Summary Of Leading Change Using Kotter's Eight Step Model
Leading change using Kotter's eight step model
This paper will present the Kotter’s eight step change model as a tool to improve patient care. Beginning with the background, followed by the relevance of the model to nursing practice, and concludes with an exploration of the Doctor of Nursing Practice competencies that would support a practice change. To illustrate use of the Kotter manner, a created example is used to illustrate how the steps related to a needed nursing practice change. The investigation of the model presented in this paper supports the potential usefulness of the model in facilitating a needed practice improvement, albeit invented for the purposes of this analysis. Nonetheless, the model presents limitation and opportunities for advancing nursing care practices. Finally, this paper will discuss the benefits of a Doctor of Nursing Practice (DNP) leading the nursing practice change effort.
Background of the Model
There are many theories and models to bring about change in organizations. One noteworthy leader in the field of organizational change is Dr. John Kotter. The eight steps for managing change has been available for over 20 years and the model has changed in the verbiage used to delineate the steps and how to better function within a traditional hierarchy (LeStage, 2015), however, the model has demonstrated to help bring about …show more content…
change. Tackovic (2013) studied the effectiveness of the model and identified when organizations use the eight-step model they were 64% more effective and successful at bringing about change than organizations that did not use the model. “The inertia of the status quo can be immense until the need for change is established, and that inertia may not be overcome by the desire of the constituents to thrive, or fear about their ability to survive, overcomes their anxiety about change” (Siler and Royeen, 2007, p. 26). Dr. John Kotter developed the model after studying over 100 businesses undergoing change. In 1995, published “Leading change” (Mindtools, n.d.), The eight steps include:
1. Create a sense of urgency.
2. Pull together the guiding team.
3. Develop the change vision and strategy.
4. Communicate for understanding and buy-in.
5. Empower others to act.
6. Produce short term wins.
7. Don’t let up.
8. Create a new culture (Middaugh, 2017, p.209).
The first step in the eight-step change process is to “Create a sense of urgency”, this procedure involving the initial assessment of the need. It involves the initial dialogue and collection of data to better understand the problem. Moreover, stakeholders must perceive a need to change to correct an acknowledged problem (Mulder, 2014). Second, “Pull together the guiding team” (Middaugh, 2017, p. 209) or “Build a Coalition” (Mulder, 2014, par 10), involves finding support from key stakeholders and customers to initiate a change and to generate a solution. This established the need for a solution (Dotolo, 2016). Next, “Develop the change vision and strategy” (Middaugh, 2017, p. 209), involves determining the central value and define the purpose for the change.
The fourth step, “Communicate for Understanding and Buy-in”, links the leaders and the followers in a shared understanding of the problem and solution. There needs to be enough followers who believe the solution has merit and for the group to comply (Dotolo, 2016, p.4). Next, step five is “Empower Others to Act” (Kotter & Rathgeber, 2005, p. 130), removes any barriers for action to make the vision a reality (Kotter & Rathgeber, 2005). Step six, “Produce Short Term Goals” (Kotter & Rathgeber, 2005, p. 130), created momentum by rewarding accomplishments. Next, step seven “Don’t Let Up”, utilizes restlessness to stimulate continued movement along the way to the vision (Dotolo, 2016). Lastly, step eight “Create a New Culture” (Kotter & Rathgeber, 2005, p. 131), refers to making the change become the new normal, sharing success stories helps affirm the benefit of change (Kotter & Rathgeber, 2005).
Relevance to nursing
A Cinahl database search using “Kotter’s eight-step model” and “nursing” resulted 3 articles. Barnfather (2013), Siler & Royeen (2007), Kroft & Scott (2007), used the Kotter eight step model in their respective health care environment to manage a change initiative. Butts and Rich (2018) define ontological is the “study of reality”, and “in nursing, ontological is what we believe to be ‘true’ in terms of the central interest to the discipline; it answers the question, ‘What is it that we believe?’(p. 95). Epistemology is the “study of knowledge, the creation, dissemination and categorization of knowledge” (Butts and Rich, 2018, p. 95). The Kotter’s eight step model is a business model for managing change, nursing has used the model in a limited number of settings. Siler and Royee (2007) compare the eight steps of Kotter’s model with the three steps of the Lewin’s model. Nevertheless, Kotter’s model provides the steps to accomplish the Lewin’s model of unfreeze, move and refreeze. From an ontological consideration, the Kotter model has the potential to be a useful tool, because of the reported examples of the tool being useful in business and the health care setting. Branfather (2013) admits “Had Kotter and Rathgeber’s (2006) eight-step process been followed from the outset, the issue of inhibitors and enablers would have been articulated and solutions found” (p. 508). Branfather (2013) discovered the Kotter model was useful even with its late adoption at the facility.
The goal of the nursing practice improvements is patient centered care to restore optimal health, and function of the person.
Person, the environment and health are foundational to the nursing metaparadigm. Kotter’s eight step model is an organized business change process, the metaparadigm of person, health, and environment must be super-imposed on the change model to make it more specific to nursing (Selanders, 2010, p. 84). One way that can be accomplished is a well written vision statement, which would include the target population, the health practice improvement and addressing the environmental factors
present.
Need for practice improvement
Chronic wounds have a significant impact on the health, and quality of life for patients, including: The cost of care, loss of productivity, pain associated with treatment, psychological impacts of lifestyle change, embarrassment and social isolation (Jarbrink et al., 2016, p. 2). Physical pain is one of the most distressing aspect of having a chronic wound and it involves the disease process which causes the wound, removal of the dressing, nerve pain when air contacts the wound bed, and anticipatory pain as the time for dressing change approaches (Solowiej and Upton ,2014). There is a limited amount of available literature regarding nurses understanding the significance of pain during dressing changes and motivation to provide effective pain management (Solowiej and Upton ,2014). The physical and psychological impact of a chronic wound can be profound for patients living with a chronic wound (Leal et al., 2017). One of the significant impact of repeated acute pain with dressing changes is the persistent triggering of pain receptors become oversensitive to stimulation, causing a heightened response to a minimum amount of stimulation (Solowiej & Upton ,2012). Moreover, painful dressing changes increase patients stress response which slows wound healing (Solowiej & Upton, 2012).
This paper will present the Kotter’s eight step change model as a tool to improve patient care. Beginning with the background, followed by the relevance of the model to nursing practice, and concludes with an exploration of the Doctor of Nursing Practice competencies that would support a practice change. To illustrate use of the Kotter manner, a created example is used to illustrate how the steps related to a needed nursing practice change. The investigation of the model presented in this paper supports the potential usefulness of the model in facilitating a needed practice improvement, albeit invented for the purposes of this analysis. Nonetheless, the model presents limitation and opportunities for advancing nursing care practices. Finally, this paper will discuss the benefits of a Doctor of Nursing Practice (DNP) leading the nursing practice change effort.
Background of the Model
There are many theories and models to bring about change in organizations. One noteworthy leader in the field of organizational change is Dr. John Kotter. The eight steps for managing change has been available for over 20 years and the model has changed in the verbiage used to delineate the steps and how to better function within a traditional hierarchy (LeStage, 2015), however, the model has demonstrated to help bring about …show more content…
change. Tackovic (2013) studied the effectiveness of the model and identified when organizations use the eight-step model they were 64% more effective and successful at bringing about change than organizations that did not use the model. “The inertia of the status quo can be immense until the need for change is established, and that inertia may not be overcome by the desire of the constituents to thrive, or fear about their ability to survive, overcomes their anxiety about change” (Siler and Royeen, 2007, p. 26). Dr. John Kotter developed the model after studying over 100 businesses undergoing change. In 1995, published “Leading change” (Mindtools, n.d.), The eight steps include:
1. Create a sense of urgency.
2. Pull together the guiding team.
3. Develop the change vision and strategy.
4. Communicate for understanding and buy-in.
5. Empower others to act.
6. Produce short term wins.
7. Don’t let up.
8. Create a new culture (Middaugh, 2017, p.209).
The first step in the eight-step change process is to “Create a sense of urgency”, this procedure involving the initial assessment of the need. It involves the initial dialogue and collection of data to better understand the problem. Moreover, stakeholders must perceive a need to change to correct an acknowledged problem (Mulder, 2014). Second, “Pull together the guiding team” (Middaugh, 2017, p. 209) or “Build a Coalition” (Mulder, 2014, par 10), involves finding support from key stakeholders and customers to initiate a change and to generate a solution. This established the need for a solution (Dotolo, 2016). Next, “Develop the change vision and strategy” (Middaugh, 2017, p. 209), involves determining the central value and define the purpose for the change.
The fourth step, “Communicate for Understanding and Buy-in”, links the leaders and the followers in a shared understanding of the problem and solution. There needs to be enough followers who believe the solution has merit and for the group to comply (Dotolo, 2016, p.4). Next, step five is “Empower Others to Act” (Kotter & Rathgeber, 2005, p. 130), removes any barriers for action to make the vision a reality (Kotter & Rathgeber, 2005). Step six, “Produce Short Term Goals” (Kotter & Rathgeber, 2005, p. 130), created momentum by rewarding accomplishments. Next, step seven “Don’t Let Up”, utilizes restlessness to stimulate continued movement along the way to the vision (Dotolo, 2016). Lastly, step eight “Create a New Culture” (Kotter & Rathgeber, 2005, p. 131), refers to making the change become the new normal, sharing success stories helps affirm the benefit of change (Kotter & Rathgeber, 2005).
Relevance to nursing
A Cinahl database search using “Kotter’s eight-step model” and “nursing” resulted 3 articles. Barnfather (2013), Siler & Royeen (2007), Kroft & Scott (2007), used the Kotter eight step model in their respective health care environment to manage a change initiative. Butts and Rich (2018) define ontological is the “study of reality”, and “in nursing, ontological is what we believe to be ‘true’ in terms of the central interest to the discipline; it answers the question, ‘What is it that we believe?’(p. 95). Epistemology is the “study of knowledge, the creation, dissemination and categorization of knowledge” (Butts and Rich, 2018, p. 95). The Kotter’s eight step model is a business model for managing change, nursing has used the model in a limited number of settings. Siler and Royee (2007) compare the eight steps of Kotter’s model with the three steps of the Lewin’s model. Nevertheless, Kotter’s model provides the steps to accomplish the Lewin’s model of unfreeze, move and refreeze. From an ontological consideration, the Kotter model has the potential to be a useful tool, because of the reported examples of the tool being useful in business and the health care setting. Branfather (2013) admits “Had Kotter and Rathgeber’s (2006) eight-step process been followed from the outset, the issue of inhibitors and enablers would have been articulated and solutions found” (p. 508). Branfather (2013) discovered the Kotter model was useful even with its late adoption at the facility.
The goal of the nursing practice improvements is patient centered care to restore optimal health, and function of the person.
Person, the environment and health are foundational to the nursing metaparadigm. Kotter’s eight step model is an organized business change process, the metaparadigm of person, health, and environment must be super-imposed on the change model to make it more specific to nursing (Selanders, 2010, p. 84). One way that can be accomplished is a well written vision statement, which would include the target population, the health practice improvement and addressing the environmental factors
present.
Need for practice improvement
Chronic wounds have a significant impact on the health, and quality of life for patients, including: The cost of care, loss of productivity, pain associated with treatment, psychological impacts of lifestyle change, embarrassment and social isolation (Jarbrink et al., 2016, p. 2). Physical pain is one of the most distressing aspect of having a chronic wound and it involves the disease process which causes the wound, removal of the dressing, nerve pain when air contacts the wound bed, and anticipatory pain as the time for dressing change approaches (Solowiej and Upton ,2014). There is a limited amount of available literature regarding nurses understanding the significance of pain during dressing changes and motivation to provide effective pain management (Solowiej and Upton ,2014). The physical and psychological impact of a chronic wound can be profound for patients living with a chronic wound (Leal et al., 2017). One of the significant impact of repeated acute pain with dressing changes is the persistent triggering of pain receptors become oversensitive to stimulation, causing a heightened response to a minimum amount of stimulation (Solowiej & Upton ,2012). Moreover, painful dressing changes increase patients stress response which slows wound healing (Solowiej & Upton, 2012).