Learn to watch out for roadblocks to change

Change is difficult under the best of circumstances. Too often, however, institutions put up roadblocks that are not only unnecessary but downright counterproductive. "The thing that will kill change the fastest is neglect," says Duke Rohe, FHIMSS, performance improvement specialist at M.D. Anderson Cancer Center in Houston.

"You have to have a system to receive and analyze suggestions. Even time passing [without any response] is a statement that an idea is not important. Employees are tied to their ideas; it’s like a piece of them. Neglecting their idea is neglecting them. When you do not act on a first or second idea, you may have blocked the next 50 ideas," he advises.

If your governance system is not idea-friendly, change won’t work, he adds. "You can mention a suggestion at a nurses’ idea council, and they can debate and discuss it, but would the change occur if they agreed on it? If there’s not a way to have that happen, even in the best of systems, your change would just be situational."

Not finding joy in the work you do, and a lack of a robust reward and recognition program can be major obstacles to ongoing change, says Linda Kosnik, RN, MSN, CSCEN, chief nursing officer at Overlook Hospital in Summit, NJ.

"Managers are often reluctant to do this, so in essence you have to mandate it," she says. "We’ve had a whole education program called People’ to show them how to reward employees."

Sometimes, employee attitudes can be an obstacle to change. "We’re located in Northwestern Missouri, and we’re the only tertiary care facility within 150 miles," notes Kay Steger, MSN, process leader for education/quality integration at Heartland Health in St. Joseph, MO. "We have a problem convincing our staff that we have competitors and that it’s important to upgrade our technology and to strive to be the best and the safest’ hospital in the country. They believe this hospital will always be open, even if we don’t change anything for 50 years."

Steger and her staff seek to counteract this complacency by noting the reality of the Internet, and that people will travel great distances to well-known facilities such as the Mayo Clinic. "People will go anywhere to try to get the best and the safest treatment," she notes.

"What we try to do is reinforce that fact using benchmarking and statistical processes. We always try to help them understand that you don’t have to be in a large city to be on the cutting edge of health care," Steger says. "We choose to be on it, and we’ve tried very hard over the last three or four years to be sure our leadership staff have the same focus as we do through behavioral interviewing."

Need more information?

For more on change, contact:

Duke Rohe, FHIMSS, Performance Improvement Specialist, M.D. Anderson Cancer Center, Houston. Telephone: (713) 745-4433.

Linda Kosnik, RN, MSN CSCEN, Chief Nursing Officer, Overlook Hospital, 99 Beauvoir Ave., Summit, NJ 07902. Telephone: (908) 522-2095.

Kay Steger, MSN, Process Leader for Education/Quality Integration, Heartland Health, 5325 Faraon, St. Joseph, MO 64506. Telephone: (816) 271-6029.