Five Reasons Change Doesn't Stick - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC

Introducing change is challenging but the biggest challenge comes in making it stick. I have talked with many nurse leaders over the past few months who are struggling with keeping bedside rounding alive on their units. It is an evidence-based practice that has been demonstrated to contribute to better patient outcomes and higher patient satisfaction. Yet sometimes we ignore the evidence and revert back to what is comfortable, faster and familiar. Change is hard because to hard wire it in practice requires a change in habits but there are other reasons why change does not stick. These include:

Out of sight, out of mind – when new initiatives start there is often a great deal of effort and energy invested in educating staff and gaining momentum but this subsides. As time moves on and there is less effort to upscale the initiative, old habits and practices can begin to emerge. A simple visualization of initiatives such as bedside rounding and where you are in timeline can be enough of a reminder that it is still an expectation.
Perceived as the flavor of the month – some organizations move quickly from one initiative to another with little attention to the timing of the changes. Staff can begin to perceive any new initiative as the flavor of the month which will dissipate.
Lack of leadership buy in – the Gallup organization reports that 70% of staff engagement with any initiative is dependent on leadership. Culture eats strategy for breakfast (lunch and dinner). When a leader does not support an initiative, there is a high probability of failure. New initiatives need cheerleaders and these are often frontline leaders.
Not hardwired into the culture – it is often said that what gets measured, gets done. This is true in implementing new initiatives. If the initiative is not part of policy, procedures and there is no way to measure success then the failure rate will be higher.
Lack of attention to timing – in Daniel Pink’s new book When, he talks about timing of initiatives as a fine art. There is strong evidence that the use of strategic timing can propel an initiative forward. Initiatives are most effective when started at the beginning of a cycle such as a new quarter, a new month, a new year or even a new week. Meetings held to drive a new initiative should ideally be held in morning because this is when people are most open to change. Every initiative has a mid-cycle point where the energy can dissipate and this needs to be strategically managed.

Making change stick requires intentional planning and great strategy. As you plan new initiatives, ask yourself questions about obstacles to change and what could drive failure. Consider these five known reasons why change doesn’t stick. When an initiative fails or is on life support, do a post mortem of what went wrong and how to fix it in the future.