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Unique Challenges for the Nephrology Professional in Managing Change. Norma Gomez, MBA, MSN, RN, CNN. CHANGE. CHANGE. THE CHANGE PROCESS. MODELS OF CHANGE. RESPONSES TO CHANGE. Poor planning End user’s not consulted Poor follow up. Involve the team Communicate Constantly Plan - PowerPoint PPT Presentation
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NORMA GOMEZ, MBA, MSN, RN, CNN
Unique Challenges for the Nephrology Professional in
Managing Change
CHANGE
CHANGE
THE CHANGE PROCESS
Figure 1
MODELS OF CHANGE
Lewin Lippitt Havelock Nursing ProcessUnfreezing Diagnose the
problemBuilding a relationship
Assessment
Moving Assess the motivation and resources
Diagnosing the problem
Diagnosis
Refreezing Select progressive change objects
Acquiring resources
Outcomes identification
Choose change agent role
Choosing the solution
Planning
Maintain change
Gaining acceptance
Implementation
Terminate helping relationship
Stabilization and self-renewal
Evaluation
RESPONSES TO CHANGE
Opportunity Oh no!
Involve the teamCommunicate ConstantlyPlanDon’t let up
Poor planningEnd user’s not consultedPoor follow up
CHALLENGES TO CHANGE
IMPLEMENTATION
PROJECT MANAGEMENT
The ideal process for implementing change is to organize and manage the work.
This is the definition of project management.
TERMS
A project is a temporary endeavor with a defined beginning and end undertaken to meet unique goals and objectives to bring about beneficial change or added value.
Specific people or groups who have a stake in the outcome of the project are stakeholders.
The project manager is responsible for the processes used to manage the project.
TERMS
The project team consists of the full-time and part-time resources assigned to work on the deliverables of the project.
Scope is the way you describe the boundaries of the project. It defines what the project will deliver and what it will not deliver.
TERMS
A deliverable is any tangible outcome that is produced by the project. All projects create deliverables.
The implementation plan tells an observer how the project team will complete the project.
ORGANIZATIONAL STEPS
Defining the workBegin the process by brainstorming
potential goals, objectives, and activities for the project.
Consider what strategies will be used, as well as resources (including staff, budget, equipment, and technical assistance) needed to carry out the plan.
Before creating a new plan of action the team should first consider whether there is an existing plan that can be modified.
ORGANIZATIONAL STEPS
The first task in formulating your plan is to identify the project team. Identify the needed skills to ensure the
project is a success. Form a team that is representative of
the stakeholders. Team members must make a
commitment to make time in their workday to attend meetings and submit reports as determined by the team.
TEAM COMPOSITIONTEAM COMPOSITION
Project Name ESA Conversion
Project Leader Jeanne Smith
Core Skills Skills
Required Team
Representative Team Status
Department Represented
Development of educational tools Jane Brown Core team Nursing
Policy development Susie Mills Core Medical Clinical/ Operations
Protocol Development Jerry White Core Medical Clinical
Implementation Gary Green Core Operations
Patient education Norma Long Core Social Services
Physician education Dr. Smith Core Physicians
Technical expertise Joe Roberts Core Chief Tech/Machine Techs
Stakeholder Interests Processes Included
Team Representative
Team Status
Team Member Liaison
IT Linda Jones PT Jerry White
Marketing Debbie Flores PT Gary Green
Processes or
Projects Affected Team
Representative Team Status
Team Member Liaison
Logistics
Toolkit
ORGANIZATIONAL STEPS
Establishing TimelinesDepending on the size and scope of change needed, the time frame may extend from weeks to months and at times possibly years.
It is important to recognize that this is a complex process, but a project has a beginning and an end.
ORGANIZATIONAL STEPS
Managing the plan Develop a preliminary plan that outlines each step.
Include who is responsible for each step and how long it will take to accomplish.
IMPLEMENTATION PLAN
It describes the activities required, the sequence of the work, who is assigned to the work, an estimate of how much effort is required, when the work is due, and other information of interest.
Once the plan is in place, it guides the team and they perform the work according to the plan.
Implementation Plan
Project Name: Machine Conversion Target 5/1/12
Project Lead: Jeanne Smith
Task/Activity Priority Action Start Date Due Date Completion Date % complete Responsible
person Notes
Clinical policies and procedures
High 2 -4 weeks prior to start date begin reviewing all policies and procedures and implement change for new machines
3/17/2012 3/22/2012 3/22/2012 100% J. Smith, Clinic Manager
Machine set-up, priming, fluid removal calculations, transducer protectors, termination of treatment, recirculation, policies and procedures revised and approved by approving body.
Staff Education High Set up educational meetings for nurses and staff MD's
3/22/2012 4/15/2012 J. Smith, Clinic Manager
Utilize Manufacturer's education materials and Clinical Representatives
Forms Medium Change forms: •Incident report form •Treatment flow sheet
• Plan of care • Reuse logs• Disinfection logs
3/22/2012 4/10/2012 B. Gomez, Adm. Assistant
Review all forms that may be impacted by this change. Need to get approving body to appove. Contact printer
ORGANZATIONAL STEPS
Execution phase The execution phase is typically the longest
phase of the project. It is the phase within which the deliverables
are physically constructed and presented for approval.
It is very important to develop a system to identify and maintain contact with individuals who have been assigned specific responsibilities within the plan. Communication Plan
ORGANIZATIONAL STEPS
Closure Following the completion of all project
deliverables, a successful project will have met its objectives and be ready for formal closure.
Once your team has planned, created, implemented, and the change has become part of your daily work (standard operating procedure), you are ready to evaluate the process Evaluation process
CASE STUDY
Consider the complexities of implementing the following
changes in a dialysis facility: Acquiring a facility of near equal size Changing to a different dialysis delivery system Changing medication from every treatment to once
per month Changing staff schedule from 12 hour shifts to 10
hour shiftsChange is clearly warranted, but where do you start?Whom do you involve? How do you see it through tocompletion?
KEY POINTS
Nurses need to participate in or lead change management projects
The first step is to identify what exactly needs to change and why
Several tools exist to help this process, including root cause analysis and process mapping
Stakeholders need to be identified and involved in the process of change for it to be successful
Communication throughout the process is essential
Identify and utilize outside resources to facilitate the change
SUMMARY
Select a change theoryCreate awarenessManage resistanceInitiate the changeEvaluate the changed environmentDisseminate the change through the
organization
QUESTIONS