My organization is a 300 bed hospital in Olathe, Kansas. Currently, I work in the Progressive Care Unit which is a 15 bed unit that takes care of patients who require more frequent monitoring than a normal telemetry floor. Because of the acuity of our patients, the nurse-to-patient ration is 1:4, unless the patient meets certain parameters. When assessing my organization using Kotter’s eight-step process, I have found that there are several areas that still need some work. Sadly, almost all of the issues seem to revolve around communication between the nurse managers, supervisors, and shift coordinators.
Many of the changes that occur do so with little warning which goes against Kotter’s first step to establish a sense of urgency and create a catalyst for change (Thomsen, 2013). Steps 2 and 3 are also weak as the coalition formed are rarely seen or acknowledged by staff. Without proper warning of changes that the organization are wanting to be implemented, it is hard for staff to provide input on how to achieve it or to see the vision that they are wanting. Communicating the vision, or step 4, seems to come in the form of emails or education opportunities. This seems great because it does encompass Kotter’s idea of using every channel to communicate the change, but it always comes as a surprise to those working so it is not embraced or goes over very well. Step 5 seems to work well with our charting system, Cerner. It has a task list that can be altered to incorporate new tasks or things that need to be done in order to improve outcomes and reduce infection risks. The organization is also good at setting short term goals and rewarding employees when good things or numbers are achieved which covers step 6 in Kotter’s change process. Step 7 focuses on producing more change throughout the organization based on existing changes and I feel like this is a weak point at times. Patient satisfaction scores are a good example of this. Low scores are recognized, but there are few suggestions on how to improve the scores or ideas on how to better them further. Step 8 (institutionalizing new approaches) creates the connections between corporate success and newer policies/behaviors. This step is based on leadership succession and development. Olathe strives to always better its employees and offers many opportunities to do this through education classes; however, with the lack of communication comes the questions of how many “leaders” we actually have.
Not every hospital is perfect and they all have their problems. Kotter’s steps do not always seem to be done in my organization. Better communication from everyone involved could definitely improve patient satisfaction, outcomes, and staff positivity.
Hi Caitlin:
I completely agree with you in that managers usually make decisions without the staff input, most of the times they decide and just through the changes at us and expect everything to be accepted and work well. My institution do not follow Kotter’s first step of creating a sense of urgency either. Glad to hear that your hospital follows step, unfortunately I cannot say this for mine.
Kotter, J.P. (1996) Leading change
Great job in laying out the steps in regard to your facility. I under stand where you come from when you say that most of the time change seems abrupt but management expects everything to be done smoothly. I know that in my facility some times the PCU’s have so many tasks for the 4 patients that they have that they seem more busy than ICU patients. So when change gets thrown in the mix it can cause communication breakdown and stress.
Hello Caitlin
Good job on your blog post. I think communication is one of the most important pieces to having a successful unit. Our unit where I work struggles with effective communication as well. I work in a small unit with less than 10 people and I use email regularly to communicate to everyone if we have any updates or changes. It is hard to get everyone together at times so email seems to help, but not everyone participates.
Patient satisfaction scores are so important and in order to improve them we need input to make the changes effective. I am a big advocate for making sure the patient’s in our unit are satisfied and comfortable. Sometimes we can’t please everyone, but if there is something we can do to improve I agree input from management is helpful.
Communication is so important especially in a unit as busy as yours. It sounds like your PCU is very similar to the PCU at my organization. The patients are very high acuity and I cant imagine how stressful that it let alone throwing in change that hasn’t been communicated. Great job on your blog post. I think Kotter’s model is very effective if used properly.