Introduction
Change is an immediate and inevitable aspect of organizational development and improvement in the contemporary fast-advancing field of healthcare. The emergence of new approaches and updated interventions based on research helps integrate best practices in the healthcare system to ensure the most favorable patient outcomes. Importantly, the change occurring in the healthcare organization’s management and functioning is pivotal for arranged and well-aligned care delivery by all staff members. One of the most impactful elements in proper care delivery is effective communication in nursing teams, which depends on the skills and integrity of the staff in exchanging relevant information. With proper communication, problem-solving and decision-making are more efficient and allow for integrating the efforts of functional teams into the achievement of hospital goals. In this project, the implementation of communication huddles for a nursing team in a large healthcare organization will be discussed based on Kotter’s eight-step change management model. The paper will outline and justify the completion of each step of the process to argue that the planned step-by-step change implementation will allow for eliminating constraints and facilitating the communication process for better patient outcomes in a long-term perspective.
Problem
Step 1: Urgency
Any organizational change is based on the initial need for obtaining a new set of skills, processes, or other specific features that transform the organization into a qualitatively new entity. In the case of a large healthcare organization in need of an advanced communication huddle launching for efficient teamwork, the change is validated by the insufficient current quality of inter-personal communication in nursing teams. Consistent with this tendency, the first step of change implementation, according to Kotter’s change management model, is the establishing of a sense of urgency for change (Baloh et al., 2018). In this regard, the urgency and immediate necessity to transform the functioning of the nursing staff in terms of communication should be highlighted. When igniting the understanding of the need for change in the employees of the organization, the management responsible for change implementation should emphasize the drawbacks in the current state of affairs and the prospective benefits that the proposed change will provide.
Indeed, the identification of current problems is helpful in validating and justifying the requirements for organizational transformation. Communication timeliness and clarity are essential for healthcare settings due to the reliance on immediate delivery of patient care in nursing decision-making (White & Stuart, 2021). Since teams in a healthcare organization without properly structured communicative processes fail to exchange relevant information in a timely manner, which jeopardizes patient safety, declines their satisfaction level, and hinders the organizational reputation. Indeed, according to Stapley et al. (2018), “delayed recognition and diagnosis of patient deterioration and lack of good communication have been highlighted as key factors to be addressed in building safe healthcare services” (p. 44). On the other hand, Schatz and Bergren (2022) state that the use of communication huddles in healthcare units allows for building strong teams and a safe environment for patients. Thus, a sense of urgency should be established in the employees by highlighting the lack of communication management practices and the desired benefits obtained as the result of the implemented change.
In order to establish a sense of urgency across the nursing teams of the organization, specific measures should be taken. In particular, the change managers should educate the employees on the importance of change and its urgency in the context of the organizational problems and needs. As stated by Carman et al. (2019), to create a sense of urgency in the team members, it is important to discuss the problem with them openly and emphasize engagement for successful change outcomes. Thus, when initiating such informative and educational discussions, the managers should emphasize the statistical relevance of the problem, which might be illustrated by the finding showing that “communication issues have been identified as the leading cause in 60–80% of adverse events” (Baloh et al., 2018, p. 572). At the same time, it should be delivered to the employees that “team huddles have been shown to improve communication among clinicians and enhance patient safety” (Baloh et al., 2018, p. 572). In such a manner, their understanding of the problem will create a proper context and a favorable change environment for the consecutive steps of the change process.
Vision & Desired Outcome
Step 2: Guiding Coalition
The second step of the change implementation process is the establishment of a reliable and well-formed guiding coalition. This step entails creating a reliable team of advocates of change who would drive the transformation toward the common goal (Baloh et al., 2018). Indeed, the existence of a unifying mission across all the team members is essential for pursuing the change smoothly and obtaining consistent outcomes. For that matter, at this stage of the initiated change process, the organization should select the team members that would be responsible for the change implementation. For that matter, the employees should be engaged and assessed for their reliability and competence, as well as adherence to the overall change mission. Importantly, for the guiding coalition to be effective, it should be competent, informed, integrated, and responsible (Carman et al., 2019). These people will be the leaders of the transformation of the organization and the initiation of a communication huddle as the final outcome. Therefore, it is important to cultivate a common understanding of the change particularities and align the actions of the team members with the same change goal.
The process of selecting appropriate competent leaders for the guiding coalition should be characterized by the deliberate identification of the personal characteristics, experiences, and skills of the employees. According to Baloh et al. (2018), one might identify if there are “any team members enthusiastic about huddles and championing them” and who are most likely to cope with the leadership positions within the change process (p. 574). While the CEO might lead the change formally, the guiding coalition is most likely to be comprised of chief nursing managers and enthusiastic leaders with necessary competencies (Baloh et al., 2018). In such a manner, the accuracy and precision in the creation of the guiding coalition at the initial stages of the change management process will ensure reliable performance of the leaders throughout the transformation period with the proper achievement of common goals through commitment and shared strategic vision, the formulation of which constitutes the next step.
Step 3: Strategic Vision
The third step of the change process is the development of a strategic vision to be followed by the team. It should be an engaging, informative, and purpose-driven statement that would incorporate the desired outcome and its implications for both the organization and individuals. According to Baloh et al. (2018), the vision should be precise and detailed to ensure its applicability to the change process. The strategic vision for the organization undergoing this change might be formulated as follows. The initiation of communication huddles for the chief nurse’s office will allow for tracking communication goals across the organization, improve timely and precise information exchange between nurses, and properly informed decision-making of teams.
The development of the strategic vision will also include the identification of the planned implementation of change. In particular, research shows that the most effective communication huddle launching practices initiated in the healthcare setting were characterized by steady implementation spreading from less frequent and isolated huddles to more frequent and those occurring in every department of the organization (Baloh et al., 2018; Schatz & Bergren, 2022). For that matter, the proposed change’s strategic vision is the arranging of communication huddle meetings once a week within one nursing team with a steady advancement to daily meetings in all departments. According to Schatz and Bergren (2022), “huddles are short, regular debriefings designed to engage clinical staff in discussions about existing or emerging safety issues” (p. 76). Thus, when expanding toward daily huddle debriefings, the team will ensure achieving the overall goal of the change management process.
Step 4: Communication
After the development of a strong and convincing strategic vision, it should be disseminated across the involved stakeholders via appropriate and effective communication means. In particular, the vision and its delivery comprise a core of the success of the overall change implementation process since they predetermine the perception of organizational transformation by employees and form their attitudes and commitment (Bonawitz et al., 2020). In this regard, it is essential to adhere to best practices addressed in the research literature to ensure that the most effective communication strategies are used to explain the generated strategic vision among employees. Indeed, Baloh et al. (2018) found that the hospitals that implemented communication huddles successfully combined several means of vision delivery to ensure clarity of message and team engagement. The most beneficial means were newsletters, training sessions, and skills fairs that “emphasized their goals and explained why they were implementing huddles” (Baloh et al., 2018, p. 575). Based on such evidence, it is relevant to use a variety of communication methods at this step of the change process.
It is planned to compose and send a newsletter containing a concisely formulated strategic vision of the implemented change with a consecutive explanation of the goals and purposes of the communication huddles. In addition, it is necessary to arrange several training sessions for employees to advance their understanding of communication huddles as an effective technique for teamwork facilitation in pursuing larger healthcare organizations’ goals (Schatz & Bergren, 2022). Furthermore, skills fairs should be initiated to identify possible gaps in the communication skills of the nurses, provide an opportunity for experience exchange, and create a favorable space for practicing and acquiring new skills necessary for proper communication huddles functioning in the future.
Barriers to Success
Step 5: Remove Barriers
When approaching a change implementation process, one should recognize, address, and remove any potential barriers that might disable or complicate the completion of the mission. In the context of the implementation of communication huddles in the healthcare organization, the managers might face several significant barriers related to both internal and external forces (Bonawitz et al., 2020). Firstly, one of the most influential obstructing factors might be financial constraints. Financial resources will be required to conduct necessary training and change process evaluation, as well as equip the communication huddles with necessary tools such as meeting rooms, boards, gadgets, and other elements (Bonawitz et al., 2020). Without proper funding, the completion of the change process might be jeopardized. Thus, to eliminate this barrier, reliable investment sources should be found.
The second possible barrier might be time constraints, which is derived from the consideration of concurrent processes inside the organization that might require staff engagement. Research shows that time-related factors are commonly observed as barriers to change implementation in large organizations (Stapley et al., 2018). The time barrier should be handled by purposeful organizational planning with time management techniques applied to ensure that the schedule for change implementation complies with other processes in the hospital.
Thirdly, resistance to change is one of the barriers that might hinder the implementation and advancement of change outcomes. Indeed, people’s adherence to stability and formerly known processes discourage them from stepping outside their comfort zone into the unknown. In such a manner, the transformation of the existing communication modes in the hospital into communication huddles might be resisted by employees that are comfortable with their current functioning (Bonawitz et al., 2020). To address this barrier, the change managers should create a safe space for feedback, through which the employees concerned with change and resisting it could discuss their issues. In response to such claims, the managers should incorporate motivational and problem-solving techniques to ensure that every team member is ready to take a risk and advance their practice level toward a higher goal. There are significant inherent risks associated with the resistance to change since the accomplishment of organizational transformation heavily relies on the participation of employees. For that matter, it requires deliberate work with the staff to remove this barrier.
Finally, another significant deteriorating factor that might complicate the completion of the change efforts is the lack of proper skills in the staff. According to Stapley et al. (2018), incompetence might provoke additional resource use due to the necessity to advance skills in employees and check their independent use of recently acquired competencies in their daily practice. For that matter, to eliminate this barrier, thorough communication skills training sessions should be initiated and conducted with the consideration of the team members’ current knowledge and practical capabilities. In other words, the training should deliberately target the knowledge and skills gap in the particular population of employees to ensure their readiness to perform within the changing environment.
Recommendations: Short Term
Step 6: Short Term Wins
The achievement of short-term goals is the sixth step of the change process. It entails the identification of achievable and measurable results within a relatively short period of time (Baloh et al., 2018). As stated by Carman et al. (2019), short-term wins might be considered as successful achievement of milestones planned across the change implementation strategy. In particular, for this project, one of the short-term wins might be improved communication effectiveness by 20% within six months. It will be implemented via staff training; the data for evaluation of this short-term win will be collected and analyzed using a self-reported questionnaire with employees to identify the perceived improvements or deteriorations in the quality and clarity of communication in teams. Another short-term win might address the acquisition of new skills and the ability to apply them to practice within the first four months. This outcome might be measured using a test to detect successful changes. A skill test will generate data for analysis in the form of answers to a set of questions; the percent of correct answers will be analyzed to identify the achievement of this short-term win.
Recommendations: Long Term & Sustainability
Step 7: Consolidate Gains
The seventh step of Kotter’s change management model is essential in maximizing the gains of the change by advancing its benefits across the organization. In particular, with the launching of chief nurses’ office communication huddles, the consolidation of achievements should be reflected in arranging the huddles on a daily basis with effective use of this measure for efficient teamwork and improved patient outcomes (Carman et al., 2019). More specifically, the organizational performance is expected to transform toward a more transparent and engaging teamwork-based process with the reliance on inter-professional communication and discussion of urgent issues pertaining to patient safety and other immediate concerns (Schatz & Bergren, 2022). To ensure that this change result is sustained, the employees will be required to report the benefits of participating in huddle-based meetings with leaders’ periodic review of the reports to detect possible concerns. The systematic use of huddles as planned will enhance new habits in the staff’s performance and form positive attitudes toward the newly introduced procedure.
Increased level of patient satisfaction with hospital care due to the efficient and well-aligned teamwork of the nursing staff is another ultimate goal of the change implementation. It will be tested in year two after the project’s completion. In particular, the evaluation of this goal’s achievement might be conducted using patient surveys and comparing them with similar survey results conducted prior to the change implementation (Baloh et al., 2018; Schatz & Bergren, 2022). In such a manner, the employees will be encouraged to advance their professionalism and expand their communication skills set to validate their competence in serving their patients with high-quality work that relies on proper communication.
The expansion from infrequent department-based huddles to daily organization huddles will designate the consolidation of change. Feedback should be collected regularly, and the necessary improvements should be made to ensure change consistency (Baloh et al., 2018). When faced with challenges, the organizational leadership might refer to the experiences of other companies to use their coping strategies. For example, as noted by Baloh et al. (2018), some hospitals failed to anchor communication huddles in organizational culture due to a lack of huddles’ priority or the ineffectiveness of leadership’s inclusion. Overall, the short-term achievements should be repeatedly reminded for the employees to motivate them to continue adhering to the changing patterns and sustain the positive outcomes, maximizing them over time.
Step 8: Anchor Change
The last step of the change process is anchoring the achievements in the organizational culture. According to Carman et al. (2019), the reinforcement of positive gains and successful results of the huddles will allow for incorporating the change into the daily routines of the hospital staff as a new norm. Senior leadership will engage in advancing communication huddles as an immediate practice across different departments of the organization to ensure that this practice is properly institutionalized (Baloh et al., 2018). For that matter, it is important to sustain thorough and deliberate monitoring of change implementation results within several years after the project is completed to avoid disruptions and address possible complications for long-term benefits.
Conclusion
In summation, Kotter’s eight-step change management model is an effective, evidence-based, and reliable approach to structuring and leading organizational change. Its well-defined phases and steps allow for thorough planning and investment of talent and resources into the sustainable long-term benefit of the organization. Within the context of healthcare, this model allows for adequate implementation of communication huddles for the nursing staff. Firstly, the sense of urgency should be ignited by pointed toward organizational problems due to ineffective communication and the expected benefits that would advance the organization and improve patient outcomes. Secondly, a guiding coalition should be formed on the basis of enthusiastic, competent, committed, and reliable leaders capable of leading the organization toward a common goal they advocate for. Thirdly, a strong strategic vision should be created to address the necessity to launch communication huddles for the nursing staff to strengthen teamwork and promote patient safety. Fourthly, this vision should be disseminated across all employees with a proper explanation for engagement.
Fifthly, such barriers as time constraints, financial limitations, resistance to change, the lack of skills, and unpredicted organizational processes should be eliminated by proper means. Sixthly, short-term wins of increasing the speed of decision-making regarding patient treatment by 20% within six months. Seventhly, the obtained wins should be consolidated and expanded across the organization to achieve the ultimate goal of consistent use of communication huddles for patient benefits. Finally, the change outcomes should be anchored in the organizational culture, becoming a new norm of the daily routine of nurses. Thus, following of such a plan will allow for eliminating communication-related losses and ensure efficient teamwork of the healthcare employees.
References
Baloh, J., Zhu, X., & Ward, M. M. (2018). Implementing team huddles in small rural hospitals: How does the Kotter model of change apply? Journal of Nursing Management, 26(5), 571-578.
Bonawitz, K., Wetmore, M., Heisler, M., Dalton, V. K., Damschroder, L. J., Forman, J., Allan, K. R., & Moniz, M. H. (2020). Champions in context: Which attributes matter for change efforts in healthcare? Implementation Science, 15(1), 1-10.
Carman, A. L., Vanderpool, R. C., Stradtman, L. R., & Edmiston, E. A. (2019). A change-management approach to closing care gaps in a federally qualified health center: A rural Kentucky case study. Preventing Chronic Disease, 16, 1-6.
Schatz, M., & Bergren, M. D. (2022). The huddle: A daily dose of communication. NASN School Nurse, 37(2), 76-78.
Stapley, E., Sharples, E., Lachman, P., Lakhanpaul, M., Wolpert, M., & Deighton, J. (2018). Factors to consider in the introduction of huddles on clinical wards: Perceptions of staff on the SAFE programme. International Journal for Quality in Health Care, 30(1), 44-49.
White, K. R., & Stuart, W. P. (2021). Increasing outpatient clinic healthcare provider engagement through nursing leader communication. Journal of Community Health Nursing, 38(1), 38-47.