By Rose O. Sherman, EdD, RN, FAAN
“Culture eats strategy for breakfast” – Peter Drucker
A nurse recently told me the story about how walking rounds were implemented in her hospital in an attempt to improve patient satisfaction scores. A review of the nursing literature indicates that when report is conducted at the bedside of the patient – the patient feels more included in his/her care planning and communication can be improved. In the situation she was presenting to me, the initiative had been announced with great fanfare and some staff education but it was failing to achieve the desired goal. The staff involved had never done bedside rounds before and were very uncomfortable with the new protocol. Patients were not being included in the conversation. The customer satisfaction scores had not improved.
Scenarios like this are not uncommon. Many new initiatives either fail or never achieve their intended outcomes.
Key Reasons for Failure
1. Initiative Fatigue in the Organization – some organizations across time implement so many “new” initiatives that they are viewed as the flavor of the month. This is especially true in organizations, units or departments that have frequent changes in leadership.
2. Lack of Front-line Leadership Support – to successfully drive initiatives across the organization and to the front line of care, leaders must fully support the initiative.
3. Failure to Engage Staff in the Planning – well designed initiatives not only include good structures and systems but also consider the knowledge, skills and abilities of the staff who are expected to implement them at the front-line.
4. Poor Planning – many good initiatives fail because of a lack of detailed planning about how, where and when to initiate the change. Planning needs to carefully consider issues like whether to pilot in one area first, how to best communicate the change to staff, staff training and an evaluation mechanism.
5. Failure to Sustain the Initiative over Time – initiatives can start with great fanfare and planning but what is often not consider is how to change the organizational culture to sustain the initiative across time.
Strategies to Promote Success
1. Create a Sense of Urgency – to effectively implement a new initiative, staff in an organization need to understand why it is needed. You need the tell the compelling story of why change is needed.
2. Consider the Organizational Culture – successful initiatives from other organizations may not be directly transferable to an organization with a different culture. This needs to be carefully considered in the planning process.
3. Get Leadership Buy-In – leaders need to have the opportunity to discuss their concerns about initiatives. Once the decision is made to move forward, front-line leaders need to be directly asked to commit to the success of the initiative.
4. Involve Staff in Every Aspect of Planning – to create buy-in and develop a better plan, staff need to be involved in the planning process. Select front-line staff champions that can help in the roll-out, training and evaluation process.
5. Don’t Make Assumptions about Training Needs – carefully plan how, when and where to educate staff about the initiative. A lecture may not be the right strategy when the initiative calls for new skills that need to be practiced and observed.
6. Plan an Ongoing Evaluation – to be successful, initiatives need to become part of the culture. They need to become part of the organizational dashboard evaluation and remain a priority after the initial launch.
Leadership Considerations
In today’s often chaotic and complex health care environments, staff can easily develop initiative fatigue. Chuck and Dan Heath in their book Made to Stick point out qualities that make ideas or initiatives really stick. From their research, initiatives need to be simple, concrete, credible and resonate with our value system.
In the case scenario presented above, bedside rounds would need to be presented as a way to truly engage the patient in his/her care. Staff often worry about what patients will think about the information that they present during these bedside rounds. Bedside rounds then become a source of anxiety and the focus of the communication is with the team. Patients can feel dehumanized when the intent is quite the opposite. Education about this initiative may not involve the “how” to effectively do this. If there are no champions on the unit to help coach staff over time, compliance can easily begin to decrease.
Successful leaders are good planners who understand that the building blocks need to be in place for initiatives to succeed.
Read to Lead
Heath, C. & Heath, D. (2007). Made to Stick. Random House Publishers.
© emergingrnleader.com 2012
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