Change Theories in Nursing
As the world evolves and more so in technology, change has become an inevitable aspect in every field and industry at a global level. The nursing industry has so far been part of this evolution by adapting new and more efficient change protocols to be able to better provide quality medical services to patients from the bedside healthcare providers to the boardroom members. Some of the most commonly adopted change theories in the field of nursing include Lewin’s theory, Lippitt’s theory built on Lewin’s, Kotter’s eight-step change model, and Rodger’s theory. According to Burrow, Annamaraju &Toney (2022), the most common problem experienced in the healthcare industry today is that nearly two-thirds of all change projects end up failing across healthcare industries due to reasons such as poor planning, poor communication, overworked and unmotivated staff and at times overwhelm from a sudden induction of too many change protocols at once. The use of various practices derived from subsequent change theories can prove beneficial in the improvement of the odds for success and overall practice.
Unwitnessed Patient Falls
In the last three months, there has been a sudden increase in unwitnessed patient falls especially around the time of shift changes in the hospital. Evidence-based changes surrounding shift change protocols have been put in place to combat this problem so far but the hospital still experienced several unwitnessed patient falls in the last month than in all three months combined. The leadership has attempted to fix this problem twice within the last four months but to no avail. In an attempt to save time, staff members have reverted to the old protocols around shift changes, which has led to an increase in unwitnessed patient falls, with some patients going unattended for much longer periods. To combat this new problem, the management decided to implement the concepts of Rodger’s theory in an attempt to avert problems surrounding shift changes.
Rodger’s Diffusion of Innovation Theory
In alignment with Rodger’s theory of change, the leadership implemented pre-change, change, and post-change protocols to avert unwitnessed patient falls around shift change timelines to acquire a reduction in the rate at which this issue occurred. The first step was including stakeholders at the pre-change stage to help identify the problem, set goals towards averting it, and strategize on how to fully avert the problem practically. According to Sahin (2006 p3), the innovation-decision process of diffusion of innovation in this theory starts with the knowledge stage. The stakeholders from all levels of service acted as peer champions for change in the persuasion of other peers into the new change protocols. Through this innovative step, many of the problems surrounding unwitnessed patient falls were able to be addressed as all issues experienced by staff on the same were raised to the management by these peer change agents and addressed.
On the adoption of the new and innovative change protocols, there was resistance at first by some of the staff, especially on the issue of extending after one’s shift is over to await handing over to other staff. Through Rodger’s change theory, the concept of innovative diffusion was implemented in the general assessment of the staff’s level of change acceptance, herein as “Innovator, early adopter, early majority, late majority and laggard” Burrow, Annamaraju &Toney (2022). The majority of staff fell in the early majority and late majority categories, explaining why there was no change despite the induction of theory-based protocols by leadership.
Innovation Diffusion
The change process did not go as smoothly as had been expected, and a lot of work is yet to be done especially on adoption and implementation. One of the reasons why there had been so much resistance to the change is the mode of communication used to relay the protocols and the time allocated between the induction of this process and the desired results (Singer, 2004 p 5). Communication channels through which change protocols are conveyed are important in the realization of a desired goal and the averment of resistance from staff, since in this case change protocols were first introduced via internal memos. It was not until the inclusion of all stakeholders and proper allocation of realistic time for change to take root that results were made visible slowly in the reduction of unwitnessed patient falls.
References
Barrow JM, Annamaraju P, Toney-Butler TJ. Change Management. [Updated 2022 Sep 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459380/
Sahin S. (2006). Detailed Review of Rogers’ Diffusion Of Innovations Theory And Educational Technology-Related Studies Based On Rogers’ Theory. The Turkish Online Journal of Educational Technology – TOJET April 2006 ISSN: 1303-6521 volume 5 Issue 2 Article 3. Pp 1-10. https://files.eric.ed.gov/fulltext/ED501453.pdf
Singer, J. (2004). Strange Bedfellows? Diffusion of Convergence in Four News Organizations. Journalism Studies, 5(1), pp. 3-18. http://doi.org/10.1080/1461670032000174701
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