Leading change with ADKAR

Authors:
  • MLMeredyth Lacombe
    Meredyth Lacombe
  • TJTerence Joyce
    Terence Joyce
  • KOKellie O'MAlley
    Kellie O'MAlley
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Abstract
How can leaders effectively manage the change they've introduced in the workplace? Our Magnet®-recognized academic medical center in New York, N.Y., was faced with transitioning over 1,000 clinicians into a new facility with a change in our care delivery model. This article describes how transformational leadership and an evidence-based change management model were used to guide our staff through the complexity of this transition. On June 24, 2018, our healthcare organization marked the opening of a new 830,000-square-foot, state-of-the-art facility supporting inpatient care units, operating and procedural areas, and a children's hospital. The construction of this new facility provided a pivotal opportunity to rethink our care paradigm. Our organization adopted Acuity Adaptable Care (AAC), an evidence-based model pioneered in the 1970s by Loma Linda University Medical Center in California, that eliminates the physical transfer of patients to various levels of care, instead bringing the level of care to the patient.1 Our plan was to implement the AAC model on three of our adult inpatient units dedicated to the care of surgery, neurosciences, and cardiothoracic patient populations requiring the ICU or an intermediate/step-down (SD) level of care. In the AAC model, patients don't transfer from the ICU to an SD unit and then to an acute care unit before discharge. The patient's acuity may change but his or her physical location doesn't change for ICU and SD levels of care. By eliminating the traditional multitransfer system, the use of this care model can dramatically improve clinical outcomes.2 A systematic review found that although few hospitals have adopted the AAC model, those that have saw a reduction in the average length of stay; a rise in patient and staff satisfaction scores; and, most important, a decrease in medication errors, falls, and mortality.2 Keeping patients with the same team of caregivers as their level of acuity changes minimizes the need for handoffs, which can open the door to potential harmful errors. In addition to the change in patient acuity, another major impact on the nursing practice environment was the decision to create specialized patient population units, grouping patients with similar diagnoses together regardless of surgical or medical origin. In the new hospital, patients are strategically placed on units with dedicated and skilled nursing staff trained in caring for these specialized patient populations, such as cardiac, neurosciences, transplant, and general surgical services. The thought process behind this decision was that when nurses receive specialized training to care for a dedicated patient population, they have a higher level of knowledge and skills that enables them to better assess patients and identify complications earlier. Supporting this notion, one literature review concluded that clustering stroke patients on a dedicated stroke unit improved the patients' survival after a stroke and decreased the length of their inpatient rehabilitation course, allowing patients to regain their independence compared with those who weren't treated on a specialized care unit.3 John Kotter, a noted thought leader in change management, estimates that 70% of change projects fail.4 However, when an organization can successfully manage change, the overall success of a project increases by six times.5 Transitioning into a new facility with a new care delivery model was a major change that required detailed planning and the use of an evidence-based change management strategy to ensure successful implementation. The first step in the development of organizational change capability is implementing a structured methodology for managing change.

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