Change Implementation and Management Plan

Change Implementation and Management Plan

It is one of the most cliché of clichés, but it nevertheless rings true: The only constant changes. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.

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As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose. Change Implementation and Management Plan

To Prepare:

  • Review the Resources and identify one change that you believe is called for in your organization/workplace.
    • This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
  • Reflect on how you might implement this change and how you might communicate this change to organizational leadership. Change Implementation and Management Plan

The Assignment (5-6-minute narrated PowerPoint presentation):

Change Implementation and Management Plan

Create a narrated PowerPoint presentation of 5 or 6 slides with video that presents a comprehensive plan to implement the change you propose.

Your narrated presentation should be 5–6 minutes in length.

Your Change Implementation and Management Plan should include the following:

  • An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
  • A description of the change being proposed
  • Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
  • Details about the type and scope of the proposed change
  • Identification of the stakeholders impacted by the change Change Implementation and Management Plan
  • Identification of a change management team (by title/role)
  • A plan for communicating the change you propose
  • A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose

Planning for Implementation of Evidence-Based Practice

Laura Cullen, MA, RN, FAAN

Susan L. Adams, PhD, RN

Expectations for evidence-based healthcare are growing, yet the most difficult step in the process, implementation, is often left to busy nursing lead- ers who may be unprepared for the challenge. Se- lecting from the long list of implementation strategies and knowing when to apply them are a bit of an ‘‘art,’’ matching clinician needs and organizational context. This article describes an application- oriented resource that nursing leaders can use to plan evidence-based practice implementation in complex healthcare systems. Change Implementation and Management Plan

Nurses in leadership positions have responsibility for provision of evidence-based healthcare that meets the expectations of patients, families, regulators and others.1-3 Research shows that use of evidence is inconsistent. Basic practices from hand hygiene to early ambulation are difficult to implement. Nurs- ing leaders are expanding use of evidence-based care delivery to improve patient and organizational out- comes by developing the infrastructure, defining the processes, strategically planning for implementation, and reporting results.

One of the 1st steps when defining the pro- cess is to select an evidence-based practice (EBP) model.4,5 Several models have been developed to

guide organizational and project leaders through the steps of the EBP process.6-10 Most of these pro- cess models include similar steps such as identifying a problem, critiquing the evidence, implementing evidence-based recommendations, evaluating the change, and disseminating results. Despite exten- sive use of EBP process models, it is understood that additional guidance may be needed at each step. Re- cent attention is now focusing on the indistinct step of implementation.11-14 Change Implementation and Management Plan

Failure to provide guidance for use of effective implementation strategies promotes the use of in- effective strategies, or worse, no strategy at all. This results in ‘‘reduced patient care quality and raises costs for all, the worst of both worlds.’’15(p380) It has been demonstrated that change happens over time; the literature provides little direction for nurses re- garding when to use specific strategies. Insights from implementation science and successful EBP work in- dicate that application of implementation strategies varies over the course of the EBP process. Assisting nurses at the point of care in leading EBP projects16

has led to creation of a 4-phase approach for plan- ning implementation.16

This article provides clinicians and nursing lead- ers with an application-oriented approach to orga- nize, plan, and select strategies for implementation of EBP changes. This guide is meant to supplement EBP process models, not replace them. It is designed to be simple and intuitive.

Implementation Strategies for Evidence-Based Practice Change Implementation and Management Plan

The Implementation Strategies for Evidence-Based Practice guide (Figure 1) is organized to assist nurses responsible for EBP in selecting implementation strategies to help practitioners and clinical teams


222 JONA � Vol. 42, No. 4 � April 2012

Author Affiliations: Evidence Based Practice Coordinator (Ms Cullen), Department of Nursing Services and Patient Care, University of Iowa Hospital and Clinics; Investigator (Dr Adams), Comprehensive Access and Delivery Research and Evaluation Center, Iowa City VA Medical Center.

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the De- partment of Veterans Affairs. Change Implementation and Management Plan

The authors declare no conflict of interest. Correspondence: Ms Cullen, Department of Nursing Services

and Patient Care, 200 Hawkins Dr, RM T100 GH, Iowa City, IA 52242-1009 (

DOI: 10.1097/NNA.0b013e31824ccd0a

Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

move clinical practice recommendations into routine workflow in practice. Strategies are selected and po- sitioned to enhance the movement through 4 phases of implementation: creating awareness and interest, building knowledge and commitment, promoting

action and adoption, and pursuing integration and sustainability to promote application by nursing and team leaders.

The implementation phases are displayed as col- umns progressing from awareness to integration.

Figure 1. Evidence-Based Practice Implementation guide. *Implementation strategy supported by some empirical evidence.

JONA � Vol. 42, No. 4 � April 2012 223 Change Implementation and Management Plan

Copyright @ 2012 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.

Each column includes strategies based on the goal for that implementation phase. Implementation strat- egies also target 2 distinct groups and are arranged in rows accordingly. The 1st section specifically targets the practitioners and organizational leaders, includ- ing key stakeholders. The 2nd section builds support for the practice change in the organizational system or context. Project leaders select implementation strat- egies that are appropriate for their particular unit and organization as the EBP initiative progresses across phases. Although the guide is diagrammed in a linear format for ease of use, the process is not directly linear and is fluid across implementation phases. In a clinical team, practitioners may be in different phases or move forward or back across phases in a nonlinear manner. Multiple strategies added cumulatively from each phase will need to be carried over for use throughout the process to keep implementation progressing. Change Implementation and Management Plan

A large list of strategies is included (Figure 1), and with varying amount of evidence to support them. The implementation strategies with empirical evidence in healthcare are marked with asterisks. Few strategies have empirical evidence using rig- orous study designs with additional support from reported application in practice or exclusively ad- dressing nursing; therefore, other practical but less well-tested strategies to support application are in- cluded as well. Because research evaluation of strat- egies across a variety of healthcare settings and with various healthcare workers is lacking, a simplified system of identification is used instead of an exten- sive grading schema Change Implementation and Management Plan.