Implementing EBP

1. Chapter 14Creating a Vision and Motivating a Change to Evidence-Based Practice in Individuals, Teams, and Organizations

2. Among the most important elements that need to be present for change to be accomplished successfully are: • 1. Vision: Developing a clear and exciting vision of what is to be accomplished can unify stakeholders • 2. Belief: Belief that the change to EBP is beneficial can lead to behavior change and foster the ability to successfully make the change Implementing EBP

3. 3. Strategic planning: Goals are established with deadline dates; a well-defined strategic plan is written. Use of a SCOT (Strengths, Challenges, Opportunities, and Threats) analysis will assist in the planning process: • Assess and identify system Strengths that will facilitate the success of a new project • Assess and identify Challenges that may hinder the initiative • Outline the Opportunities for success • Delineate the Threats to project completion, with strategies to overcome them Implementing EBP—(cont.)

4. 4. Action: Putting the strategic plan with its actionable objectives into motion • 5. Persistence: Continuing to move forward despite of unforeseen barriers; being nimble and open to revising approaches to allow continued progress • 6. Patience: Allows for continued progress even when results of actions are not yet seen Implementing EBP—(cont.)

5. Changing an organization is a highly emotional process • Group change requires individual change • No fundamental change takes place without strong leadership • The leader must be willing to change before others are expected to change • The larger and more drastic the change, the more difficult the change • The greater the number of individuals involved, the tougher the change will be to make (Duck, 2002) Organizational Change Models: Basic Assumptions of the Change Curve Model

6. Stage I: Stagnation: Characteristics include lack of effective leadership, failed initiatives, and too few resources; depression occurs and/or hyperactivity exists; individuals may feel stressed and exhausted • Stage II: Preparation: Emotional climate is anxiety mixed with hopefulness; possibly reduced productivity; buy-in is essential; opportunity exists of getting people excited, but may fail if preparation is too long or too short Organizational Change Models: Stages of the Change Curve Model

7. Stage III: Implementation: Individuals must see “what is in it for me?”; it is essential to assess readiness for change and increase confidence in making the change • Stage IV: Determination: The highest chance of failure is in this stage; if results are not as expected, change fatigue may set in if determination to see the change through is not firm; highlighting small successes is crucial • Stage V: Fruition: Positive outcomes are seen; reward and celebration for effort is important; danger in this stage is that organization reverts back to complacency and begins stagnation Organizational Change Models: Stages of the Change Curve Model—(cont.)

8. Step 1: Create a sense of urgency: Create the emotional feeling that “we need to move NOW,” which is especially important when individuals are complacent • Step 2: Form a team: Select members who possess the needed knowledge and skills, the respect and trust of others, and enthusiasm and commitment; opinion leaders are particularly important • Step 3: Vision and strategy: Create a clear vision and workable strategy with reasonable timeline Organizational Change Models: Kotter and Cohen’s Model of Change

9. Step 4: Communicating the vision: Communicate the vision and strategies with “heartfelt messages” that appeal to the emotions, which will motivate change; repeating the message will make the strategies clearer • Step 5: Empowerment: Remove barriers that inhibit successful change • Step 6: Interim successes: Establish short-term successes to celebrate Organizational Change Models: Kotter and Cohen’s Model of Change—(cont.)

10. Step 7: Ongoing persistence: Cultivate ongoing persistence; giving up too early will doom the project • Step 8: Nourishment: Encourage and feed the new culture to make the change permanent through celebration and planting meaningful infrastructures Organizational Change Models: Kotter and Cohen’s Model of Change—(cont.)

11. Organizational Change Models: Roger’s Theory of Diffusion of Innovations

12. Originally conceptualized to explain the process of changes in health behaviors, but also is applicable to organizational change • Stages: • Precontemplation: The individual is not intending to take action in the next 6 months (40% of an organization) • Contemplation: The individual is intending to take action within the next 6 months (40% of an organization) • Preparation: The individual plans to take action in the next 30 days (20% of organization) Organizational Change Models: The Transtheoretical Model of Health Behavior Change

13. Stages—(cont.): • Action: Overt changes were made less than 6 months ago • Maintenance: Overt changes were made more than 6 months ago • By matching intervention strategies to the stage in which individuals are currently engaged, the model proposes that resistance, stress, and the time needed to implement the change will diminish Organizational Change Models: The Transtheoretical Model of Health Behavior Change—(cont.)

14. Allow individuals to express their skepticism, fears, and anxieties in order to clarify misconceptions • Educate clinicians about EBP in a way that appeals to their emotions; this enhances their beliefs about their ability to implement it • Know the personality types of the individuals involved • Produce a written strategic plan • Develop SMART (i.e., Specific, Measurable, Attainable, Relevant, and Time bound) goals to be achieved Strategies to Overcome Barriers to Implementing EBP

15. Communicate the plan clearly and often; use several media modes (e.g., written, visual/graphic, and video) if possible • Acknowledge that the team-building process is dynamic and requires creativity and flexibility • Match organizational resources and administrative support closely to the diffusion of EBP • Enlist leaders and managers early in the change • Create a critical mass of EBP adopters within leadership and individual clinicians to sustain the change Strategies to Overcome Barriers to Implementing EBP—(cont.)

16. “Knowing and Working with Personality Types”: Rohm’s Taxonomy (the DISC Model)

17. “Knowing and Working with Personality Types”: Rohm’s Taxonomy (the DISC Model)—(cont.)

18. Stages of Team Formation

19. According to Roger’s theory of diffusion of innovation, the minimum percentage (critical mass) of people who “adopt” to the change that would signal that a change has begun to take hold is: a. 5% b. 15% c. 40% d. 60% Question

20. b.15% Rationale: According to the theory, there needs to be a critical mass of 15% to 20% of a combination of innovators, early adopters, and early majority before it can be assumed that an innovative change really begins to take hold. Answer

21. What model of organizational change would be most likely to give priority to changing nurses’ feelings about EBP over presenting them with new information? The transtheoretical model of health behavior change The Change Curve model Diffusion of innovations model Kotter and Cohen’s model of change Question

22. d.Kotter and Cohen’s model of change Rationale: Kotter and Cohen propose that the key to organizational change lies in helping people to feel differently (i.e., appealing to their emotions). They assert that individuals change their behavior less when they are given facts or analyses than when they are shown evidence that influences their feelings. Answer

23. According to Rohm’s taxonomy (the DISC model), individuals with which of the following personality styles are most likely to be comfortable in a leadership role? Driver Inspired Supportive and steady Contemplator Question

24. a.Driver Individuals with “D” (Driver) personality styles like to take charge of projects and are highly task oriented, making them well suited to positions of leadership Answer