Change is difficult for most people. It often requires moving outside of one’s comfort zone, doing something different, or acquiring new skills. Understanding the dynamics of change management is another necessary leadership skill when implementing quality and safety initiatives. Though there are many different models of change, this article will be focusing on Kurt Lewin’s model of organizational change, with the inclusion of general change concepts.
Lewin’s Model of Organizational Change
Lewin’s approach breaks down change into three phases: unfreeze, change, and refreeze. Unfreezing involves creating a case for changing the status quo by ensuring there is a good reason for it (i.e. bad patient outcome such as maternal or neonatal serious injury or death or the need to incorporate evidence-based guidelines). At this phase the role of leadership is to motivate staff and create the impetus for change.
Ensuring employees are part of this process is key because they can provide valuable insight and ideas into what will work best to help implement change. They can help to solve problems around issues that may come up associated with the changes. Staff involvement also helps increase buy-in and ultimately results in a better change process.
This can be done by forming a multidisciplinary team with frontline staff and leadership that contains both formal and informal leaders. Meetings can be held with this group prior to, throughout, and after the changes are implemented. This group should contain staff who will serve as champions for the changes in the day-to-day. Determining if data can be used to track changes is a consideration in this process.
In the change phase, people actively participate in the change. Time and clear, continuous communication are needed to do this effectively. Working with teams to determine any challenges or barriers encountered is essential to ensuring the efforts are successful. Processes can be adjusted to better fit the environment based on team feedback.
The role of leadership during this phase is managing the transition, in other words checking in with staff regularly to see how the changes are going, if adjustments are needed, and providing overall support. Sometimes this involves simply listening to the difficulties in adjusting to the change. This can be done in day-to-day conversation and through periodic meetings with the champion group. Successes should be celebrated and lessons learned. Sharing data and patient stories are also helpful especially if improvement can be demonstrated.
In the refreeze phase, the changes have been incorporated into the day-to-day, creating a new normal. An important leadership function in this phase is building in sustainability- consideration for what needs to be done to maintain the initiative. For instance, building changes into education for new hires and yearly mandatory education may be helpful in ensuring the knowledge gained is not lost with new staff or forgotten over time with trained staff. In this phase, monitoring data helps to ensure the processes are being maintained.
Case Example
Unfreeze– a common theme noted in massive postpartum hemorrhage cases was a delay in recognizing substantial blood loss on the pads underneath the patient during cesarean delivery. The typical workflow is to clean up the patient at the end of the case and weigh these pads. This resulted in a delay in key hemorrhage interventions. The call to action was clear- we needed to do better for our patients!
Change- Calibrated drapes were utilized to measure vaginal blood loss during cesarean delivery for patients with high postpartum hemorrhage risk level. A barrier identified was staff feeling rushed and unsupported in this critical step. This was addressed and corrected by leadership.
Refreeze phase- Changes incorporated. Data demonstrated a reduction in massive hemorrhage cases due to earlier identification and interventions.
References
Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: A critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge, 3(3), 123-127. doi:10.1016/j.jik.2016.07.002
Copyright by Jeanette Zocco MSN, RNC-OB, C-EFM, C-ONQS