Change model in healthcare (2023)

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In healthcare, leading change successfully is frequently achieved via change management methods, including According to research in conducted by Harrison et al. The other two models have been included for balance against more soft, person-centered approaches, as this is a large part of healthcare practice. Part of their value to healthcare is that some of these included models, such as the ADKAR model, focus less on tasks and do not make staff implement changes before they can understand them.

The ADKAR model focuses more on human psychology, helping staff to understand the need for change to support healthcare change management, making it more suitable and effective in healthcare organizations. It helps manage change within short-term, intensive change initiatives due to the aggressive top-down approach to achieving change through three stages.

The preparation stage. Look at how things operate to see the resources needed for the desired results. Communication is essential in this phase, as healthcare staff must be aware of what changes need to happen to prepare them for the subsequent steps. The implementation stage. Project leaders set changes into motion, and communication is again of very high significance as change is a complex process to handle for team members.

Support must be available via communication channels at this critical phase. Implement required skills of staff needed for change to take place. The refreeze stage is part of an ongoing process to achieve success. This stage involves developing a strategy to ensure change sticks. Analyze the effect of the new changes and measure how close you are to achieving goals set at the unfreeze phase. Healthcare managers and change leadership should use this theory alongside a softer model for longer-term change management strategies.

Leaders must bear in mind that without a softer model monitoring employee experience to some level alongside the Lewin Model, adverse effects on employee retention and performance may occur due to burnout. This model supports change leaders with implementing change initiatives in healthcare organizations as it is task-oriented, and healthcare organizations are often driven by completing tasks to a schedule. The model includes eight steps:. Motivate the team by creating an environment filled with a sense of urgency.

Build a guiding coalition, including all the right staff to plan, coordinate and carry out the change. Establish a clear vision and each accompanying change initiative. Break goals into bite-size chunks and communicate successes little and often. Maintain momentum, and push harder after every successful implementation.

The sense of urgency for short-term wins could lead to high rates of staff burnout. Something healthcare staff are already at risk of before the change leader implements a change plan. Over a few months, short-period change management strategies in health care work well with this model. One example could be a move to paperless patient onboarding in an ER unit, which is a high-pressure, task-oriented environment.

Although burnout due to this change could potentially be high, staff may be more pragmatic and see improvements quickly, reducing staff stress and increasing patient care quality over the time taken to implement the change. Paperless onboarding would primarily involve getting used to new technology and simple employee training , and the sense of urgency, the first step of the model, is innate in ER staff due to the nature of the work. ADKAR Awareness, Desire, Knowledge, Ability, Reinforcement analysis is vastly different from the first two models as it focuses on understanding the emotions and thoughts of the people affected by the change.

In healthcare, many stakeholders are affected by changes with different ways of gaining or losing. There are five steps to achieving an ADKAR analysis; the first is creating awareness for healthcare staff. Show healthcare staff what changes are necessary and why. Detail is needed when explaining changes, and change leaders should define training schedules.

Face-to-face announcements and training are preferred so staff can ask questions to enable them to participate early in the process. Create a desire to be supportive of the change to create an environment in which employee engagement increases so much that attitudes toward change become positive organically. Ensure adequate support is available for employees. Training, coaching, and checklists provided by the business are some types of support. Ensure employees, relatives, and patients can give feedback about their change journey.

Leaders of change, such as project leaders or healthcare managers, record and action this to provide the best opportunity for learning and development. At this point, the change leader can make further adjustments to the plan based on the feedback.

Use rewards and cash or holiday incentives to employees and other means such as championing staff who embody shared values. Also, HR could implement an internal advertising campaign to remind everyone that the change leader adjusted the plan based on their feedback.

These actions ensure the new status quo is maintained for ongoing performance improvement. Of all the change management tools in this list, the ADKAR model is the model most focused on human experience and supporting staff to engage with new ways of fulfilling their role naturally. For this reason, the ADKAR model can be effective for long-term change strategies within large or small teams.

It can be beneficial in healthcare environments due to the many stakeholders of different professions with competing goals. The ADKAR model is great for many healthcare contexts but particularly for departments caring for high vulnerability patients needing sensitive communication with patients and relatives, like an intensive care unit. Staff in such care environments can hold more specialized skills than in other departments. The ADKAR change management model can support the change with constant feedback and communication to ensure that changes do not negatively impact care.

Developed by William Bridges over thirty years ago, the Bridges transition model focuses on the human experience of processing and acting on change. This model is softer, more philosophical, and more human-oriented than some of the other models and is formed of three basic principles Although it sounds somewhat philosophical, every ending is also a beginning.

This point forms the first phase of the Bridges transition model. This phase represents the human act of accepting and managing loss. Within this stage, staff lose some things to a change management strategy and keep others.

Managers strengthen professional relationships and increase communication by outwardly acknowledging this. Once the loss is accepted comes the next phase: the neutral zone. This zone is when the strategy has ensured the old culture is out, but the new culture is not in force. This stage is the most critical stage of the transition period when staff is changing their deeply embedded beliefs and routines for completing tasks and what values they hold.

Significant concepts such as identity and sense of reality are confronted in this stage and re-aligned. New ways of understanding things, new values, and new attitudes all contribute to forming a sense of the new status quo, cementing changes as part of a transformation strategy. When change is well managed, staff members feel liberated and empowered as they begin to understand and act on their new role within a new system.

For some companies, change models such as the bridges transition model will help them to understand the employee experience of processing change. Understanding the employee experience of change is powerful in healthcare to reduce resistance to change because there are many different levels of staff with different specialisms who are empowered to complete tasks a certain way. Engaging with this hierarchy of specialisms is easier with the Bridges transition model as it encourages understanding staff mentalities.

However, using the Bridges transition model with a more task-oriented model can help establish leadership in health care environments and the need to reach specific change goals. A change leader is a senior staff member, often a healthcare manager, who becomes a change agent. A change agent is a staff member who begins the change process and often goes on to coordinate changes as a change leader.

The essential attributes of a change leader are that they have a deep understanding of their current healthcare organization culture and communicate with staff effectively to implement change using the appropriate change model. The leadership style of the change leader is an essential means of ensuring the best communication is possible and that the communication style fits with the change management model. The five leadership styles can be used for various reasons by a change leader in healthcare in many other applications.

The five leadership styles are below. I give a task; you do it. This premise is behind the authoritarian leadership style, with no dialogue between the change leader and the team. In this style, change leaders take on the role of a visible authority figure. This style is excellent when the change leader has superior knowledge on a topic compared to the rest of the team, and there are strict time constraints for change projects.

This combination can lead to impressive results when an organization needs change to occur over a short period.

In contrast to the authoritarian style, the participative leadership style involves much more collaboration and dialogue. Participative leadership is far more democratic and makes a more engaging experience for team members, motivating them to contribute ideas and solutions. On the other hand, the discussion takes time and can lead to unclear answers, making this leadership style inappropriate in a time-constrained environment. The participative leadership style fits well with the ADKAR change management model due to the promotion of understanding and dialogue between change leaders and team members.

However, within the context of change, the change leader would benefit from experience in change management to coordinate team members toward the best outcome in a democratic but focused manner. The delegating leadership style involves assigning initiatives to other staff within a team. This style works best when the unit is experienced and proficient in the task, naturally taking responsibility and enjoying working alone.

Change leaders using this style must be aware of conflict when the team cannot reach an agreement, resulting in team divisions and lowering morale and motivation. Everything is evident in the transactional leadership style; the leader, goals, and what will happen if the team achieves or fail objectives.

Transactional leadership is oriented toward the structure to complete tasks rather than organizational change. Change leaders give rewards or punishments in response to goals being hit or missed. The expansive literature utilising the Model for Improvement was not included in this review given the definition by the IHI as a model to accelerate improvement models rather than as a change model in itself.

Furthermore, an aim of this review was to explore how change management models may support the use of improvement models such as the Model for Improvement. Synonyms and relevant concepts were developed for these two major concepts being evaluated in this review of change management and healthcare delivery. Results were merged using reference-management software Endnote X9.

The review process utilised the Covidence systematic review software Veritas Health Innovation, Melbourne, Australia for screening and extraction. Two reviewers TB, RH screened the titles and abstracts against the eligibility criteria. Full-text documents were obtained for all potentially relevant articles.

The eligibility criteria were then applied to the articles by two reviewers TB, RH. Two further reviewers conducted a face validity check on the final set of articles for inclusion HLD, RW , with disagreements resolved via consultation. A narrative empirical synthesis was undertaken in stages, based on the review objectives. Initial descriptions of eligible studies and results were tabulated Table 1. Common concepts were discussed between the review team members and patterns in the data explored to identify consistent findings in relation to the study objectives.

In this process, interrogation of the findings explored relationships between study characteristics and their findings; the findings of different studies; and the influence of the use of different outcome measures, methods and settings on the resulting data. The literature was then subjected to a quality appraisal process before a narrative synthesis of the findings was produced. Due to heterogeneity of the study types selected, appraisal of methodological and reporting quality of the included studies and overall body of evidence was carried out using the revised version of the Quality Assessment for Diverse Studies tool QuADS , which has demonstrated reliability and validity.

After duplicates were removed, papers were extracted from Endnote into Covidence. After title and abstract screening, papers fulfilled the inclusion criteria and copies of full texts were obtained. Full-text screening led to a total of 38 papers included in the review. Figure 1 demonstrates the screening and selection process. The most common reasons for excluding papers at full-text review were because they did not discuss a formal change management method explicitly , were not in a healthcare setting, 16 were commentary, protocol or editorial pieces, 11 or were not in health service delivery.

The distinct and expansive literature employing the Model for Improvement as a methodology was excluded because, whilst the model intersects with change management methodologies, the focus is determining the nature of changes and adaptations to introduce through incremental introduction and analysis of changes rather than the process of managing the change.

This body of work was therefore beyond the scope of the present review. Two articles emerged from non-OECD countries: Nepal 1 study and Uganda 1 study ; and one study did not specify the country. Most studies were conducted in hospital settings 29 studies , with more than half of these at a department or unit level 17 studies. Other settings included regional level health organisations health centres or clinics, education centres, community health settings and one in a residential aged care facility.

Most studies only involved a single institution, 28 seven studies involved in between 2 and 9 institutions, and three studies involved more than ten institutions with the largest number being 25 institutes. The impetus for change for the majority of studies came from within the organisation 34 studies. In two further studies, change was due to a directive from the state or national health department. In the final two studies, both conducted in non-OECD countries, the impetus for change was from healthcare professional associations.

Most studies performed strongly in reporting their theoretical and conceptual underpinning, and in reporting of research aims and the involvement of stakeholders in the process of change.

Many studies were case examples of change models and presented in a non-traditional research format. This limited their suitability for quality appraisal regarding the reporting of recruitment methods, data collection and data analyses.

Studies often performed poorly on reporting of sampling to address research aims, description of data collection procedure, recruitment and critical discussion of strength and limitations of the study. The findings of the quality appraisal may be indicative of the nature of the publications identified but highlight a lack of transparency regarding the quality of the research design and methods used to gather the data, which must be acknowledged in interpreting the review findings.

Thirty-eight of the identified articles described applications of change management models predominantly applied from the discipline of management into healthcare.

Applications of the Kotter model were primarily identified in nurse-led, local level, single unit or site quality improvement projects. The Kotter model was also applied in a quality improvement program in head and neck surgery in a Canadian surgical department, with authors concluding the model provided a guiding principle to support the change process.

One physician-led study focused on bringing about change in the management of chest pain in a US emergency department using their locally developed AdventHealth Clinical Transformation method. A key value of taking this planned approach was the ability to maintain clinician engagement in the project and achieving outcomes at a timed accountable follow-up.

Twelve institutional-level projects were identified. Stoller et al reported a teamwork enhancement intervention across four respiratory departments of a US hospital to implement and optimise utilisation of the Respiratory Therapy Consult Service RTCS. However, the application of the model in this context was primarily focused on the moving stage, with few activities that appeared to address the first and third stages of the model and limited data reported of the outcomes of this change project.

It was notable that unfreezing activities identified the development of new policies and procedures, with the overall project primarily focused on bringing in the new technology and the moving stage.

Across four medical-surgical units in two Kaiser Permanente hospitals in the US, a Nurse Knowledge Exchange NKE was developed to integrate change management methods into the implantation of practice change. In a larger scale institutional project, Riches 4 Stages Model was applied to transitioning a radiation therapy department to a new hospital site. The authors reported the model as valuable in supporting smooth transition.

A final study of a large four-year change project introducing technology upgrades into a healthcare organisation utilised the Change Acceleration Process CAP model.

Six national or system-wide projects were identified. In this study, it should be noted that the model was not applied to explore the role throughout the study. One international multi-system project was identified that reported the management of change in a World Health Organisation WHO project seeking to shift Allergic Rhinitis and its Impact on Asthma ARIA from a guideline to integrated care pathways using mobile technology in patients with allergic rhinitis and asthma multimorbidity. In maternity services in Uganda and Nepal, change occurred through dissemination workshops, reminders, case reviews, practical workshops and team building guided by AIM methodology.

The operationalisation of AIM was not detailed in the studies. Whilst many studies utilised structured change management models reported successful change, it was not possible to detect whether the use of a model, method or process contributed to the success. Baloh et al followed eight hospitals in the US through a two-year implementation of team huddles TeamSTEPPS to explore, through interviews with 47 leader and change managers or champions, how they performed in relation to the three overarching Kotter phases.

Using the Lewin and McKinsey 7S models together, Sokol et al described the application of change management theory to office-wide culture and structural support to meet the twin goals of safe opioid prescribing and treating patients with opioid-use disorder.

Specifically, the programs reported as successful were those introduced in systems that used change management methods aligned more closely with the Kotter model.

Our findings identify multiple change management models that are applied to bring about change in healthcare teams, services and organisations. In the reviewed articles, it was apparent that change management models provided a frame of reference for change agents to support them to consider key elements required for change to occur and be sustained.

Key elements include exploring why change is needed and crafting the right messages for stakeholders at every step to bring them along on the change journey. In the included studies, models that included a series of stages or steps, eg, Lewin or Kotter provided change agents with a series of goal posts to monitor and to create moments of celebration along the change journey.

Notably, there was little emphasis on reliance on the models to overcome resistance or develop specific change activities; their value was consistently in providing a broad guiding framework for clinicians creating change. Drawing upon change management models as a guiding framework rather than as a prescriptive management process is in keeping with contemporary thinking regarding healthcare as a complex adaptive system.

A complex adaptive system seeks to draw out and mobilize the natural creativity of health care professionals to adapt to circumstances and to evolve new and better ways of achieving quality akin to bottom-up change and requires change agents to shift away from the reliance on top-down, highly controlled change processes. For example, Baloh et al in exploring the introduction and implementation of huddles in rural US hospitals noted the value of integrating broad concepts from change management models, particularly in relation to the earlier model steps, with appropriate implementation scope and strategies.

Methods also emerged from this review that are not as prominent as other change management models and methods but appeared to be used successfully to create and sustain change in healthcare delivery models and services. This review has not determined one change management model as preferred over another. This finding suggests that the guiding framework and flexibility within this to enable a range of activities and actions suited to the particular circumstance is of key value rather than a particular change management approach.

It was notable that in the context of healthcare, change management models were often used by clinicians in local-level projects. The models were rarely used to address issues of resistance and more often used to provide a framework to house a broad and diverse range of activities to facilitate successful sustained change. Clinician engagement in the change process emerged as a critical factor for change to take hold and be sustained. Change is naturally challenging for humans, particularly when it is rapid and ongoing.

The guiding principles of the change management models we identified as commonly used in healthcare seek to create an enabling culture for change; seen through shared ways of thinking, assumptions and visible manifestations.

The reviewed articles suggest an enabling culture for change is central to creating opportunities for and supporting clinician engagement from decision-making about change through to change implementation. It is well established that implementation research is focused to more than translation of evidence from bench to bedside. As the scientific study of methods to promote the systematic uptake of clinical research findings and other evidence-based practices into routine practice, and hence to improve the quality effectiveness, reliability, safety, appropriateness, equity, efficiency of health care, it is inextricably linked with healthcare change and its management.

One artefact of organisations with cultures supportive of change is the presence of co-design efforts. Such approaches are however contingent on appropriate supports to ensure participants have both the capability and capacity to engage. Our findings must be considered in terms of the limitations of the included studies and the review process. It is possible that some relevant studies were not captured by the database search or were made available after the search date.

The included studies were often case examples of change initiatives with limited breadth of sample and a lack of detail reported about the research methods. The quality of such studies was therefore challenging to appraisal due to the limited reported information.

The ability to generalise findings from such studies was also limited when case examples were utilised. We do note however that the wide range of included studies demonstrated consistent commonalities across change principles and applications of change management models across multiple settings and change projects in health.

Change management models are commonly applied to guide change processes at local, institutional and system-levels in healthcare. Clinician-led change is common, with the value of change management models being primarily to provide a supportive yet flexible framework to direct change processes. The review also highlights the potential opportunities to integrate models for change management with models commonly applied for improvement and implementation to support positive changes in healthcare.

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work. J Healthc Leadersh. Published online Mar Author information Article notes Copyright and License information Disclaimer.

Received Oct 28; Accepted Jan This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.

Abstract Background The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets.

Methods A systematic review and narrative synthesis was undertaken. Results Thirty-eight studies were included that reported the use of 12 change management methodologies in healthcare contexts across 10 countries. Conclusion Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. Keywords: healthcare change, change management, transformation, implementation, improvement. Introduction The ability to adapt and change is critical to contemporary health service delivery in order to meet changing population needs, the demands of increasing life expectancy and complex health conditions.

Exclusion Criteria Publications discussing a hypothetical change as a result of a planned intervention were excluded. Study Identification Synonyms and relevant concepts were developed for these two major concepts being evaluated in this review of change management and healthcare delivery.

Data Synthesis A narrative empirical synthesis was undertaken in stages, based on the review objectives. Table 1 Summary of Included Studies.

In the other half, success was dependent on the scope of implementation and the strategies utilised. However, there are still unmet needs for the management of rhinitis and asthma in real life. Presence of a revert back into the handwritten caseload due to a lack in continues driving force thereby making resistance forces increase. Also, the level of patient involvement increased.

For a change to be successful, there must be authentic, committed leadership visible to everyone within the organization throughout the duration of an initiative.

Leading change activities included having a sponsor or champion and team members who demonstrated visible, active, public commitment and were supportive of the change. Kotter's principles provided the structure to achieve the necessary changes to attitudes and behaviours.

To influence multiple stakeholders to modify their traditional practices and sustain changes. Specialist outpatient appointments given within the timeframe requested by the ED doctor increased from Early discharges increased from Median wait for admission remained unchanged.

The initiative is ongoing, but early results indicate that the proportion of radical intent RT courses peer reviewed province wide increased from The four-stage model of change assisted in the smooth implementation of a transition plan for radiation oncology. Change management theory to support both safe opioid prescribing and treating patients with OUD over the past 5 years resulted in changes to the practices, people, skills, and infrastructure in the clinic.

Spira 61 Quantitative Surveillance data and surveys Two hospitals, Uganda Maternity Departments Accelerated Implementation Method To increase the use of intrapartum and postnatal essential interventions EIs in two hospitals in Uganda EIs that were regularly used had no improvement, however, seldom used EIs had a significant improvement in use due to the implementation package of activities developed Spira 62 Quantitative Surveillance data Two tertiary teaching hospitals, Nepal Maternity Departments Accelerated Implementation Method To increase the use of intrapartum and postnatal essential interventions EIs in two hospitals in Nepal Only the timely administration of antibiotics caesarean increased, with all other EIs not showing improvement Stoller 46 Mixed method Randomised control trail, observational and in-person interviews Respiratory therapy department, Cleveland clinic, Cleveland, Ohio RCT on patients, 71 RTCS groups and 74 physicians.

Understanding and embracing change is important. In the second and third quarters of the intervention, the number of falls significantly dropped, with zero falls with injury in the third quarter. Open in a separate window. Assessment of Study Quality Due to heterogeneity of the study types selected, appraisal of methodological and reporting quality of the included studies and overall body of evidence was carried out using the revised version of the Quality Assessment for Diverse Studies tool QuADS , which has demonstrated reliability and validity.

Results Results of the Search After duplicates were removed, papers were extracted from Endnote into Covidence.

Figure 1. Excluded Studies The most common reasons for excluding papers at full-text review were because they did not discuss a formal change management method explicitly , were not in a healthcare setting, 16 were commentary, protocol or editorial pieces, 11 or were not in health service delivery.

Review Findings Change Management Models Utilised Thirty-eight of the identified articles described applications of change management models predominantly applied from the discipline of management into healthcare.

Local-Level Change Applications of the Kotter model were primarily identified in nurse-led, local level, single unit or site quality improvement projects. Institutional Change Twelve institutional-level projects were identified.

Applications of Change Management Models Whilst many studies utilised structured change management models reported successful change, it was not possible to detect whether the use of a model, method or process contributed to the success. Discussion Our findings identify multiple change management models that are applied to bring about change in healthcare teams, services and organisations. Limitations Our findings must be considered in terms of the limitations of the included studies and the review process.

Conclusion Change management models are commonly applied to guide change processes at local, institutional and system-levels in healthcare. Funding Statement No funding linked to this submission. Data Sharing Statement All data included in the review are publicly available research findings. Author Contributions All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure The authors report no conflicts of interest in this work. References 1. Priorities and challenges for health leadership and workforce management globally: a rapid review. An Institute of Medicine Report; From volume to value in health care: the work begins. Harvard business press; Value based health care: setting the scene for Australia. Value Health. Implementing models of care for musculoskeletal conditions in health systems to support value-based care.

Best Pract Res Clin Rheumatol. Scott I. Ten clinician-driven strategies for maximising value of Australian health care. Aust Health Rev. Organization WH. World Health Organization; Health Expect. Learning from incidents in health care: critique from a Safety-II perspective.

Saf Sci. Narine L, Persaud D. Gaining and maintaining commitment to large-scale change in healthcare organizations. Health Serv Manage Res. Health Foundation. Accessed March3, Accelerating quality improvement within your organization: applying the model for improvement.

J Am Pharm Assoc. Strengthening evaluation and implementation by specifying components of behaviour change interventions: a study protocol. Implement Sci. Specifying and reporting complex behaviour change interventions: the need for a scientific method. BioMed Central. When complexity science meets implementation science: a theoretical and empirical analysis of systems change. BMC Med. Large-system transformation in health care: a realist review. Milbank Q.

Driving for successful change processes in healthcare by putting staff at the wheel. J Health Organ Manag. Transformational change in health care systems: an organizational model. Health Care Manage Rev. The care and keeping of clinicians in quality improvement. Int J Qual Health Care. Managing complex healthcare change: a qualitative exploration of current practice in New South Wales, Australia.

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Implementing team huddles in small rural hospitals: how does the Kotter model of change apply? J Nurs Manag.

Allergic Rhinitis and its Impact on Asthma ARIA Phase 4 : change management in allergic rhinitis and asthma multimorbidity using mobile technology. J Allergy Clin Immunol. Burden M. Using a change model to reduce the risk of surgical site infection. Br J Nurs. A change-management approach to closing care gaps in a federally qualified health center: a rural Kentucky case study.

Prev Chronic Dis. Healthc Q. Designing and integrating a quality management program for patients undergoing head and neck resection with free-flap reconstruction.

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The most commonly applied methodologies were Kotter's Model 19 studies and Lewin's Model 11 studies. Change management methodologies were applied in projects at local ward or unit level 14 , institutional level 12 and system or multi-system 6 levels.

The remainder of the studies provided commentary on the success of change efforts that had not utilised a change methodology with reference to change management approaches. Conclusion: Change management methodologies were often used as guiding principle to underpin a change in complex healthcare contexts. The lack of prescription application of the change management methodologies was identified. Change management methodologies were valued for providing guiding principles for change that are well suited to enable methodologies to be applied in the context of complex and unique healthcare contexts, and to be used in synergy with implementation and improvement methodologies.

Keywords: change management; healthcare change; implementation; improvement; transformation. Abstract Background: The increasing prioritisation of healthcare quality across the six domains of efficiency, safety, patient-centredness, effectiveness, timeliness and accessibility has given rise to accelerated change both in the uptake of initiatives and the realisation of their outcomes to meet external targets.

The difference in healthcare is that equipment involves higher-cost one-off expenses, and investing in research is a higher-cost ongoing process than research in other fields. A financial company may commission software developers to make a customer banking app and update it monthly.

However, healthcare research requires more significant investment over a more extended period as new information is being harvested by researchers, requiring specialized staff. New care practices are the research outcomes and must be implemented by change leaders immediately, mainly where cultural shifts brought on by Covid are concerned. But these practices are constantly changing as research discovers new findings.

The relentlessly dynamic impact of research on care makes it challenging for healthcare staff to keep up, creating negative feelings toward change and increasing the need for change management models. Employees in healthcare are a unique group. Unlike other industries, healthcare practice enflames staff opinions and values, leading to value-based care practice.

This dynamic is very different from rules in other industries because, in healthcare, people look after vulnerable people who depend on them. When it comes to vulnerable people, there are a lot of very fixed opinions on specific care practices, cultural attitudes, and differing standards. This reason is why the change process is challenging due to limiting beliefs.

Individual change leads to organizational change. Within a different healthcare organization, there are smaller sub-cultures in departments and wards within an overarching organizational culture. Change managers need to identify the different cultures in other areas and be aware of why staff resists change to facilitate change effectively. Such issues often stem from group dynamics, resulting in negative feelings about change. These common issues must be known by change leaders and identified in specific individuals and groups to help staff understand and support the change.

The change leader can tackle this issue by engaging in shared decision-making as a part of successful change processes to overcome resistance and sustain change. The ever-pressing progress of technology is unavoidable in any industry, especially the healthcare industry. One example is that hospitals and clinics have adopted electronic medical records EMR in the United States. Moving to digital medical records has required many healthcare organizations to rework their entire medical records systems, but it also equips them for the future, increasing productivity and efficiency.

Technology adoption and change management in healthcare are fraught with similar challenges to technology adoption in any other industry. But in many ways, healthcare staff face more complex challenges to successful digital adoption than other industries. Healthcare staff needs to understand the drawbacks as well as the benefits of any technology adoption. Suppose the team is given training before and during technology adoption. In that case, staff can help reduce losses, and when staff feels more confident with technology, they will be more open to embracing future technology adoption.

Staff is often motivated by opportunities or threats. One way to reduce resistance is to promote the opportunities of technology rather than its potential threats. In healthcare settings, there are several ways to communicate these benefits. EMRs are more easily shared, and patient history is more straightforward for clerical and medical staff to move from one healthcare setting to the next. Additionally, convenience and efficiency are improved, leading to improved quality of care.

Although managing change is more complex and challenging in health care than in other industries, the process is made more accessible and effective by choosing the most suitable change management methods.

In healthcare, leading change successfully is frequently achieved via change management methods, including According to research in conducted by Harrison et al. The other two models have been included for balance against more soft, person-centered approaches, as this is a large part of healthcare practice. Part of their value to healthcare is that some of these included models, such as the ADKAR model, focus less on tasks and do not make staff implement changes before they can understand them.

The ADKAR model focuses more on human psychology, helping staff to understand the need for change to support healthcare change management, making it more suitable and effective in healthcare organizations. It helps manage change within short-term, intensive change initiatives due to the aggressive top-down approach to achieving change through three stages.

The preparation stage. Look at how things operate to see the resources needed for the desired results. Communication is essential in this phase, as healthcare staff must be aware of what changes need to happen to prepare them for the subsequent steps. The implementation stage. Project leaders set changes into motion, and communication is again of very high significance as change is a complex process to handle for team members. Support must be available via communication channels at this critical phase.

Implement required skills of staff needed for change to take place. The refreeze stage is part of an ongoing process to achieve success. This stage involves developing a strategy to ensure change sticks. Analyze the effect of the new changes and measure how close you are to achieving goals set at the unfreeze phase. Healthcare managers and change leadership should use this theory alongside a softer model for longer-term change management strategies.

Leaders must bear in mind that without a softer model monitoring employee experience to some level alongside the Lewin Model, adverse effects on employee retention and performance may occur due to burnout.

This model supports change leaders with implementing change initiatives in healthcare organizations as it is task-oriented, and healthcare organizations are often driven by completing tasks to a schedule. The model includes eight steps:. Motivate the team by creating an environment filled with a sense of urgency. Build a guiding coalition, including all the right staff to plan, coordinate and carry out the change. Establish a clear vision and each accompanying change initiative.

Break goals into bite-size chunks and communicate successes little and often. Maintain momentum, and push harder after every successful implementation. The sense of urgency for short-term wins could lead to high rates of staff burnout. Something healthcare staff are already at risk of before the change leader implements a change plan. Over a few months, short-period change management strategies in health care work well with this model. One example could be a move to paperless patient onboarding in an ER unit, which is a high-pressure, task-oriented environment.

Although burnout due to this change could potentially be high, staff may be more pragmatic and see improvements quickly, reducing staff stress and increasing patient care quality over the time taken to implement the change. Paperless onboarding would primarily involve getting used to new technology and simple employee training , and the sense of urgency, the first step of the model, is innate in ER staff due to the nature of the work. ADKAR Awareness, Desire, Knowledge, Ability, Reinforcement analysis is vastly different from the first two models as it focuses on understanding the emotions and thoughts of the people affected by the change.

In healthcare, many stakeholders are affected by changes with different ways of gaining or losing. There are five steps to achieving an ADKAR analysis; the first is creating awareness for healthcare staff. Show healthcare staff what changes are necessary and why.

Detail is needed when explaining changes, and change leaders should define training schedules. Face-to-face announcements and training are preferred so staff can ask questions to enable them to participate early in the process. Create a desire to be supportive of the change to create an environment in which employee engagement increases so much that attitudes toward change become positive organically. Ensure adequate support is available for employees.

Training, coaching, and checklists provided by the business are some types of support. Ensure employees, relatives, and patients can give feedback about their change journey. Leaders of change, such as project leaders or healthcare managers, record and action this to provide the best opportunity for learning and development. At this point, the change leader can make further adjustments to the plan based on the feedback. Use rewards and cash or holiday incentives to employees and other means such as championing staff who embody shared values.

Also, HR could implement an internal advertising campaign to remind everyone that the change leader adjusted the plan based on their feedback. These actions ensure the new status quo is maintained for ongoing performance improvement. Of all the change management tools in this list, the ADKAR model is the model most focused on human experience and supporting staff to engage with new ways of fulfilling their role naturally.

For this reason, the ADKAR model can be effective for long-term change strategies within large or small teams. It can be beneficial in healthcare environments due to the many stakeholders of different professions with competing goals. The ADKAR model is great for many healthcare contexts but particularly for departments caring for high vulnerability patients needing sensitive communication with patients and relatives, like an intensive care unit.

Staff in such care environments can hold more specialized skills than in other departments. The ADKAR change management model can support the change with constant feedback and communication to ensure that changes do not negatively impact care. Developed by William Bridges over thirty years ago, the Bridges transition model focuses on the human experience of processing and acting on change.

This model is softer, more philosophical, and more human-oriented than some of the other models and is formed of three basic principles Although it sounds somewhat philosophical, every ending is also a beginning. This point forms the first phase of the Bridges transition model. This phase represents the human act of accepting and managing loss. Within this stage, staff lose some things to a change management strategy and keep others.

Managers strengthen professional relationships and increase communication by outwardly acknowledging this. Once the loss is accepted comes the next phase: the neutral zone.