being involved in a medication error, potentially leading to lost time from work (Dennison, 2007). While medication errors can occur at any stage in the process, the nurse is often the last line of defense for catching mistakes due to the nature of the administration of meds at the bedside. This can translate into the onus of responsibility being shifted onto the nurse to not only catch drug errors before they occur, but take the blame if they do occur (Wilkins & Shields, 2008).

The ISMPC has worked closely with hospitals, pharmacies and drug companies to address many preventable occurrences ranging from medication reconciliation programs to the standardization of drug names and labeling. The introduction of automated pharmacy dispensing machines, bar-coding and scanning of medications is a national project throughout Canada, aimed at reducing medication errors and ultimately improving patient safety. The technology involved in bar-code scanning also integrates electronic medication records (EMR) and computerized physician order entry (CPOE) into practice, thereby reducing paper documents and the possibility of transcription errors, ineligible handwriting or missed signatures. BCMA technology consists of bar coded medication packets and bar codes on patient identification bands as well as a scanner attached to a medication cart. The process begins when the nurse uses the scanning device to scan the patient’s identification band then scans the packet of medication being administered. At that time the cart communicates wirelessly with the patient’s electronic medication administration record (MAR) and verifies several elements; that the medication is the correct one ordered for that patient and that the dose, time, route, frequency are correct. Without bar-coding this process is completed manually by the nurse by checking against the paper MAR, verifying these same elements and has been estimated to take up to thirty minutes per patient (Foote & Coleman, 2008) in extreme cases.

With added distractions, complexities of care, and faced paced environments, nurses may inadvertently overlook inconspicuous errors or fail to catch packaging errors, leading to medication mishaps that could have serious consequences. When used correctly, BCMA systems can lessen the chance of medication errors – sometimes reducing medication errors by as much as eighty percent (Carroll, 2003; Foote & Coleman, 2008; Young, Slebodnik & Sands, 2010). The introduction of BCMA technology at our psychiatric facility can improve patient safety and also decrease time spent on medication administration, thereby allowing more time for patient contact. Currently nurses use old medication carts that have worn wheels, broken drawers and some are health and safety hazards. The nurses use paper medication records and must double check medications against the MAR sheets before administering. The facility has recently introduced new computerized swipe access carts that are bar code scanner friendly with the intent to introduce bar coding once the pharmacy department converts to electronic medication dispensing and electronic medication records. While many nurses will welcome this time-saving change, others will feel overwhelmed by the magnitude of the change; therefore careful planning and support on the part of the organization will lessen the stress associated with the implementation.

Change Management.

In today’s busy healthcare environment, nurses are expected to keep up with modern integrated technology, often with little say as to how it affects them. As with any new change, ‘buy in’ by front line nurses is essential to a smooth transition of any informatics project, as many nurses can be unsure and resistive to new computer aided devices in practice (Bozak, 2003). Managing change has always been challenging in health care facilities, and new technologies often incite resistance from nurses who already cannot find enough time in their shift to complete patient related tasks. Several common barriers have been identified when implementing a change in procedure of this magnitude including lack of cooperation amongst staff, fear of using new techniques, and resistance to change in hopes that the new technology would just disappear (Spetz, Burgess & Phibbs, 2012). One barrier that could impact the implementation at our psychiatric hospital is the possibility of a patient refusing to wear identification bands, which are necessary for BCMA to work. Other barriers include short cuts that some nurses have adopted to save time, such as pre pouring medications, which contravenes Canadian nursing standards of practice. Several studies identified barriers to successful implementation of BCMA through the use of ‘workarounds”. In one study, researchers found “15 types of BCMA-related workarounds and 31 separate probable causes of the identified workarounds” (Koppel, Wetterneck, Telles & Karsh, 2012).

Workarounds are common and are a unprofessional attempts to circumvent computer failures or save time. They come about through frustration on the part of the nurses when they are unable to find a solution to an immediate problem. Some common workarounds in BCMA include administering medications without scanning the patient’s wristband, placing the wristband on a stationary object such as the end of the bed, scanning medication packages after delivery and administering medications without scanning the medication bar code. For successful implementation of a project as large as bar-coding, careful planning and identification of all barriers are imperative. Not all nurses are comfortable with technology in the work environment, thus they may be resistant to changing practice, or be afraid of failure (Bozak, 2003). It is important to recognize the different educational needs of the various nurses and acknowledge the varying attitudes and stresses the nurses might have. Using Lewin’s Change Management Theory as a framework can strengthen the probability of successful BCMA implementation.

Lewin’s Change Management Theory.

Many health care organizations have used Kurt Lewin’s theory to understand human behaviour as it relates to change and patterns of resistance to change. Also referred to as Lewin’s Force Field Analysis, the model encompasses three distinct phases known as unfreezing, moving and freezing or refreezing (Bozak, 2003). The intention of the model is to identify factors that can impede change from occurring; forces that oppose change often called restraining or ‘static forces’ and forces that promote or drive change, referred to as ‘driving forces’. When health care organizations fully understand what behaviours drive or oppose change, then work to strengthen the positive driving forces, change can occur successfully (Bozak, 2003).

In Lewin’s first ‘unfreezing’ stage, an understanding of the difficulties related to the identified problem are sought and “strategies are developed to strengthen the driving forces and weaken or reduce the restraining forces” (Bozak, 2003, p. 81). Unfreezing involves identifying key players that will be affected by the change and gathering them together to communicate ideas and create lists of all driving and static forces that will affect the project. The second ‘moving’ stage is where the actual change in practice takes place as a result of equalization of the opposing forces, thereby allowing the driving forces to support the change. In this stage, implementation of the project produces the change desired, so it is important to continue to keep lines of communication with the nursing staff open. Finally, once the desired change has occurred, the ‘refreezing’ stage can be used to evaluate the stability of the change and the overall effectiveness within practice.

Application of the change management theory.

Unfreezing Stage.

The first step of Lewin’s Analysis involves identifying the change focus; specifically, implementing a bar-code scanning system of medication delivery at a large psychiatric facility. Key components of this step are communicating with all stakeholders including frontline nurses, managers and administration. Bozak (2003) asserted that it was important that lines of communication remain open and honest, which creates a “sense of security and trust in all those involved with the proposed change” (p. 83). The inclusion of front line staff in planning groups and key decision – making processes promotes a feeling of empowerment that helps to overcome their resistance to the change and enables them to understand the importance of the project and how it will beneficially affect client care.

During the unfreezing stage, round table discussions with the purpose of teasing out the driving and restraining forces will help identify barriers that may need to be overcome. In this facility some restraining forces might be; staff resistance to using computerized devices, the possibility of workarounds, lack of computer experience, lack of trust in the organization, and aversion to using a new system. Driving forces would be the forces that will help move the project to completion such as; adequate financial investment, support from upper level management, potential for ease of use and better time management. The important point here is that this exercise actively engages all parties to work towards accentuating the positive driving forces and diminishing the restraining forces so that BCMA is successfully adopted without the use of dangerous workarounds with full nursing investment in the outcome.

Moving Stage.

The moving stage represents the period of actual change including the planning and implementation stages of the project. Implementing bar coding across the facility will require sustained effort from various teams, some of which include; information technology (IT), pharmacy, clinical information services (CIS), nursing, program managers, clinical nurse educators and administrators. A project of this magnitude will affect all of these departments in different ways, so planning an effective roll out with the assistance and inclusion of all stakeholders is imperative. Bozak (2003) recommended actively involving nursing staff, to create a feeling of ownership of the success of the project. Some areas to consider at this facility are implementation timelines, reliability of the equipment, educational training needs, effects on workflow, organizational culture and leadership (Spetz, Burgess & Phibbs, 2012). It is also important to have a project leader to oversee and monitor a project of this magnitude through all phases. Challenges in this stage may include discovering the use of workarounds that can be resolved through further education.

Refreezing Stage.

In this final stage of Lewin’s theory, the process of freezing or refreezing the changed practice occurs and leads to a time of “stability and evaluation” (Bozak, 2003, p. 84). Ongoing support of the nurses on the frontline and technology support to all stakeholders should continue until the change is deemed complete and all users are comfortable with the technology. Once completed and fully operational, an evaluation and summary of problems encountered, successes realized, and challenges encountered throughout the project should be done, for future reference.

Conclusão.

With any project of this magnitude, it is imperative to have a complete plan in place for ultimate success. Using Lewin’s Change Management theory to guide the implementation of BCMA at this large psychiatric facility can help to promote acceptance by frontline nurses by involving them in all aspects of the planning and implementation. Creating this ‘buy in’ from frontline nurses builds autonomy and ownership of the project, ultimately leading to success. The use of brainstorming round table discussions to identify driving and resisting forces is a first step in this process. Addressing restraining forces helps to promote adoption to ensure the smooth implementation of the BCMA resulting in reduced medication errors. Often, nurses are forced to change practice without having the opportunity to give input, which has eroded their trust of the organization over time. By using Lewin’s theory, we can help reduce stakeholder resistance and fear of change through the development of a well thought plan and active participation in the change process.

Referências.

Bozak, M., (2003). Using Lewin’s force field analysis in implementing a nursing information system. Computers, Informatics, Nursing , 21(2), pp.80-85.

Carroll P. (2003). Medication errors: The bigger picture. R N, 66 (1), 52-58.

Dennison, R. (2007). A medication safety education program to reduce the risk of harm caused by medication errors. Journal Of Continuing Education In Nursing , 38(4), 176-184.

DeYoung, J., Vanderkooi, M., & Barletta, J. (2009). Effect of bar-code-assisted medication administration on medication error rates in an adult medical intensive care unit. American Journal of Health-System Pharmacy, 66(12), 1110-1115. doi:10.2146/ajhp080355.

Foote, S. O., & Coleman, J. R. (2008). Medication administration: The implementation process of bar-coding for medication administration to enhance medication safety. Nursing Economics, 26 (3), 207-210.

Koppel, R., Wetterneck, T., Telles, J. L., & Karsh, B., (2008). Workarounds to barcode medication administration systems: Their occurrences, Causes, and threats to patient safety. Journal of American Medical Information Association, 15, 408-423. doi: 10.1197/jamia. M2616.

Institute of Safe Medication Practices Canada, 2012. Retrieved from ismp-canada/index. htm.

Lehman, K., (2008). Change management: magic or mayhem. Journal for Nurses in Staff Development , 24(4), 176-184.

Rack, L., Dudjak, L., & Wolf, G., (2011). Study of Nurse Workarounds in a Hospital Using Bar Code Medication Administration System. Journal of Nursing Care Quality. 27(3) 232-239. doi: 10.1097/NCQ.0b013e318240a854.

Spetz, J., Burgess, J. F., & Phibbs, C. S. (2012). What determines successful implementation of inpatient information technology systems? The American Journal of Managed Care, 18 (3), 157-162.

The National Coordinating Council for Medication Error reporting and Prevention, (2012). Retrieved from nccmerp/

Wilkins, K. & Shields, M., (2008). Correlates of medication error in hospitals. Statistics Canada . Retrieved from statcan. gc. ca/pub/82-003-x/2008002/article/10565-eng. htm.

Author Biography.

Karen Sutherland RN BScN CPMHN(C) is a first year Masters of Nursing Student at Memorial University. She works at a large psychiatric hospital in Ontario as a nurse educator/practice lead, specializing in forensic mental health nursing. She completed her post RN BScN degree at Laurentian University in Ontario in 2009 and her RN diploma from George Brown College, Toronto Ontario in 1983. Most recently, she obtained her Canadian Nurses Association Specialty Certificate in Psychiatric and Mental Health Nursing.

The Monieson Centre for Business Research.

The Monieson Centre for Business Research was established in 2000 by Mel Goodes in recognition of Professor Danny Monieson’s academic career at Queen’s University. Professor Monieson was driven by the desire to produce rigorous academic research that advances our thinking about business practice. Inspired by this legacy, the Monieson Centre funds collaborative faculty initiatives, driven by rigorous academic research that forms the foundation for usable knowledge that impacts our thinking about business issues of contemporary importance.

At present, the Monieson Centre supports three collaborative research initiatives which help to establish Smith School of Business expertise in the following domains of business research.

Mel Goodes and Professor Danny Monieson.

Research Initiatives.

Disruptive Technologies & Financial Innovation.

This research group aims to investigate the effect of disruptive technology on Finance. The focus of the grant is on the “disintermediation” of finance through technological innovation. Specifically, the Collaborative Grant will study how technology can change the process by which borrowers and lenders (and savers and consumers) are matched through financial markets.

The research group will seek to answer important questions such as: does technology make this process more transparent, or do a select few benefit at the expense of the many? The Grant will be used to establish the infrastructure of a virtual data center that will enhance collaboration through data sharing between both internal and external researchers.

Crowds & Organizações.

An important byproduct of the widespread use of social media and communication technologies has been the rising exposure of organizations to multiple audiences, which include not just their customers but also proximate and more distal publics. While recent research has brought light on the sources of organized contention faced by organizations, we know comparatively much less about the role played by audiences in the creation of organizational purpose.

This research group will focus on the interactive creation of meaning and organizational purpose between organizations and their audiences, by addressing the following questions: How are organizational audiences created? How do organizations influence or manage the process of audience formation? How do organizations develop a shared sense of purpose in interaction with their multiple audiences in society?

Social Entrepreneurship and Resilient Communities: Examining Aboriginal, Rural and Remote Contexts.

Tina Dacin, Peter Dacin, Madeline Toubiana and Simone Parniak.

Canadians face a number of social issues including poverty, healthcare, civic engagement, education and the environment. The effects of these concerns are particularly felt by Aboriginal populations in remote and rural communities, who have failing systems and limited resources as a result of the lasting effects of colonialism. In a changing business landscape with increased complexity and rising uncertainty, traditional business solutions that address diverse societal concerns, often misdirected (Moyo, 2009) or poorly executed, are bringing about a number of shifts in how organizations must simultaneously serve the needs of both customers and society (Marquis, Glynn & Davis, 2007). This business landscape combined with the unique needs of these communities has resulted in a quest to find novel solutions through various forms and techniques of social innovation and social enterprise.

Growing Up Poor & Liderança.

Julian Barling, Nick Turner, Julie Weatherhead (PhD Student)

Scholars have spent decades trying to expand our understanding of leadership, mostly by asking minor variations of the same old questions, an approach that lessens the likelihood that new knowledge is created. This research group seeks to redress this by asking new questions about leadership, specifically if and how growing up in poverty influences later leadership. Specific questions that will be addressed include: How does early childhood poverty influence who becomes a leader? How does exposure to early childhood poverty influence the type and quality of leadership behaviors once assuming a leadership position? Can we enhance the motivation to lead among late adolescents reared in poverty? Can we reduce implicit negative stereotypes and biases held by leadership selection committees that disadvantage lower SES applicants?

Using Kotter’s Change Management Theory and Innovation Diffusion Theory In Implementing an Electronic Medical Record.

by Melanie Neumeier, RN.

Masters of Nursing Student,

Memorial University of Newfoundland and Labrador.

The high incidence of preventable medical errors in health care is a key factor that has led to pressure on health care organizations to implement electronic medical records (EMRs) as a means to mitigate the issues antecedent to these adverse outcomes. However, despite the potential benefits of implementing an EMR, the adoption of this technology has been slow. There are many potential barriers to the implementation of an EMR with the most salient being poor change management. There are many change management theories available and two that have been used to successfully implement technological innovations in health care are Kotter’s Change Management Theory and Rogers’ Innovation Diffusion theory. This article presents a theoretical discussion of how a combination of these two theories could be applied in practice to successfully implement an EMR.

Electronic medical record, change management, innovation diffusion, Kotter’s Change Management Theory, Rogers’ Innovation Diffusion theory.

Introdução.

The trend in the United States following the Institute of Medicine (IOM) report To Err is Human: Building a Safer Health System has been to move toward the adoption of an electronic health record (EHR) as a means to transform health care and improve patient safety (Pomerleau, 2008). The goal of an electronic health record that connects care providers to patient information nationwide has permeated the Canadian health care system as well, but before a national EHR can be realized, health regions across the country need to implement an electronic medical record (EMR). The electronic medical record (EMR) allows for efficient access to patient information and can include functions such as computerized prescriber order entry (CPOE) and electronic medication administration record (eMAR) (Holtz & Krein, 2011). Using an EMR with CPOE improves access to more complete patient information (Holtz & Krein, 2011), enhances medication safety, decreases prescribing errors (Horning, 2011), and eliminates the need for redundant data entry and the potential for error that causes (McLane, 2005). Yet despite these benefits many health regions are slow to adopt this technology (Wolf, 2006). One of the reasons for this slow adoption may be that reports show up to 50 per cent of attempts to implement health information technology (HIT) initiatives fail (McLane, 2005). Barriers to the successful implementation of an EMR identified in the literature include: high costs, lack of standardization, concerns about privacy, and an unwillingness of staff to accept and use the new system (Hillestead et al., 2005; McLane, 2005).

Effective change management is integral to the successful implementation of an EMR (McCarthy & Eastman, 2010). Change management is about engaging and preparing people. It is about behavior change, maximizing abilities, and achieving results. It is about identifying and anticipating barriers and creating strategic solutions. It is the human side of implementation, and it is an essential practice in order to be successful in “the new world of EMRs” (p. 2). The purpose of this paper is to demonstrate how using Kotter’s Change Management Theory and Rogers’ Innovation Diffusion Theory can help identify and address barriers to change that could be encountered when implementing an EMR.

Implementing an EMR.

The IOM report To Err is Human: Building a Safer Health System (2000) details shocking statistics that at least 44,000 people, and perhaps as many as 98,000 people, die in hospitals each year in the United States as a result of preventable medical errors. Estimates from the Canadian Institute for Health Information (CIHI) suggested that one in ten adult Canadians taking medications would receive the wrong medication or dose (CIHI, 2007). These errors have been linked to system issues that lead people to make mistakes or fail to prevent them, versus poor care from individual providers (IOM, 2000). System issues that have been implicated include: difficulty in obtaining complete and accurate patient medication lists, multiple care providers in multiple locations with access to incomplete information, transcription errors, illegible writing, delay in receiving information, lack of clinical decision support tools, and lack of automated medication alert systems (CIHI, 2007; IOM, 2000; McLane, 2005; Sassen, 2009). As systems issues have been identified as contributing factors mistakes can best be prevented through systems interventions that make it “harder for people to do something wrong and easier for them to do it right” (IOM, 2000, p.2). One of the primary ways to improve patient safety is to reduce the risk of adverse drug events, and one strategy for reducing that risk is to implement an EMR (CIHI, 2007).

What is an EMR?

“An EMR is one or more computerized clinical information systems that collects, stores, and displays patient information” (McLane, 2005, p.85). An EMR is designed to replace the traditional paper medical record, and at its most basic level, provides a legible, organized method of recording and retrieving patient information. An EMR allows for “efficient retrieval and access to patient data, including notes, laboratory results, and prescription records” (Holtz & Krein, 2011, p. 248). However, an EMR is more than just an efficient electronic filing system for patient records. An EMR can include patient safety and provider support features such as computerized clinical decision support (CDS), computerized provider order entry (CPOE), electronic medication administration record (eMAR), and electronic medication alerts, just to name a few. These embedded safety and clinical support tools have been shown to decrease the number of prescribing and medication administration errors, improve access to information and decision making, and decrease costs (CIHI, 2007; Holtz & Krein, 2011; IOM, 2000). However, despite the evidence to suggest that implementing an EMR may reduce system inefficiencies that are contributing to adverse events, the adoption of this technology has been slow, and many attempts to implement change have been unsuccessful (McLane, 2005; Wolf, 2006).

Barriers to Implementation.

Barriers to successful implementation of EMRs identified in the literature include: high costs, lack of standardization, concerns about privacy, and an unwillingness of staff to accept and use the new system (Hillestead et al., 2005; McLane, 2005).

However, considering that attempts to implement EMRs continue to fail despite the commitment of serious financial resources (McLane, 2005), I would suggest that the most significant barrier to implementation is a resistance to change. An EMR is not simply a tool to enhance efficiency through automation, but is in fact a transformational tool that “refashions how work is done and how people relate to each other” (McLane, 2005, p. 87). Implementing an EMR involves significant change, and if that change was not sought by staff, significant resistance may be the response. Staff acceptance of and willingness to use an innovation are major determinants of that innovation’s success and considering that nurses are a primary stakeholder in healthcare, it is important to understand their adoption tendencies in order to develop a successful implementation plan (Holtz & Krein, 2011).

In her review of the current literature on EMR implementation Sassen (2009) examined nurses’ feelings about the EMR and reasons for adopting or rejecting it. She found that the most important factor influencing the attitude a nurse ultimately adopts towards an EMR are the change management techniques used. Nurses emphasized the need to be involved in the decision making process from the beginning as part of project teams and usability testing. When nurses were not included in shared decision making their suspicions and myths regarding EMRs were not dispelled, and the EMR did not adequately support nurses’ work. Neglecting to manage the human side of technology implementation led to serious challenges and failure for the EMR to be adopted.

As a change management strategy prior to the roll out of an EMR, McLane (2005) surveyed a sample of staff to gain an understanding of their experience with and opinions about computers and their expectations for the EMR. Concerns about patient confidentiality and nursing workload were raised in the surveys. Survey data was used to guide staff education about expected benefits of the EMR and when those benefits would be seen, as well as patient safety features of the EMR including confidentiality protection. The survey data also guided the development and design of the nursing documentation feature. Assessing and recognizing the attitudes and expectations of staff prior to the implementation of the EMR allowed the planning team to create a system that met the needs of its users and resulted in a successful launch of their EMR.

Holtz and Krein (2011) used the unified theory of acceptance and use of technology (UTAUT) model to understand nurses’ perceptions of a newly implemented EMR. The UTAUT model considers performance expectancy, effort expectancy, social influence, and facilitating conditions as key predictors of a person’s intention to use technology and actual use behavior. Results of the study showed performance expectancy or the degree to which an individual believes an innovation will help them perform their job, and social influence or the degree to which an individual feels social pressures to use an innovation, were significant factors in EMR adoption. Social influence was found to be the most significant factor with nurses having the strongest influence on the attitudes and perceptions of their nursing coworkers. Nurses in this report were more concerned about the impressions of other nurses than the improved productivity provided by the EMR.

This brief review of the literature highlights the importance of understanding the human side of technology implementation. Discrete barriers and facilitators to successful EMR implementation varied, but the need to address the human factors in change was clear. McCarthy and Eastman (2010) state “If the goal of your EMR implementation is to achieve sustainable results, growth, or organizational transformation, then a substantial investment in people must be central to your overall implementation strategy” (p. viii). I believe that this investment in people can be facilitated through the thoughtful application of change management theory.

Theoretical Framework.

Initiating a change is a complicated process, and following a theoretical framework can provide a basis for making informed decisions that allows for better control over the outcomes of action (McEwen & Wills, 2007). Two theories on change and innovation that have been used successfully to facilitate the adoption of technology in health care organizations are Rogers’ Innovation Diffusion Theory and Kotter’s Change Management Model (Campbell, 2008; Wolf, 2006). Both of these models provide steps and guidelines for engaging individuals and organizations to support both willingness and ability, thus helping to improve the likelihood the EMR would be adopted.

Kotter’s Change Management Theory.

There are many different change management models, but one that has been used successfully in health care (Clark, 2010), and specifically to address the adoption of technological innovations (Campbell, 2008), is John Kotter’s eight-stage process for transformational change (Kotter, 1996). This dynamic model is comprised of eight stages that can be organized into three phases. The first phase is “creating a climate for change” and includes establishing a sense of urgency, creating a guiding coalition, and developing a vision and strategy. The second phase is “engaging and enabling the organization” and includes communicating the vision, empowering action, and creating short-term wins. The final phase is “implementing and sustaining the change” and includes consolidating gains and producing more change, and anchoring new approaches in the culture.

Creating a climate for change.

The first stage is establishing a sense of urgency. The biggest mistake in attempting change is to allow complacency (Kotter, 1996). This is a critical step because without a sense of urgency people will cling to the status quo and resist change. Creating urgency involves helping people see and feel first hand why a change needs to occur (Campbell, 2008).

The second stage is creating a guiding coalition. The guiding team members need to have the knowledge, credibility, influence, and skills required to mobilize change (Kotter, 1996). The third stage is developing a vision and strategy. In this stage you need to create a clear and defining vision that is shared by all stakeholders. The result should be a compelling statement that clearly articulates what you are trying to achieve that can be explained in five minutes or less (Kotter, 1996). The vision needs to include a collective sense of what a desirable future looks like, in clear and measurable terms that all stakeholders can stand behind (Clark, 2010).

Engaging and enabling the organization.

The first stage in this phase is communicating the vision. Once the vision has been created and agreed upon by members from all stakeholder groups, it is imperative that it be communicated frequently and convincingly to all groups. This involves communicating the vision in words and actions by leading through example. Members from all groups need to be hearing the same message from everyone in order to gain buy-in and guide them from awareness of the change to a state where they feel empowered to advocate for the change (Campbell, 2008). This involves engaging in continuous dialogue with stakeholders to build commitment and trust.

The next two stages in this phase are enabling action and creating short-term wins. At this stage all parties need to work together to remove obstacles and empower all members to participate. It may involve providing incentives for embracing change, and feedback on how they can use the changes for their benefit (Campbell, 2008). Changing the culture of a workplace takes time, and as time goes on urgency drops and complacency rises (Kotter, 1996). Creating short-term wins can help keep the momentum going. Wins should be celebrated in a highly visible way that is connected to the vision and then that momentum can be used to set new achievable goals (Clark, 2010). After each win it is important to analyze what went right and what needs improvement.

Implementing and sustaining the change.

The seventh and eighth stages are consolidating gains to produce more change and anchoring new approaches in the organizational culture. The warning in these stages is not to declare victory prematurely. Declaring that the change has been successfully implemented means that people lose all urgency and if the changes have not been firmly anchored into the culture, people will slip back into the “old” way of doing things (Kotter, 1996). In this phase there needs to be a continued focus on the desired vision and the strategic steps required to achieve it until the change becomes a permanent part of the organization’s culture and is reflected in the shared norms and values (Clark, 2010).

Rogers’ Innovation Diffusion Theory.

Rogers (1983) defined innovation as “an idea, practice, or object that is perceived as new” (p. 11), and diffusion as “the process by which an innovation is communicated through certain channels over time among the members of a social system” (p.10). As a new idea or innovation is shared throughout an organization there will be individuals within that organization that adopt the innovation sooner than others. According to Rogers (1983) there are five classifications of individuals when it comes to the adoption of an innovation. The very first people to adopt the innovation are known as the innovators, followed by the early adopters, early majority, late majority, and followed lastly if at all by the laggards. Innovators are keen to change and try new things, and represent a very small percentage of the population. Early adopters are the opinion leaders in an organization that other people will observe to determine if an innovation is worthwhile. The people in the early majority group take more time to consider if they will try an innovation than the early adopters, while those in the late majority group tend to adopt an innovation only after the majority of individuals in the organization have already done so. The laggards are the last group to adopt an innovation after everyone else has accepted the change, and some individuals in this group may never adopt the innovation.

Rogers (1983) identified five main stages in the innovation diffusion process: knowledge; persuasion; decisão; implementação; and confirmation. Rogers (1983) stated that “knowledge occurs when an individual is exposed to the innovation’s existence and gains some understanding of how it functions” (p.20). At the knowledge stage an individual wants to know what the innovation is, and how and why it works. “Persuasion occurs when an individual forms a favorable or unfavorable attitude toward the innovation” (Rogers, 1983, p.20). In this stage people want to decrease the uncertainty about the outcome of using an innovation. People want to know the advantages and disadvantages of an innovation and how its use would ultimately affect them.

The decision stage is the stage where a choice is made whether or not to implement an innovation (Rogers, 1983). Factors that may hinder or facilitate the decision to adopt an innovation are related to the perceived attributes of the innovation which include its relative advantage, compatibility, complexity, trialability, and observability. These perceived attributes of an innovation are what make it more or less appealing (Ting-Ting Lee, 2004). The relative advantage is the degree to which an innovation is perceived as better than the current practice. It is the perception of how beneficial the change will be. Compatibility is the degree of fit between the proposed change and the individuals or organization that is undergoing the change (Horner, et al., 2004). This relates to how consistent the innovation is with individual and organizational “values, beliefs, past experiences, and needs” (Ting-Ting Lee, 2004, p. 232). The complexity is the degree to which an innovation is perceived as difficult to understand or use. Trialability refers to the availability of opportunities to test the innovation before wide-scale adoption, and observability refers to the extent that the results are visible to others. Innovations with a high degree of observability tend to be adopted faster than those where the results are not highly visible (Rogers, 1983).

Once the decision is made to accept an innovation, the implementation stage begins. The implementation stage is the actual implementation of the innovation, and the confirmation stage involves evaluating the worth of the innovation over time. In the following section I discuss how using Rogers’ Innovation Diffusion Theory in conjunction with Kotter’s Change Management Theory can guide the successful adoption and implementation of an EMR.

Discussão.

I believe that the marriage of Rogers’ Innovation Diffusion Theory and Kotter’s Change Management Theory provides a unique way to understand and approach the implementation of technological innovations. I have combined the models and organized them into three distinct phases: planning change, implementing change, and cementing change.

Planning Change.

This phase incorporates the change strategies from Kotter’s first four stages (establishing a sense of urgency, creating a guiding coalition, developing a vision and strategy, and communicating the vision) along with the knowledge, persuasion, and decision phases of the Innovation Diffusion Theory. Taking the time to understand your end users is essential in this phase. Using surveys, focus groups, or interviews to gain an understanding of the needs, wants, expectations, and attitudes of all user groups is a great start. In this phase group leaders should share knowledge about what an EMR is and is not, and deal with any misconceptions or unrealistic expectations. Developing a sense of urgency can be a part of the awareness campaign and is an integral component of persuasion. People need more than to understand that there is a need for change, they need to feel it (Kotter, 1996). This urgency can be created by showing videos that share the personal repercussions of preventable medical errors, or the success stories of other hospitals that have successfully implemented an EMR (Campbell, 2008). Data from the organizational assessment should be used to generate other ideas for creating urgency that would be applicable for each institution and the unique motivating needs of its members.

Creating a guiding coalition involves selecting the right people, and these people should include early adopters from each end user group. These early adopters are opinion leaders who can help continue to drive the sense of urgency and motivate the early majority to buy in to the project. Early adopters can be recruited as system super-users or EMR peer experts. This can aid in persuasion as Holtz and Krein (2011) discovered that nurses’ social influence on each other had the most significance in their decision to adopt the EMR.

Developing a vision and a strategy needs to be completed with representatives from all stakeholder groups and should include the data gleaned from the pre-implementation assessment. The vision statement should be service-oriented in order to create emotional motivation, and not specifically related to efficiency or cost containment (Campbell, 2008). Once this vision is decided it should be communicated frequently, in multiple media forms, and to all groups that will be impacted by the EMR implementation.

The perceived attributes of the EMR, and how those advantages can be showcased should also be considered at this stage. Based on data from the initial assessment and information gained from continual ‘pulse checks’ throughout the process, adjustments to the design features of the EMR and communications about the EMR should be made to address the perceived attributes of the EMR. End users need to be able to test out the EMR to see if it meets their needs and will in fact improve their work. Training needs to occur to decrease the perceived complexity of the EMR and increase its relative advantage. The creation of the guiding vision needs to be done with compatibility factors in mind, and the positive impact the EMR is expected to have on the organization should be highly publicized.

Implementing Change.

This stage involves the actual roll out of the planned change. This involves anticipating barriers and removing obstacles, empowering action, providing incentives, and creating and celebrating short-term wins. This might mean that when you go live with the EMR that extra staff work each shift including super-users to reduce stress and deal with any operational difficulties. Units that are having difficulty with implementation may benefit from having users from successful units come and share their tips and strategies (Campbell, 2008). Short-term wins can be at the individual, unit, or organizational level. For each nurse who was afraid to use the computer and now completes her/his computer charting effortlessly, and for each regular staff who takes on a leadership role as a super-user there should be public recognition. Each unit that reaches 100% implementation and every decrease in medication errors or increase in patient satisfaction related to the EMR should be celebrated. The organization should celebrate each team win and market their successes to other health regions and the public. As each win is celebrated the focus needs to return to the vision and the steps required reach that vision.

Cementing Change.

The final stage is cementing change and includes the confirmation of the change through consolidating gains to create more change, and anchoring that change within the organizational culture. The fatal flaw in this stage would be to abandon the change process as soon as the EMR was officially up and running. Changing culture takes time, and old habits quickly take hold once the urgency is lost. Dedicated teams can be created to deal with unforeseen system or user problems as they arise, and information about what else is achievable or what other health care organizations are doing can be shared to help sustain the change (Campbell, 2008). Change can only be cemented once it becomes part of the organizational culture, or in other words, when it simply becomes “the way we do things around here” and this can only be accomplished once the change has been shown to be successful over time (p.33). So keep the dialogue going, keep identifying and training new super-users, and keep the vision at the forefront of the action.

Conclusão.

In response to the devastating effects of preventable medical errors, there has been increasing pressure for health care organizations to adopt EMRs. EMRs allow for efficient access to complete patient information and have been shown to mitigate some of the systems causes of adverse events. However, despite the potential benefits of EMRs and the pressure to implement them, adoption of this technology continues to be slow. In this paper I identified potential barriers to the implementation of an EMR, with a specific focus on change management issues. Change is a challenging process, and successful change is not accidental. The integration of a theoretical framework that combines Kotter’s Change Management Theory and Rogers’ Innovation Diffusion Theory can provide the necessary structure to successfully plan, implement, and cement the adoption of an EMR.

Referências.

Campbell, R. J. (2008). Change management in health care. Health Care Manager, 27 (1), 23-39.

CIHI (2007). Patient Safety in Canada: An Update. Retrieved from: secure. cihi. ca/free_products/Patient_Safety_AIB_EN_070814.pdf.

Clark, C. (2010). From incivility to civility: Transforming the culture. Reflections on Nursing Leadership, 36 (3).

Hillestad, R., Bigelow, J., Bower, A., Girosi, F., Meili, R., Scoville, R., & Taylor, R. (2005). Can electronic medical record systems transform health care? Potential health benefits, savings, and costs. Health Affairs, 24 (5), 1103-1117.

Holtz, B., & Krein, S. (2011). Understanding nurse perceptions of a newly implemented electronic medical record system. Journal of Technology in Human Services, 29 (4), 247-262. doi: 10.1080/15228835.2011.639931.

Horner, S. D., Abel, E., Taylor, K., & Sands, D. (2004). Using theory to guide the diffusion of genetics content in nursing curricula. Nurse Outlook, 52 , 80-84. doi: 10.1016/j. outlook.2003.08.008.

Horning, R. (2011). Implementing an electronic medical record with computerized prescriber order entry at a critical access hospital. American Journal of Health-System Pharmacy, 68 (23), 2288-2292. doi:10.2146/ajhp110249.

Kotter, J. P. (1996). Leading Change. Boston, MA: Harvard Business School Press.

McCarthy, C., & Eastman, D. (2010). Change Management Strategies for an Effective EMR Implementation. HIMSS, Chicago, IL.

McLane, S. (2005). Designing an EMR planning process based on staff attitudes toward and opinions about computers in healthcare. CIN: Computers, Informatics, Nursing, 23 (2), 85-92.

McEwen, M., & Wills, E. M. (2007). Theoretical Basis for Nursing 2 nd Edition. New York, NY: Lippincott Williams & Wilkins.

Pomerleau, M. (2008). Electronic health record: Are you ready for the next step? Nursing for Women’s Health, 12 (2), 151-156.

Rogers, E. (1983). Diffusion of Innovations . New York, NY: Free Press.

Sassen EJ. (2009). Love, hate, or indifference: How nurses really feel about the electronic health record system. Computers, Informatics, Nursing, 27 (5), 281-287.

Ting-Ting Lee (2004). Nurses’ adoption of technology: Application of Rogers’ Innovation-Diffusion Model. Applied Nursing Research , 17(4), 231-238. doi: 10.1016/S0897-1897(04)00071-0.

Wolf DM. (2006). Community hospital successfully implements eRecord and CPOE. Computers, Informatics, Nursing, 24 (6), 307-316.

Author Biography.

Melanie Neumeier, RN, is an MN student at Memorial University of Newfoundland and Labrador and is an adjunct professor with the University of Regina and the Saskatchewan Institute of Applied Science and Technology (SIAST) in Saskatoon, SK. She currently teaches clinical courses and health assessment and has a nursing background in cardiac surgery and home enteral nutrition.

Communication in Change Management.

Communication Is Key When You Want People to Change.

You cannot over-communicate when you are asking your organization to change. Every successful executive, who has led a successful change management effort, expresses the need for overcommunicating during a change experience and makes this statement in retrospect.

No organization exists in which employees are completely happy with communication. Communication is one of the toughest issues in organizations.

It is an area that is most frequently complained about by employees during organizational change and during daily operations. O motivo?

Effective communication requires four components that are interworking perfectly to create shared meaning , a favorite definition of communication.

The individual sending the message must present the message clearly and in detail, and radiate integrity and authenticity. The person receiving the message must decide to listen, ask questions for clarity, and trust the sender of the message. The delivery method chosen must suit the circumstances and the needs of both the sender and the receiver. The content of the message has to resonate and connect, on some level, with the already-held beliefs of the receiver. It must contain the information that the employee wants to hear. It must answer the employee's most cherished and cared about questions. With all of this going on in a communication, it’s a wonder that organizations ever do it well.

Change management practitioners have provided a broad range of suggestions about how to communicate well during any organizational changes.

Recommendations About Communication for Effective Change Management.

Develop a written communication plan to ensure that all of the following occur within your change management process.

Communicate consistently, frequently, and through multiple channels, including speaking, writing, video, training, focus groups, bulletin boards, Intranets, and more about the change. Communicate all that is known about the changes, as quickly as the information is available. (Make clear that your bias is toward instant communication, so some of the details may change at a later date.) Tell people that your other choice is to hold all communication until you are positive about the decisions, goals, and progress. This is disastrous in effective change management. Provide significant amounts of time for people to ask questions, request clarification, and provide input. If you have been part of a scenario in which a leader presented changes, on overhead transparencies, to a large group, and then fled, you know what bad news this is for change integration. People must feel involved in the change. Involvement creates commitment—nothing else is as significant during a change process. Clearly communicate the vision, the mission, and the objectives of the change management effort. Help people to understand how these changes will affect them personally. (If you don’t help with this process, people will make up their own stories, usually more negative than the truth.) Recognize that true communication is a conversation . It is two-way and real discussion must result. It cannot be just a presentation. The change leaders or sponsors need to spend time conversing one-on-one or in small groups with the people who are expected to make the changes. Communicate the reasons for the changes in such a way that people understand the context, the purpose, and the need. Practitioners have called this: “building a memorable, conceptual framework,” and “creating a theoretical framework to underpin the change.” Provide answers to questions only if you know the answer. Leaders destroy their credibility when they provide incorrect information or appear to stumble or back-peddle when providing an answer. It is much better to say you don’t know, and that you will try to find out.

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