Application of Kotter’s Change Theory in Nursing

John Kotter was born in California on 25th February 1947. He graduated from Massachusetts Institute of technology in 1968 with a Bachelor of Science in electrical engineering and a Master of Science later in 1970. In 1972, John completed his Doctor in Business Administration at Harvard Business School. He joined Harvard Business School faculty and in 1981 he received tenure and a full professorship. He retired from full-time faculty member in 2001.

John Kotter co-founded a business consultancy firm (Kotter International) in 2008. This firm applies Kotter’s research on strategy execution, leadership and other large scale modifications. Kotter is a biographer of 20 books. John’s book ‘Leading Change’ became a global bestseller in 1995. Kotter illustrates an 8-step progression for cultural change in this book. Kotter later changed his idea on structural change from top-down to deliberate bottom up development (Clay & Brett, 2017).

Overview of Kotter’s Change Theory

The escalated rate of technology dictates changes in organisational undertakings. Preparing people to receive and implement fresh methods of working is thus necessary. Dr. John Kotter expounds on eight basic steps for effective transformation. First, one needs to convince people that the change is urgently needed. Second, a team of influential leaders is to be created to represent the whole organisation. Third step is developing realistic and attainable idea of the change. Fourth, involves publicizing the vision to the desired audience. Fifth, unravel any obstructions to the change and find their solutions beforehand. In the sixth step, one needs to create rapid successes and overcome resistance. Seventh, keep stirring the change frontward regardless of new opposition along the way. Lastly, infuse the new amendments into the group culture.

Purpose of Kotter’s Change Theory

Often, unceasing success in any institution demands vital changes. Most change actions fail due to diverse mistakes which includes; tolerating too much complacency, failing to form a competent coalition, poor choice of a vision, allowing obstacles to choke the change process, inability to get short-term triumphs, declaring success impulsively and lastly, not diffusing the changes in the communal culture. Kotter’s change theory is thus designed to help organisations avoid such errors.

Thesis Statement

This papers focuses on the account of Kotter’s change theory, its diffusion in nursing practise and consequences of change in nursing field.

Discussion

Major Components of Kotter’s Change Theory

Kotter’s change model has eight key steps. Consistent with Kotter, following the exact order of steps is crucial in attaining success. Below are the components of Kotter’s change theory in sequence.

• Step one: Establish an impression of urgency. A high level of motivation in the target audience is crucial for the change process to succeed. Therefore, people need to be convinced that the change is necessary now. This sense of urgency will propel them towards accepting and finally implementing the change.
• Step two: Formation of guiding associations. One needs to create a team of competent and persuasive leaders from the organisation. The team should be well informed about the change. This is because, the team is supposed to influence the entire system in embracing and applying the change.
• Step three: Develop a vision for the change. The aim of change should be realistic and essential. Having precise strategies for attaining the goal is also key. One should explain the means of achieving the change while focusing on the vision.
• Step four: Discuss the vision with target people. Boldly talk about the vision with an aim of winning people. Breakdown the change into simpler languages for easy understanding. Create an environment that encourages dialogue with your audience. Strive to ensure that all the components of change are clearly understood.
• Step five: Encourage others to act. Determining barriers to change such as workers’ skillsets and organisations’ structures is important. Working to remove these barriers quickly will empower the employees to act in accordance with the change.
• Step six: Create short-term wins. Prior planning on how to create quick wins is vital. This is because, short-term wins plays helps in overcoming obstructions. The wins leads the change process to long-term victories.
• Step seven: Don’t stop the change process. Re-emergence of obstructions later in the process should not cause the collapse of the process. One should instead focus on the vision and the laid-down plans to keep moving. The earnestness to change should be elevated to empower and inspire the employees to welcome the change.
• Step eight: Incorporate the change into the culture. Ensure that the change becomes part of the norm in the organisation. Present staff should view the change as a benefit over the previous way of working. New employees should clearly see the change as part of the culture. Generally, the change should supersede the former styles in advantage (Libby & Betsy, 2017).

Dr. John Kotter insists that to achieve success in change process, the above steps must be implemented in the above order.

According to research, 70% of change projects miscarry. This implies that, a majority of people are really bad at adopting new ideas. Kotter identifies 8 mistakes that stumbles change efforts consequently leading to failure of projects as listed below.

• Accepting too much contentment, therefore people have no good reason to change.
• Failure to come up with a powerful helping coalition. For any change to be effective, one needs a helping hand from competent leaders, without which, failure is sure.
• Having unclear vision and failing to precisely unveil to people the details of the change.
• Failure to communicate the components of the vision clearly. Proper communications should grab minds and hearts of target audience.
• Allowing obstacles to stop the vision. Achieving success in implementing any change is not easy due to the emergence of change blockers throughout the process.
• Inability to create quick wins. Quick wins acts as motivators and signs that one is on the right track. Failure to create such wins, automatically leads to failure of the process.
• Declaring victory at sight of the first positive sign can terribly crumble the whole process due to prejudgement. Assuming that the project is already a sure success leads to reluctance and non-preparation to counter any problems. Therefore, if faced with any challenge, the process will certainly stop leading to failure.
• Neglecting to infuse the changes in the organisational culture. For any change to be successful, it must be anchored firmly.

Implementation of Kotters Change Theory in Nursing

A need for constant improvement of services in the health care sector necessitates that nurses should embrace changes. This need has led to application of Kotter’s theory in the nursing field to enhance the value of services. Nurse Coaches, have played a crucial role in bringing about the needed changes in the nursing profession. Further down is a description on how Kotter’s change model has been used to communicate relevant information at bedside while changing shifts (Chowthi et al., 2016).

• Step 1: Creating a sense of urgency. This step entails motivating the workers to embrace change as a way of solving current problems. Viewing a problem as a chance to change and clearly addressing it assures one of positive results. For instance, administration in the nursing field realised the need of precise communication at bedside. Implementation of Kotter’s first step was effected by exposing the demerits of poor communication during handoff process. By discussing risk for harming patients, nurses were willing to foster bedside communication.
• Step 2: Formation of a guiding coalition. Competent leaders are required to persuade others to adopt a change. In the infusion of this step in nursing field, nurse leaders (nurse manager, nurse educator, senior bedside nurse) were educated about the eight steps of Kotter’s change theory by a nurse director. Additionally, leaders used literature on safety initiatives from the institute of medicine. With all the relevant information at hand, the cohesive leaders were equipped to create a vision for change.
• Step 3: Creating a vision. This stage involves shaping the vision and coming up with strategies to achieve it. This step was implemented by coming up with 3-step process that included explaining the roles of incoming and outgoing nurse and officiating communication structure for the handoff procedure at bedside. The results were better communication among nurses, patients and relatives at bedside.
• Step 4: Disseminating the vision. After establishing the vision, it is important to share it to the execution team. In the nursing field, articles explaining the significance of bedside handoffs and implementation of change concurrent with Kotter’s model were availed to the staff. Thorough education of the staff on the vision of change was conducted during staff meetings and other education sessions.
• Step 5: Empowering others to act. Effective communication and direct assistance from others are key during adoption of a concept. To implement this step in nursing, the staff were empowered to embrace the vision by reinforcing home grown system. Nursing groups were convened daily to assess the efficacy of countermeasure until full adoption was achieved. Nursing leadership provided relevant support to employees who were unpleased with change. This was a continuous process until all setbacks to change in staff fraternity were resolved.
• Step 6: Creating quick wins. In order to sustain change processes, a team is encouraged to create immediate and visible wins. During the application of this step in the nursing practice, two examples of instant wins were identified. First, staff were able to identify missed prescriptions on the electronic medication record at the start of the shift. Second, the staff realised an improvement in efficiency in work completion and that they were able to leave on time. By emphasising on such wins, the motion of the project was strengthened.
• Step 7: Building on the change. Coming up with inventions that boost changes while focusing on the vision is key in change process. In the nursing field, nurse leaders trained and supported the staff while maintaining the change. Additionally, the leaders emphasized on the need to uphold critical thinking which resulted into emergence of new procedures. Implementation of this step in the daily management system improved patient care services. For instance, by revising the assignments of the staff, patients were organised according to bed location, leading to reduced walking and moving nurses near their patients.
• Step 8: Institutionalizing the change. Full compliance to the change requires a cultural initiative to enable the vision to become a norm. This step was applied in the nursing practice by integrating bedside handoff change into new nurse orientations and education of nurses. Consequently, bedside handoff became a cultural practice in the unit. Acceptance from the majority propelled the change regardless of a few oppositions from a few nurses who were resistant. Eventually, the new practise enhanced communication and patient satisfaction, making a nursing field a better working place (Small et al., 2016).

Potential Driving Forces in Kotter’s Change Theory.

Application of Kotter’s 8-steps into the nursing field was possible because of the nature of the model as outlined below.

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• The implementation process is an easy step-by-step procedure.
• Kotter provided clear steps which are easy to understand and apply.
• The model focuses on preparing and embracing the change
• Kotter’s change theory allows for easy transition.
• The focus of the model is on buy-in of employees leading to success.
• The model is flexible enough to fit into the cultures of most classical ladders.

According to Kotter, Change agents are essential in supporting the process of change. In the nursing field the change agents are the leaders of various departments and units. First, the agents play a critical character of consultant. They provide nurses with relevant data from both internal and external sources. This data is essential in building of predictive models by the management and employees. Agents can also answer any questions from employees hence clearing all doubts concerning the change. Second, the agents are trainers. The nurse leaders educates employees on new skillset to enable the staff to solve various problems in their units. Lastly, agents are researchers. As researchers, the nurse leaders develop evaluation systems that asses the efficiency of the change process in their respective staff members.

Restraining Forces in Kotter’s Change Theory

Restraining forces are barriers to change. Resistance comes in mainly at transition level. In the Nursing practise, the staff are not flexible enough to abandon the old practises. Competent nurses in particular, tend to be rigid as they cherish their long term experience in their routine procedures. Sometimes this leads to professional negligence such as negligence in double checking of high alert medications. Such nurses believe that they don’t need to change, experience in old ways is more important to them.

Nurses are often hesitant to change their old practises due to various reasons. To begin with, failure to appreciate the need to change. The aim of modernisation might have been misunderstood or considered irrelevant and incapable of solving current problems. Second, some nurses might be against the tactics of applying the amendments rather than the change itself. Additionally, some nurses perceive the change as an embarrassment and threat to their self-esteem or interest thus becoming intolerant to change. Furthermore, lack of trust in the nurse educators and other change agents based on past failures in implementing changes. The nature of the Kotter’s model such as strict following of steps, long implementation time, and lack of room for co-creation can lead to frustration among the nurses if their needs are overlooked. Lastly, change agents in the nursing practise have reported lack of resources as one of the major restraining force (Tang & Ngang, 2019).

Ways of Overcoming Resistance to Change

There are a number of strategies that can be adopted to overcome resistance to change. First, empirical-rational approach which assumes that the behaviour of nurses is driven by rational self-interest. Nurses can embrace a change if its benefits are well explained and justified. Proper communication and enticements are necessary in this strategy. Research have revealed that some nurses are usually convinced in the change. Nurse educators are thus advised to target such converts and use them as influencers.

Second, we have the normative re-educative strategy which banks on the assumption that nurses act in line with socio-cultural norms. Nurse educators are expected to focus on the impact of alteration in the already existing cultural activities of the staff. The strategy should not distort the skills, attitudes, values and relationship among the nurses. Since culture does not evolve quickly, this strategy is effective for middle and long term projects such as establishment of a Magnet Recognition Program which takes up to five years to achieve.

Third, educators can use power-coercive policy whereby changes are imposed on nurses by the management. Defiant nurses are often subject to disciplinary actions. This strategy is considered effective especially for the changes that are urgent and a must do nursing policies that explain the standards of care. Changes in policies such as patient identification before administering medicine should use this approach too.

The fourth strategy is called environmental adaptive scheme. This involves construction of a new organisation and thereafter transferring staff from old building to new one. This strategy is therefore considered impractical for the nurse educator (Salam et al., 2016).

Need of Change in Nursing Practice

Changes in the nursing practice are inevitable and paramount. This is due to the ever-evolving techniques in the field that are aimed at improving the quality of services and enhance efficiency at work. Regulations in the nursing practise are constantly evolving to improve on the quality and safety of health care services. The old methods are prone to errors thus nurses are instructed to embrace modifications to evade such errors. Any nursing system that is reluctant to adjustment is considered obsolete and with a limited chance to advance. Just like any other business, nursing practises should aim at satisfying its clients (patients). Therefore, any beneficial and justified change in nursing practice should be embraced (Joseph & Joyce, 2017).

Implication of Change in Nursing Practise

Changes that have been introduced in the nursing practice have improved the quality of health care services and elevated the standards of hospitals. For instance the introduction of clear communication at bedside while changing shifts have increased the level of accuracy while handling patients. Additionally, safety to the patients have improved. This is evidenced by prior identification of patients by the nurse on duty before administration of medicine. Furthermore, the transition of shift has been made easier by clearly defining the roles of each nurse thus eliminating the possibilities of role mix-ups or exchange. The nurses have also been relieved of too much walking as they are stationed closer to their respective patients. Education of nurses on the new skillsets have also improved their level of expertise thus equipping them to handle problems in their field of operation. Generally, adoption of new procedures in the nursing practise have steered growth in the profession (Baloh et al., 2018).

Conclusion

A change theory is essential when anticipating modifications in nursing practice. Selecting a model that effectively fits the needs of administration, staff and patients is crucial for sustainability. The chief cause of failure in most change progressions in nursing practice are reluctance to support and empower the nurses to adopt the new procedures. Embracing planned changes in nursing practice is necessary but it can be demanding due to resistance. Therefore one need to have in place proper strategies to aid in dealing with the barriers to revolution. Kotter’s 8-step model is easy to understand and can be easily applied for effective change.