Unique Challenges for the
Nephrology Professional in
Managing Change
NORMA GOMEZ, MBA, MSN,
RN, CNN
CHANGE
CHANGE
THE CHANGE PROCESS
MODELS OF CHANGE
Lewin
Lippitt
Havelock
Nursing Process
Unfreezing
Diagnose the
problem
Building a
relationship
Assessment
Moving
Assess the
motivation and
resources
Diagnosing the
problem
Diagnosis
Refreezing
Select progressive
change objects
Acquiring
resources
Outcomes
identification
Choose change
agent role
Choosing the
solution
Planning
Maintain change
Gaining
acceptance
Implementation
Terminate helping
relationship
Stabilization and
self-renewal
Evaluation
Figure 1
RESPONSES TO CHANGE
Involve the team
Communicate Constantly
Plan
Don’t let up
Poor planning
End user’s not consulted
Poor follow up
Oh no!
Opportunity
CHALLENGES TO CHANGE
IMPLEMENTATION
PROJECT MANAGEMENT
 The ideal process for implementing
change is to organize and manage the
work.
 This is the definition of project
management.
TERMS
 A project is a temporary endeavor with a
defined beginning and end undertaken to
meet unique goals and objectives to bring
about beneficial change or added value.
 Specific people or groups who have a stake
in the outcome of the project are
stakeholders.
 The project manager is responsible for
the processes used to manage the project.
TERMS
 The project team consists of the full-time
and part-time resources assigned to work on
the deliverables of the project.
 Scope is the way you describe the
boundaries of the project. It defines what the
project will deliver and what it will not
deliver.
TERMS
 A deliverable is any tangible outcome that
is produced by the project. All projects
create deliverables.
 The implementation plan tells an
observer how the project team will complete
the project.
ORGANIZATIONAL STEPS
 Defining the work
 Begin
the process by brainstorming
potential goals, objectives, and activities
for the project.
 Consider what strategies will be used, as
well as resources (including staff, budget,
equipment, and technical assistance)
needed to carry out the plan.
 Before creating a new plan of action the
team should first consider whether there is
an existing plan that can be modified.
ORGANIZATIONAL STEPS
 The first task in formulating your plan is to identify
the project team.
 Identify the needed skills to ensure the
project is a success.
 Form a team that is representative of the
stakeholders.
 Team members must make a commitment
to make time in their workday to attend
meetings and submit reports as
determined by the team.
TEAM COMPOSITION
TEAM COMPOSITION
Project Name
Project Leader
ESA Conversion
Jeanne Smith
Core Skills
Skills
Required
Development of educational
tools
Policy development
Team
Representative
Team
Status
Department
Represented
Jane Brown
Core team
Nursing
Susie Mills
Core
Medical Clinical/ Operations
Protocol Development
Jerry White
Core
Medical Clinical
Implementation
Gary Green
Core
Operations
Patient education
Norma Long
Core
Social Services
Physician education
Dr. Smith
Core
Physicians
Technical expertise
Joe Roberts
Core
Chief Tech/Machine Techs
Stakeholder Interests
Processes
Included
Team
Representative
Team
Status
Team
Member Liaison
IT
Linda Jones
PT
Jerry White
Marketing
Debbie Flores
PT
Gary Green
Processes or
Projects Affected
Logistics
Toolkit
Team
Representative
Team
Status
Team
Member Liaison
ORGANIZATIONAL STEPS
 Establishing Timelines
 Depending
on the size and scope of
change needed, the time frame may
extend from weeks to months and at
times possibly years.
 It is important to recognize that this
is a complex process, but a project
has a beginning and an end.
ORGANIZATIONAL STEPS
 Managing the plan
 Develop
a preliminary plan that
outlines each step.
 Include who is responsible for each
step and how long it will take to
accomplish.
IMPLEMENTATION PLAN
 It describes the activities required, the
sequence of the work, who is assigned to the
work, an estimate of how much effort is
required, when the work is due, and other
information of interest.
 Once the plan is in place, it guides the team
and they perform the work according to the
plan.
Implementation Plan
Project Name: Machine Conversion
Target 5/1/12
Project Lead: Jeanne Smith
Action
Start Date
Due Date
Completion
Date
% complete
Clinical policies High
and procedures
2 -4 weeks prior to
start date begin
reviewing all policies
and procedures and
implement change for
new machines
3/17/2012
3/22/2012
3/22/2012
100%
Staff Education
High
Set up educational
meetings for nurses
and staff MD's
3/22/2012
Forms
Medium
Change forms:
3/22/2012
•Incident report form
•Treatment flow sheet
• Plan of care
• Reuse logs
• Disinfection logs
Task/Activity
Priority
Responsible
person
Notes
J. Smith,
Clinic
Manager
Machine set-up, priming, fluid
removal calculations,
transducer protectors,
termination of treatment,
recirculation, policies and
procedures revised and
approved by approving body.
4/15/2012
J. Smith,
Clinic
Manager
Utilize Manufacturer's
education materials and
Clinical Representatives
4/10/2012
B. Gomez,
Adm.
Assistant
Review all forms that may be
impacted by this change. Need
to get approving body to
appove.
Contact printer
ORGANZATIONAL STEPS
 Execution phase
The execution phase is typically the longest phase
of the project.
 It is the phase within which the deliverables are
physically constructed and presented for
approval.
 It is very important to develop a system to
identify and maintain contact with individuals
who have been assigned specific responsibilities
within the plan.
 Communication Plan

ORGANIZATIONAL STEPS
 Closure
 Following
the completion of all project
deliverables, a successful project will have
met its objectives and be ready for formal
closure.
 Once your team has planned, created,
implemented, and the change has become
part of your daily work (standard
operating procedure), you are ready to
evaluate the process
Evaluation process
CASE STUDY
 Consider the complexities of implementing the
following
changes in a dialysis facility:




Acquiring a facility of near equal size
Changing to a different dialysis delivery system
Changing medication from every treatment to once
per month
Changing staff schedule from 12 hour shifts to 10 hour
shifts
Change is clearly warranted, but where do you start?
Whom do you involve? How do you see it through to
completion?
KEY POINTS
 Nurses need to participate in or lead change





management projects
The first step is to identify what exactly needs to
change and why
Several tools exist to help this process, including
root cause analysis and process mapping
Stakeholders need to be identified and involved in
the process of change for it to be successful
Communication throughout the process is essential
Identify and utilize outside resources to facilitate
the change
SUMMARY
 Select a change theory
 Create awareness
 Manage resistance
 Initiate the change
 Evaluate the changed environment
 Disseminate the change through the organization
QUESTIONS