Exploring Change Management: Developing the Educational Skills Necessary to Support Sustainable Best Practice Implementation
Summary
Change is not easy. People feel more comfortable with the status quo because it’s what has always been done, and it feels safe. With the introduction of the Fixing Long-Term Care Act (FLTCA), 2021, and accompanying Regulations (O. Reg. 246/22) the new legislation focuses on improving the quality of care and services to one of our most vulnerable populations, the elderly. In this updated Act, the call to improve care requires changes from everyone. At Hampton Terrace Care Centre the question we wanted to answer, is how to be leaders in change management to ensure our resident’s care is of the highest standard.
The post-pandemic healthcare system is picking up the pieces of a stressful and overwhelming few years. Building capacity to successfully lead these change initiatives was identified as a need in our organization. As leaders, it is difficult to ask the front-line healthcare workers on your team to continually give their all and change their practices when the burnout and turnover rates are astronomical, and the increasing workloads are a concern for safety. There is no more left to give, yet we must ask for these changes despite the facts.
As a BPSO, Hampton Terrace has the privilege to work with the RNAO to ensure our organization’s goals and practices align with RNAO Best Practice recommendations and the FLTCA, 2021. The RNAO Advanced Clinical Practice Fellowship focused on building the knowledge and skills necessary to effectively lead change in the workplace and develop strategies for sustainability. The proposed learning plan was developed to support the acquisition of knowledge and skills in change management as it relates to the healthcare sector. The fellowship was completed with the full support of Hampton Terrace Care Centre (Unger Homes Ltd.) and nurse manager/educator, and mentor, Cathy Jager, RN, BScN, MSN/NE.
Overall Learning:
Three learning goals were developed to acquire the necessary educational skills to support sustainable best practice implementation. Each learning goal encompassed educational activities to advance change management knowledge.
Attainment of professional certification in change management. This certificate was delivered from a business administration perspective and to link this learning to the health sector membership to the Canadian College of Health Leaders (CCHL) was obtained. With this membership a LEADS Lite web-series was attended to introduce the LEADS Canada framework. In addition, participation in webinars on the current Healthcare HR Crisis highlighted strategies for health leaders to retain staff and develop return on investment (ROI) calculations. The combination of these three educational activities provided an understanding of how to be a better leader, what the healthcare sector needs from their leaders, and how to lead change from start to finish.
Create and conduct an anonymous staff survey on the current knowledge and understanding of change management in the organization. After completing the staff survey, the results reflected positive feelings, but lack of knowledge about change management. Majority of respondents were open to changes if they are informed, had a part in planning, and had a say in the evaluation and updates. By using the strengths and interests of the team members, the ownership in a project becomes organization wide. Sustainability is only possible if the team feels valued when working hard to make change.
Conduct an interview with a change management expert. Bahar Karimi, RN, LTC Administrator, Research Executive, and a PhD candidate, provided the experience of a professional interview focusing on the important factors in creating sustainable change and her trials and successes in change implementation in LTC. Gaining motivation takes positive work culture built on respect and communication. Respect leads to increased ownership in a change project and leads to increased capacity. All stakeholders must share the vision for change to be successful. Building capacity leads to sustainability because we create that sense of accountability and ownership with the employees and colleagues.
Outcomes
Residents and families at Hampton Terrace now understand RNAO’s LTC-BPSO and ACPF programs. Both family council meeting, and resident council meeting were attended to present the fellowship activities, including an introduction of BPSO for those who were new. Families understand the necessity of best practice changes and the benefits of receiving care and services aligned with evidence-based recommendations.
Best Practice Tips are shared in the resident and family newsletter as a way of keeping families educated and informed. Topics mentioned in past newsletters include definitions of evidence-based practice, why clinical changes are necessary, and how these changes positively affect resident care and services. In addition, admission information is given to families about BPSO and who to contact with any questions about getting involved.
Residents in other LTC homes benefit from the dissemination of knowledge learned through the fellowship. As part of the partnership with RNAO, Hampton Terrace shares resources and tools to assist these homes in achieving successful evidence-based practice implementation for improved care of their residents.
Through the dissemination of change management knowledge Hampton Terrace’s staff are more aware of the process of practice change, and how to be involved in future change. Staff feel more motivated to be part of future change teams which will provide better capacity for change implementation. Staff feel more valued for their work and have an increased motivation for innovation. They feel more comfortable identifying knowledge gaps and bringing them forward to their supervisor. This kind of communication has strengthened the relationship between management and front-line staff.
The management team is trained to identify the need for change, create change teams, plan change initiatives, and implement changes successfully. With these tools, Hampton Terrace will be a leader in the LTC sector for their resiliency in an ever-changing healthcare system.
Overall experience
The Advanced Clinical Practice Fellowship program granted me the opportunity to expand my knowledge and skills in leading effective practice changes. With the fellowship, my goal was to advance my practice as a healthcare leader in LTC and disseminate these learnings to those in similar roles in my organization. My hope is to inspire others to seek out their own opportunities for knowledge advancement in their practice because I have found this fellowship to be one of the most valuable experiences of my nursing career.
Change is necessary but difficult, but with the right tools anyone can successfully lead a change initiative. I have gained the knowledge and skill to implement change from inception to final implementation and evaluation. By using a combination of factors, I can identify a need, create a shared vision, put together a team, create motivation for a project, plan the change, identify the key change drivers, use their strengths, assess the system factors, roll out the plan, and create sustainability strategies.
My favourite moment of the fellowship was spending time talking to staff about leadership and change and what it means to feel valued as an employee. I felt a sense of improved work culture with the time spent building positive working relationships.
The biggest takeaway from the fellowship learning activities was the importance of investment in people. Ownership and accountability will bring about better sustainability (Karimi, 2022). People want to feel involved and valued, and the knowledge and skills acquired during this fellowship have allowed me to not only complete my goals but given me the opportunity to share it with others so they may become better leaders in sustainable change.
