307 Change Models

Change Models

By Joseph Chamness

Learning objectives

1. Elements for successful change

2. Four change models

3. Barriers + breakthrough tactics

• Vision – clear, shared picture of the win

• Belief – team trusts they can achieve it

• Strategic Plan – SCOT + SMART goals as GPS

• Persistence & Patience – stamina over drama 

Elements for Successful Change

• Co‑created vision → max buy‑in

• Checklist: purpose, patient impact, metrics, timeline ​

​

Vision-Paint the Picture

Techniques: emotional storytelling, skill drills, CBT triangle


“Belief = I‑CAN: Inspire, Coach, Affirm, Normalize.”

Belief—Ignite the Heart

• SCOT analysis

• SMART goals

​Strategic Plan: Map the Route

Celebrate micro‑wins, expect resistance

Persistence & Patience: Run the Marathon

Multiple Choice

A 32‑bed medical‑surgical unit has experienced an increase in patient falls. The nurse manager wants to launch an evidence‑based quality‑improvement project. Which initial action by the nurse manager BEST demonstrates the creation of a shared vision for fall reduction?

• Post the unit’s quarterly fall‑rate dashboard and instruct staff to reduce falls by 10% within the next 3 months.

• E‑mail the updated hospital fall‑prevention policy to all staff and require electronic acknowledgement of receipt

• Ask hospital executives to issue a memo mandating immediate adherence to the corporate fall‑prevention protocol.

• Schedule an interdisciplinary huddle—including nurses, physical therapists, nursing assistants, and housekeepers—to co‑develop a zero‑falls goal by July and generate unit‑specific strategies.

Multiple Choice

A pediatric ICU is rolling out a new evidence‑based sedation protocol. Several night‑shift nurses say, “We’ve never titrated dexmedetomidine before—I’m afraid I’ll do it wrong.”
Which manager action BEST strengthens the staff’s belief in their ability to implement the change?

• Post laminated flow sheets of the protocol on the break‑room bulletin board.

• Conduct a 30‑minute hands‑on skills lab where nurses practice dose calculations on high‑fidelity simulators and receive real‑time coaching.

• E‑mail a systematic‑review article supporting dexmedetomidine use to all staff.

• Assign one “super‑user” nurse to manage all sedation until others feel ready.

Multiple Choice

During a fall‑reduction project, the quality team drafts this objective:
“Decrease patient falls by 20 % using hourly rounding and bed alarms.”
Which revision makes the goal fully SMART?

• Lower patient falls by 20% hospital-wide through increased hourly rounding.

• Reduce patient falls in the medical-surgical unit within the next 6 months by implementing fall-prevention best practices.

• Reduce falls by 20 % in the medical‑surgical unit through hourly rounding and bed alarms within the next 6 months.

• Minimize patient falls through hourly rounding and bed-alarm use in the medical surgical unit by the end of the fiscal year.

Multiple Choice

Three months after launching bedside shift report, compliance audits have slipped from 85 % to 60 %.
Which manager response BEST uses mini‑victories to restore momentum and persistence?

• Announce a unit‑wide pizza party once compliance climbs back to ≥ 85 % for two consecutive weeks.

• Publicly recognize the two teams still achieving > 90 % compliance and invite them to share tactics at tomorrow’s huddle.

• Schedule one‑on‑one retraining sessions for all staff who scored < 70 % on the audit over the next month.

• Require charge nurses to complete a bedside‑report checklist after every shift and submit daily logs to management.

Change Curve Model

1. Stagnation – unaware

2. Preparation – gathering ammo

3. Implementation – launching

4. Determination – push through dips

5. Fruition – new normal ​

Kotter & Cohen's Model of Change

1. Create sense of Urgency

2. Form Team

3. Develop Vision & Strategy

4. Communicate the vision

5. Empower

6. Short Wins

7. Persistence

8. Nourishment

Roger's Diffusion of Innovation

5 Groups:
1. Innovators: Risk Takers (2.5%)
2. Early Adopters: Respected opinion Leaders (13.5%)
3. Early Majority: Adopt once benefits are demonstrated (34%)
4. Late Majority: Skeptical (34%)
5. Laggards: Tradition-bound accepts when old way is no longer possible (16%)



Need to have approximately 15% to 20% of people adopting the innovation for change to occur.

The Transtheoretical Model of Health Behavior Change

• Pre-Contemplation

• Contemplation

• Preparation

• Action

• Maintenance

Multiple Choice

A hospital is rolling out bar‑code medication scanning. Staff have completed training and the scanners went live yesterday. Nurses report frustration with slower med passes but are still trying to use the devices.
Which stage of The Change Curve Model is the unit MOST likely experiencing?

• Determination

• Stagnation

• Fruition

• Preparation

Multiple Choice

A telemetry unit wants to increase early ambulation after cardiac surgery. According to Kotter and Cohen, which tactic will MOST effectively trigger behavior change?

• Present a meta‑analysis proving ambulation reduces pneumonia.

• Display last quarter’s ambulation compliance rates.

• Share a short video of a post‑op patient describing how walking helped her go home sooner.

• Hand out laminated algorithms for early ambulation.

Multiple Choice

According to Rogers’ Diffusion of Innovation theory, what is the MINIMUM percentage of combined innovators and early adopters needed to signal that a new practice is likely to gain momentum?

• 5%

• 35%

• 60%

• 15%

Multiple Choice

A stroke unit introduces a bedside swallow screen. Which group will MOST effectively influence the early majority to adopt the practice?

• Laggards

• Early adopters

• Hospital executives

• Infection‑control nurses from another campus

Multiple Choice

An RN says, “I keep forgetting to use the bedside swallow screen, but I’m setting phone reminders so I’ll remember on my next shift.”
This statement reflects which stage of the Transtheoretical Model of Health Behavioral Change ?

• Pre‑contemplation

• Contemplation

• Preparation

• Maintenance

Top 6 Barriers – “6 R’s of Resistance”

​Breakthrough Moves – Match to Barriers

• Safe vent sessions → Rumors

• Emotion + data → Risk aversion

• Written plan & SMART goals → Routines

• Leadership champions → Relationships

• Budget & staffing plan → Resources

• Role clarification huddles → Role confusion

Questions?