Change Management

In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan.


Change is inevitable in health care. A significant problem specific to health care is that almost two-thirds of all change projects fail for many reasons, such as poor planning, unmotivated staff, deficient communication, or excessively frequent changes. All healthcare providers, at the bedside to the boardroom, have a role in ensuring effective change. Using best practices derived from change theories can help improve the odds of success and subsequent practice improvement. Suppose a health care provider works in a hospital department that has experienced a 3-month increase in unwitnessed patient falls during the hours surrounding shift change. Evidence-based changes in the current shift change process would likely decrease patient falls; however, departmental leadership has attempted unsuccessfully to fix this problem twice in the past 3 months. Staff continues to revert to previous shift change protocols to save time, which leaves patients unmonitored for extended periods. What can departmental leadership and staff do differently to create sustained, positive change to serve the department’s patients and employees? The answer may lie within the work of several change leaders and theorists. Although theories may seem abstract and impractical for direct healthcare practice, they can be quite helpful for solving common healthcare problems. Lewin was an early change scholar who proposed a three-step process for ensuring successful change. Other theorists like Lippitt, Kotter, and Rogers have added to the collective change knowledge to expand upon Lewin’s original Planned Change Theory. Although each change theory is different with unique strengths and weaknesses, the theories’ commonalities can provide best practices for sustaining positive change. Lewin’s Theory of Planned Change includes the following change stages: Lippitt, building on Lewin’s original theory, created the Phases of Change Theory that encompass the following change phases: Kotter’s Eight-Step Change Model, created in 1995, include the following change management steps: Finally, Rogers’ Diffusion of Innovation Theory introduced these five change phases:

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