Preparation is the key to a smooth changeover
Unit managers are critical
When St. Joseph’s Hospital of Atlanta sought to lessen the clerical workload of its nurses to give them more bedside time, the process took 10 to 12 weeks on each unit, says Shahin Vojdani, RN, nursing project leader. This included two weeks for observation and the remainder of the time for implementation.
Vojdani says a few of the steps the team took on each unit to ensure success were:
1. Prepare staff.
The vice president of nursing and the project leader met with staff and presented an overview of the upcoming clinical changes, as well as why, how, and when they would be implemented.
"I can’t say enough about this preparation process," stresses Vojdani. "We thought we had prepared enough because the majority of the staff would say they understood why it was necessary to make these changes, but when it actually affected them, they had a change of heart."
The key to preparing staff was the director or manager on the unit. "There was a direct relationship between his or her understanding of the project and the success of the new model on that unit," Vojdani says. "We realized that when directors or managers were supportive, staff had an easier time during the transition period."
2. Observe.
After meeting with staff, Vojdani spent time on all shifts of each unit to learn about the following factors: patient population, activities, workload, efficiency, and overtime. "We did not make changes during this time but made observations and obtained data," she says. Vojdani also considers this observation period as a time to build relationships with staff. "I never went there in street clothes; instead I kept scrubs on to send the message: I am one of you,’" she says.
3. Communicating with staff.
At the end of the observation period, Vojdani scheduled a meeting with the staff to review the data that were collected and to about expectations during the upcoming implementation. She continued to communicate by holding meetings throughout the implementation phase. "We went to them on all three shifts and the weekends, rather than asking them to come at our convenience," she explains. The team also informed physicians before making changes that would affect their practices on a unit.
Finally, Vojdani and the team encouraged feedback but discouraged negativity. "We didn’t accept comments such as I don’t like this.’ They had to tell us why they didn’t like a certain change as well as how it could be improved," she says. By insisting on a reason for the resistance, Vajdoni and the team could then decide whether the problem was with the process or the personality.
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