ChangeManagement:UsingtheADKARModelforSuccess

KandaceAnderson,BSN,RNC-MNN&GinaZimmerman,BSN,RNClinicalNurseSupervisors:NewFamilyCenter

BaylorScott&WhiteAllSaintsMedicalCenter– AndrewsWomen’sHospital14008thAveFortWorthTX,76104

Background:

A new Pelvic Medicine Center (PMC) opened on the campus of Andrew’s Women’s Hospital in Fort Worth, Texas, serving women of all ages for the evaluation & treatment of pelvic floor disorders. The leadership team of our Mother-Baby unit is collaborating with the PMC to increase awareness of the center as a beneficial resource for postpartum patients. Using the ADKARChange Management Model, we are implementing a nursing process to screen our postpartum patients who are at higher risk for developing a pelvic floor disorder.

Definition:

The ADKAR model guides leaders to consider five key areas: Awareness, Desire, Knowledge, Ability and Reinforcement. This theory suggests that leaders must engage individuals throughout change in order to accomplish organizational goals. The steps are sequential and cumulative, and focus on change at the individual level. Use of this model can be key to smooth, successful and sustainable change. Each step in the process is critical. If gaps occur, the process will be unsuccessful.

Leadership Strategy:

• To promote AWARENESS, we invited the PMC nurse practitioner and physical therapists to our staff meeting. They discussed post childbirth pelvic floor disorders and current treatment options. Educational pamphlets were placed on our units and flyers were distributed to our physicians.• To instill DESIRE, we emphasized the benefits to our patients in all

communications. Treatment for pelvic floor disorders improves health outcomes and quality of life.• To increase KNOWLEDGE, we are providing staff education through

pertinent journal articles which outline evidence based practice.• To enhance ABILITY, we’ve developed a risk factor screening tool as

well as a patient education flyer specific to potential postpartum pelvic floor disorders. We will communicate a clear process for using these new forms through email, huddles, staff meetings and individual coaching.• To ensure REINFORCEMENT, we will utilize screening tools for data

collection. Results and patient outcomes will be shared with staff. Next steps are to integrate the screening tool and patient education documents into our electronic health record.

Impact:

The ADKAR model has been a helpful guide in our approach to change management as we have been able to apply it throughout the planning phase of our project. We will continue to refer to the ADKAR gap model for any necessary corrective actions. Implementation is currently in the beginning steps. Integrating new processes requires careful thought, preparation and follow up. The ADKAR Change Management Model is a very simple, easy to use framework for successful implementation of any size change, and can be used by leaders at all levels.

References:

Brincat, C., Crosby. E., McLeod, A., Fenner, D. (2014). Experiences during the first four years of a postpartum perineal clinic in the USA. International Journal of Gynecology and Obstetrics, 128 (1).

“Change Management” (n.d.) Retrieved from https://www.dhs/state.or.us

DeBevoise, T., Dobinsky, A., McCurdy-Robinson, C., et al. (2015). Pelvic floor physical therapy: More than Kegels. Women’s Healthcare: A Clinical Journal for NPs, 34-39.

Hiatt, J. (2017). ADKAR Change Management Model Overview, Prosci, Inc. Retrieved from https://Prosci.com.adkar/adkar-model

Hilde, G., Bo, K., (2015). The pelvic floor during pregnancy and after childbirth, and the effect of pelvic floor muscle training on urinary incontinence: a literature review. Current Women’s Health Reviews, 11, 19-30.

Lowell, L. (2018). Change Management. Lecture presented at Foundations of Nursing Leadership, Fort Worth, Texas.