Change Management - A Key Leadership Competency

By Rose O. Sherman, EdD, RN, FAAN

The late Peter Drucker, an internationally known leadership thought leader, once observed that “culture eats strategy for breakfast”. This often repeated is important to consider when trying to implement any new change into a work culture. Many nurse leaders today will readily admit that one of their most significant challenges is dealing with the rapid changes occurring in the health care environment. This change is happening on many levels. Organizations today are gearing up for the implementation of ICD 10 coding which will require change in documentation from both physicians and nurses. Insurers are moving to reimbursement models that are almost totally based on pay for performance on a wide variety of measures, and the list keeps growing. The level of uncertainty during these difficult economic times makes future planning difficult. We know that the future will require that we take some bold action but resistance to change in times of uncertainty can be challenging. Skill with change management is now an important new leadership competency.

Accepting Change

In most situations where we are asked to change, we are substituting new and unfamiliar behaviors or practices for old comfortable ones. This can make us feel insecure about our work and is often personally exhausting. That is why the reaction to change can be quite emotional especially among more seasoned staff with well established clinical patterns of working. It is important to keep in mind that resistance to change is often a manifestation of insecurity.

The Role of the Nurse Leader in the Change Process

As a leader, reflecting on your own reaction to the change and what you are projecting to others is an important first step. You may be demonstrating resistance yourself in subtle ways that are both verbal and nonverbal. Leaders play a key role in framing the context of change for their staff. This is especially true in uncertain environments. You must help to manage change in a way that employees can cope with it. To be successful, change cannot be imposed but rather the leader should look for ways to enable and involve staff. Finding ways to successfully embed change into the culture matters. John P. Kotter, a Harvard Business Professor, is a highly regarded expert in the field of change management. He proposes the following 8 step model that leaders can use to understand and manage change:

Create a sense of urgency about the need for change – inspire staff to see the need for the change and make the change objectives real and relevant.
Build a team to help guide the change – get the right people in place (skills, abilities and attitude) to make the change happen.
Develop and communicate the change vision – a simple, clear strategy of what the change is and how the change will occur.
Communicate for buy-In -involve as many people as possible, keep them informed and respond to their needs.
Empower action – remove obstacles, provide feedback and reward progress.
Create short-term wins – establish some easy to reach goals – manage the change in bite-size chunks.
Don’t let up – build and encourage determination and persistence – report on the progress.
Make the change stick – this is the most challenging part of change -weave the change into the culture and practice in tangible ways.

Change can be hard but altering the pace of change in our environments is not likely to be a leadership option now or in the future. What is within our control is how we personally respond to change, and how we frame and facilitate change for our followers. Proficiency with change management is a key skill that every leader needs to develop.

Read to Lead

Kotter, J. (1996). Leading Change. Boston, MA: Harvard Press.

Kotter International. The Eight Step Process for Leading Change