1. NORMA GOMEZ, MBA, MSN, RN, CNN Unique Challenges for the Nephrology Professional in Managing Change

2. CHANGE

4. THE CHANGE PROCESS

5. MODELS OF CHANGE Figure 1 LewinLippittHavelockNursing Process UnfreezingDiagnose the problem Building a relationship Assessment MovingAssess the motivation and resources Diagnosing the problem Diagnosis RefreezingSelect progressive change objects Acquiring resources Outcomes identification Choose change agent role Choosing the solution Planning Maintain changeGaining acceptance Implementation Terminate helping relationship Stabilization and self-renewal Evaluation

7. RESPONSES TO CHANGE Opportunity Oh no! Involve the team Communicate Constantly Plan Don’t let up Poor planning End user’s not consulted Poor follow up

8. CHALLENGES TO CHANGE

9. IMPLEMENTATION

10. PROJECT MANAGEMENT The ideal process for implementing change is to organize and manage the work. This is the definition of project management.

11. TERMS A project is a temporary endeavor with a defined beginning and end undertaken to meet unique goals and objectives to bring about beneficial change or added value. Specific people or groups who have a stake in the outcome of the project are stakeholders. The project manager is responsible for the processes used to manage the project.

12. TERMS The project team consists of the full-time and part-time resources assigned to work on the deliverables of the project. Scope is the way you describe the boundaries of the project. It defines what the project will deliver and what it will not deliver.

13. TERMS A deliverable is any tangible outcome that is produced by the project. All projects create deliverables. The implementation plan tells an observer how the project team will complete the project.

14. ORGANIZATIONAL STEPS Defining the work  Begin the process by brainstorming potential goals, objectives, and activities for the project.  Consider what strategies will be used, as well as resources (including staff, budget, equipment, and technical assistance) needed to carry out the plan.  Before creating a new plan of action the team should first consider whether there is an existing plan that can be modified.

15. ORGANIZATIONAL STEPS The first task in formulating your plan is to identify the project team.  Identify the needed skills to ensure the project is a success.  Form a team that is representative of the stakeholders.  Team members must make a commitment to make time in their workday to attend meetings and submit reports as determined by the team.

16. TEAM COMPOSITION

17. ORGANIZATIONAL STEPS Establishing Timelines  Depending on the size and scope of change needed, the time frame may extend from weeks to months and at times possibly years.  It is important to recognize that this is a complex process, but a project has a beginning and an end.

18. ORGANIZATIONAL STEPS Managing the plan  Develop a preliminary plan that outlines each step.  Include who is responsible for each step and how long it will take to accomplish.

19. IMPLEMENTATION PLAN It describes the activities required, the sequence of the work, who is assigned to the work, an estimate of how much effort is required, when the work is due, and other information of interest. Once the plan is in place, it guides the team and they perform the work according to the plan.

20. Implementation Plan Project Name: Machine Conversion Target 5/1/12 Project Lead: Jeanne Smith Task/ActivityPriorityActionStart DateDue Date Completion Date % complete Responsible person Notes Clinical policies and procedures High2 -4 weeks prior to start date begin reviewing all policies and procedures and implement change for new machines 3/17/20123/22/2012 100%J. Smith, Clinic Manager Machine set-up, priming, fluid removal calculations, transducer protectors, termination of treatment, recirculation, policies and procedures revised and approved by approving body. Staff EducationHighSet up educational meetings for nurses and staff MD's 3/22/20124/15/2012 J. Smith, Clinic Manager Utilize Manufacturer's education materials and Clinical Representatives FormsMediumChange forms: Incident report form Treatment flow sheet Plan of care Reuse logs Disinfection logs 3/22/20124/10/2012 B. Gomez, Adm. Assistant Review all forms that may be impacted by this change. Need to get approving body to appove. Contact printer

21. ORGANZATIONAL STEPS Execution phase  The execution phase is typically the longest phase of the project.  It is the phase within which the deliverables are physically constructed and presented for approval.  It is very important to develop a system to identify and maintain contact with individuals who have been assigned specific responsibilities within the plan.  Communication Plan

22. ORGANIZATIONAL STEPS Closure  Following the completion of all project deliverables, a successful project will have met its objectives and be ready for formal closure.  Once your team has planned, created, implemented, and the change has become part of your daily work (standard operating procedure), you are ready to evaluate the process  Evaluation process

24. CASE STUDY Consider the complexities of implementing the following changes in a dialysis facility:  Acquiring a facility of near equal size  Changing to a different dialysis delivery system  Changing medication from every treatment to once per month  Changing staff schedule from 12 hour shifts to 10 hour shifts Change is clearly warranted, but where do you start? Whom do you involve? How do you see it through to completion?

25. KEY POINTS Nurses need to participate in or lead change management projects The first step is to identify what exactly needs to change and why Several tools exist to help this process, including root cause analysis and process mapping Stakeholders need to be identified and involved in the process of change for it to be successful Communication throughout the process is essential Identify and utilize outside resources to facilitate the change

26. SUMMARY Select a change theory Create awareness Manage resistance Initiate the change Evaluate the changed environment Disseminate the change through the organization

27. QUESTIONS