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clinical operating environment

Given the ever-changing clinical operating environment, change management has become a key element in ensuring good performance and success. Some of changes overwhelming nurses include economic hardships, workforce diversity, and the changing technology among many others. To ensure that nurses can cope and sustain all these changes, many researchers have argued that change management should be given a priority in all clinical settings. Management of change could be achieved using entrepreneurship, which should involve planning for change. Nurses should become entrepreneurs and enhance the spirit of providing services to those in need, come up with innovative as well as impactful services based on their experience. This achievement would improve the lives of the sick, their families, as well as other care providers (Chaudhry, Wang, Wu, Maglione, Mojica, Roth, Morton and Shekelle, 2006). Therefore, nurses desiring to change must be innovative and hard working to achieve the transformation and overcome resistance Overhage, 2007). With regard to change management, the aim is to look at the various theories related to change and their application in the clinical setting. Included is an analysis of various reasons why nurses should plan and analyze changes in the practical environment. Various strategies for ensuring the planned change is sustained in health care setting are discussed. Finally, the assignment draws a conclusion of all the main concepts discussed in the assignment.
The health care environment is an area where diagnosis, treatment, and prevention of ailments are done. This environment is associated with the provision of care and drugs to help fight and prevent diseases by a trained specialist or practitioner of medicine. Nurses need change in their workplace given the health care environment faces a lot of challenges. According to Braithwaite et al (2009), health care environment can be defined as the condition that surrounding health workers and patients. In my opinion, the health care environment include the area in which any health activity is taking place, either temporarily or permanently. According to Dwayne and Patrick (2007), today’s clinical setting are undergoing various change, such as workforce diversity, changing technology, the depreciating finances and other resources, globalization, and competition among others. According to Elizabeth et al (2006), change can be defined as making something become different from what it was originally. Therefore, change management can be described as the ability to effectively plan for change, assess all the risks involved, and strategize on how to minimize the risks in order to produce positive results. As Grace (2007) point out, most of these changes are unplanned and hence bring about various unpredictable outcome, most of which are undesirable. On the other hand, planned changes are organized events and strategies put in place to ensure that specific goals are achieved. Therefore, it is highly important that nurses plan and evaluate various changes to realize their organizational goals.
Various theories are related to change and be applied in clinical settings. According to Lewin’s change theory involves a three stage model to effective change in an organization mainly the unfreezing stage followed be change and refreeze stage. The theory explains the behavior that exists in an organization and how behavior works in the opposite direction to oppose change and cause a shift in the balance of forces (Katherine et al 2007). The theory was developed by Kurt Lewin, and it involves three stage, and it is widely used in clinical contexts. The first stage of this theory is known as the unfreezing stage and is followed by the second stage called moving stage than the final stage, which is the re-freezing stage (Kerridge 2009). According to this theory, there are two forces of change; the driving and the resisting forces. The resisting forces refer to employees who do not embrace change whereas the driving forces are the employees who push for change and support it (Overhage 2007). This theory is highly applicable in today’s modern health setting. Nurses should act as the driving force for positive change in health care organization. This is true because the nurses are the main stakeholders in the clinical setup. They should be able to evaluate their organizations and identify things that need change, plan the desired change, and push for it by convincing their employers and the other employees within their organization (Linda 2009). Rogers’ change theory was developed by Everette Rogers. It is a modification of Lewin’s theory. It is based on five stage. The first step in this theory is awareness. Awareness stage will help nurses’ to be made aware of the changes taking place in their organizations and the importance of embracing these changes to achieve their organizational goal. Apart from awareness, the second stage is interest. Here, a nurse leader should ensure that nurses develop interest in the changes taking place. Evaluation is the third stage whereby the changes are evaluated on the basis of their negative and positive impacts on the organization. After evaluating the changes, it is important they are implemented, and if they prove beneficial to the organization, they are adopted (Patrick & Barry 2011).
The other model is the theory of reasoned action and planned behavior. According to this theory, a person’s performance is highly determined by the person’s aim to execute that performance. The theory suggests that, for any change to occur, an individual should have a positive attitude towards the desired behavior and should have a positive influence from the surrounding environment (Thomas et al 2007). Influence may be from people such as peers and working colleagues. According to theory of reasoned action and planned behavior; for a nurse to change his or her attitude towards change and embrace it, his or her attitudes towards change should first change. This is especially through awareness and positive influence from his or her colleagues (Timothy 2008). Therefore, nurse leaders should ensure that all nurses are made aware of the importance of planned change in order to instill a positive attitude in them towards it. They should also balance their team members appropriately to ensure that nurses who embraced and support change get to influence others on the opposition side to win them over on their side (Twentyman et al 2006). Spradley’s change theory, the theory incorporates eight steps that to manage change in a given organization. The first step is to recognize the change symptoms to diagnose the problem that needs a change. After identifying the problem, alternative solutions are evaluated, and the best change to address the problem is identified. The next stage involves planning on how to implement the change and the actual implementation of desired change takes place. After its implementation, the change is evaluated, and various strategies laid down to stabilize it (Rasul 2010). The theory is highly applicable in clinical contexts. Before implementing any change, nurse leaders should evaluate it to estimate its benefits and shortcomings in the organization. Even after implementation, nurses should reevaluate the change and come up with ways of stabilizing it in cases where it is found beneficial to the organization (Simon 2011). According to social cognitive theory, people can change through experience and interaction with other others. The theory argues that a change in behavior is also affected by environment and personal factors. The theory suggests that, for a person to change, one should believe in oneself and have the ability and motivation to perform the desired behavior. Therefore, for any meaningful changes to take place in the clinical setting, nurse leaders should lead by example to influence positively their team members (William et al 2006). A nurse leader should be able to plan and implement change. The nurse leader should also embrace change for the other nurses to emulate and support positive change in their work environment (Kritsonis 2006). According to the social cognitive theory, effective change management can be achieved in health care institutions. In this case, nurses in support of the planned change influence the ones resisting change by constantly reminding them the importance of the various changes occurring in their organization. The scholars agree that planned change is effective in yielding a different health environment (Malloch et al 2006) .
Among the theories discussed, Lewin’s theory is the most applicable in the clinical context because it considers change to be a result of transformations in the forces present in the symbolic field. Following the challenges the heath care setting is facing, change has proven paramount and the theories above could help in achieving planned change and therefore, positive results. Where change is aspired, entrepreneurship is inevitable because innovation guides change. Heath practitioners aspiring change are bound to become entrepreneurs. According to Drayton et al (2009), an entrepreneur can be defined as an individual with innovative and prompt solution to most of the problems and challenges facing an organization. Nurse leaders should choose the kind of entrepreneurship, which is likely to cause positive change. Among the existing types of entrepreneurs, include social entrepreneur is an individual who is motivated by a desire to facilitate and change the social environment of an organization. Such individuals are ambitious, persistent, and highly effective in addressing various social problems because they have the ability to accept the world as it is. The social entrepreneur is driven by the desire and emotions to address some of the big issues affecting people in the community such as diseases, poverty among others (Linda 2009). All healthcare organizations should be social entrepreneurs in order to address the various health issues especially among the poor communities. A good example of a good social entrepreneur in health care setting is an organization by the name PATH. This organization collaborates with NGOs and the government to come up with solutions top persistence health issues such as AIDS, malaria and provide free vaccinations especially in poor rural communities, in order to improve their health (Linda 2009).
On the other hand, a serial entrepreneur is an individual with ability to always come up with new business ideas and start new businesses. A serial entrepreneur possesses the ability to assess risk associated with new business ideas and hence comes up with ways of minimizes such risks. He/she can be asset to the health care system because he/she can emerge new clinical approaches to aid the currently care dilemmas . A good example of a derail entrepreneur is Thomas Alva Edison who has been credited with numerous innovation, such as invention of the light bulb (Rasul 2010) . In addition are lifestyle entrepreneurs; these are people who run a business based on their passions and not the aim to make profit to combine their personal interests with their talents to earn a living while working on field they have interest in (Linda 2009). Last are co-operative entrepreneur who are individuals with the ability to collaborate with other entrepreneurs in other to develop business projects (Simon 2011). According to Linda (2009), entrepreneurs are people who posses many characteristics among them being: self confident, self driven, highly innovative, good managers of money and time, possess the ability to network just to mention but a few. Social entrepreneurship as a change model is highly applicable in healthcare setting. If health care organizations embrace social entrepreneurship, they will be able to come up with solution to various health issues within the community and hence have a positive social change (Drayton et al 2009). Social entrepreneurship as a change model in healthcare setting should be adopted because it will lead to more saved lives and more people especially the vulnerable receiving quality health care. The government alone cannot ensure sufficient health care to all people. Therefore, social entrepreneurship in health care setting will play a critical role in ensuring that healthcare in vulnerable communities is developed and improved (Chaudhry et al 2006) .
With entrepreneurship in play, the challenges faced by the heath sector should change to solutions. The important factor is for nurse leaders to plan and analyze the necessary change to curb the changes. The challenges are because of globalization and technological advancement (Michelle and LeAnn 2010). Globalization has made the world small and organizations have established their branches in almost all countries. People have become free to work in any country (Albrecht 2010). This means that workforce has become diverse in terms of nationality and age. The health sector has seen increased growth because of many private hospital being established. This has brought about increased competition amid the civic and the private segment. According to Katherine et al (2007), technology is changing and health care providers are required to keep in pace with it to remain competitive in the market. Because of these challenges, many healthcare providers require that their nurse managers have the right skills needed to plan and analyze change so that it can result to positive effects, such as increased workforce competencies, higher performance, and positive patient outcomes.
According to Kerridge (2009), may health care organization require their nurse employees to take a leading role in managing and maintaining change to improve performance and achieve positive patient outcomes. Heading (2009) emphasizes the importance for nurses to plan and strategize on change management, as this is an essential skill in today’s health care organization, which is faced with challenge of changing workforce and technology. As Kerridge (2009) points out, nurses have the potential to plan and analyze change to contribute to improvement of service. According to Malloch et al (2006), planning is an essential component of any change management strategy. For a nurse to manage change in their practical environment, they have to develop a plan of implementing and sustaining the desired change in their organization. It is argued that as entrepreneurs, nurses should plan, implement, and maintain desired change in their organization to achieve their organizational goals. By planning for change, nurses show their commitment to change and hence show the rest of their colleagues on how they intend to manage change. Though analyzing change, nurses can determine the essential elements required for implementing and maintaining it and hence plan properly and appropriately.
According to Thomas et al (2007), in planning and strategizing for change, nurses should first create pressure for change to occur. A nurse leader should be able to identify the need for change a and communicate it effectively throughout their organization to the rest of their team members to win their support. This is possible though identification of all factors that might force an organization change the way it executes its various functions. Such factors include impact from the improving technology, competition, and workforce diversity among many others. Tse (2006) argues that identification for a need to change and making all members in an organization understand the need for that change enables support and   commitment from all tem members. This is highly necessary as it ensures that the planned change is successfully implemented and sustained. In addition to identifying the need for change, Twentymen et al (2006) argues that nurse leaders should explain to their team members how they stand to benefit from the planned change. For people to support change within any organization, they have to feel they are benefiting in one way or another. Therefore, nurse leaders should plan changes in a way they will benefit their team members to ensure that the planned changes is effectively implemented and sustained (Henderson, Winch and Heel, 2006).
According to Patrick and Barry (2011), having identified and emphasized the need for change, nurses should then set goals for the intended change. Each goal might have various objectives for it to be achieved. This shows that a nurse leader has to come up with smart objectives, which states the desired change and the expected product. Through analyzing change, nurses can discuss with their colleagues to make change achievable and realistic. This also ensures the planned change is achieved within a specific period. After setting clear objectives, nurses can plan strategically for the desired change. According to Hoerl and Gardner (2010), planning for change involves identify and listing down all the tasks to be carried out to achieve each listed objective. This is possible by analyzing each objective and determining the resources both human and financial are required to achieve it. Bret (2007), argues that more an objective is broken down, the more manageable and achievable it becomes. Through analyzing objectives, a nurse leader can motivate the other project members in developing their own objectives to achieve the desired change. Nurses can determine key milestones required to achieve the desired change and hence properly plan on how and when they will be completed. Through this, the change progress is shown, and this keeps team members motivated towards achieving the desired change in their organization. Planning for change also enables nurses to identify the possible risks brought by the desired change and hence come with strategies of eliminating them. As Biuso (2008) point out, this is highly important in the clinical context because it ensures improved patient safety, and this brings about positive patient outcomes.
According to Braithwaite et al (2009), planning for change enables a health care provider to research and identify other people and organization that have addressed similar changes. This way, issues relating to the desired change such as costs, risks, and timeframe are identified. This helps in saving time and prevents making mistakes that would be costly during implementation of the desired change. As George et al (2007) points out, planning for change enables one to learn from others and see what they have done. However, Kaplan et al (2010) points out that nurses have to bear in mind they might be working in a different environment from the ones, which they are learning from and this means the people and circumstances surrounding the desired change will change meaning the results may not be replicated. This way, a nurses leader can plan effectively to ensure that positive results are achieved after implemented successfully. A nurse leader who plans and analyzes changes can identify the driver and restricting forces of the desired change. After identifying these antagonistic forces, a nurse can ensure the resisting forces are minimized and the driving forces enhanced to ensure the desired change become successful. Having planned and analyzed the need for change, nurse leaders should identify the strategies that can be employed to ensure that the planned change is sustained.
However, there are challenges experienced in change management. According to William et al (2006), one of elements that present obstacles to sustaining change in any organization is resistance from people. For any change to be sustained, a nurse leader should react appropriately to this resistance. According to Oreg (2006), to ensure the implemented change is sustained, nurses have to ensure that its’ driving force is greater than its opposing forces. According to Lewin’s theory, sustenance of change in an organization is possible through refreezing, which means that a conducive organization culture that supports the implemented change is created. According to Griscti and Jacono (2006), changes can be sustained in an organization through empowering action. This involves creating opportunities to involve all the employees within the organization. This way, every employee can feel appreciated and hence will remain committed in ensuring that the planned change is sustained. Timothy (2008) points out that it is highly important that nurse managers provide directions each day to keep employees informed on what is required to sustain the change.
Change in an organization can also sustain through the generation of short-term goals so they are easily achievable. As Mclnnes and Kidd (2006) explain, when employees achieve the goals set by the planned changes, they embrace the change and remain committed to ensuring the change is sustained. The change should also allow frequent negotiations with the various employee organization to provide them with the best. If employees are well catered for by the implemented change, they wholly embrace and remain motivated to achieve the set goals. John et al (2009), points out that it is important that nurse leaders identify all the elements that can support the planned change and hence ensure they are strengthened. According to Jennifer and Patrick (2012), one of these elements is transformational leadership. Transformational leader has the ability to lead by example hence can influence other people in their organization to not only embrace change but also sustain it. Transformational leaders are also able to identify factors that might hinder and block the planned change, such as ineffective communication, lack of employee involvement and hence avoid or eliminate them to sustain the planned change.
According to Eugene et al (2006), the other thing that can sustain planned change in an organization is through appreciation and reward system. When employees are appreciated are rewarded for their hard work, they can embrace, and support change ensuring that it is sustained. A nurse leader should also establish effective leadership systems to ensure that information essential for sustaining the implemented change. When employees are informed of what is always expected of them, they act appropriately ensuring the implemented change is strengthened and hence maintained. Bret et al (2007), points out that adoption of an organizational structure is essential for sustaining change. Through an organizational structure, nurses can adopt the desired ethics and behavior. This is highly important, as it will lead to sustenance of implemented change. This is because an organizational structure advocates for ethics and behavior that will support the implemented change in the organization.
As Albrecht (2010) explain, another factor that ensures sustenance of implemented change in organization is provision of support and training for the employees. Health care providers should support their employees through training and education. This ensures the employees are trained on skills needed to adopt the planned change. Booth (2007) supports this argument by pointing that through education, nurses can know the importance of change in their organization, and this enable them to support it. Leaders in organization can lead to sustenance of planned change by learning the importance of celebrating success. Through setting short-term goals, employees can achieve them easily. According to Eugene et al (2006), it is highly important that leaders learn how to celebrate success through such things, such as increased holidays and wage increment, they embrace the change and remain committed in ensuring that it is maintained.
In summary, change management in the modern healthcare setting is highly important. This is because the sector is facing various change in terms of workforce, various duties, and patient needs among many others. In order to manage all these change, health care organizations have to ensure their nurse leaders are trained on essential skills required to manage change. Various theories of change can be applied in management of change in clinical environment. Some of these theories include Social cognitive theory, the theory of Reasoned Action and Planned Behavior, Spradley’s change theory, and lewin’s change theory among many others. The theory by Lewin is the most applicable, as it highlights what is to be done before implementing change and what is to be done to sustain it in the organization. Clearly, it is important that nurses plan and analyze change. Some of the factors that make planning and analyzing of change in heath care setting are, driving forces for change are identified and enhanced, and the opposing forces for change are identified and minimized. Through planning for change, nurses can involve all their team members to ensure the desired change is effectively implemented. Because not everybody in an organization support change, nurse leaders should identify sources of human resistance to change and try to eliminate it in order to sustain it. Effective leadership, employee involvement, rewards and effective communication all play an important role in ensuring the planned change is sustained within an organization.

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