Theory, Risk and Quality Management in Nursing

Theory and Change Management

Change can be implemented in several ways in healthcare settings. Change implementation is, however, the most complex and challenging aspect of organizational development. Nevertheless, theories provide frameworks to ensure that change is planned, purposeful, calculated, and collaborative for successful outcomes. Hence, nurse leaders and agents of change should understand theoretical concepts that guide change management (Mitchell, 2013).

Nurse leaders who initiate change should understand aspects of change theories as they acknowledge the relevance of change in quality improvement. Theories offer opportunities to understand change processes, improve chances of change success, and assist to eliminate potential challenges to change (Mitchell, 2013). Change theories help in identifying several issues related to execution of change plan. Thus, only structured approaches provided by theories usually lead to effective change management.

Several theories, including Lewin’s change model, Roger’s theory, and Lippit’s theory have been adopted to drive change management in healthcare settings. Lewin’s theory is widely used in healthcare settings because of its simplicity (Mitchell, 2013). It provides a structure for the need to initiate change, impellent change, and sustain change efforts to avoid fallback. Lewin’s theory is an example of Planned Change Theory suitable for healthcare settings (Sutherland, 2013).

A good theory is, therefore, so practical for nurse leaders who wish to comprehend human behaviors in change management efforts (Jones, 2012).

Theory and Quality Management

At all times, nurses strive to improve quality of care. Best practices however are guides with theoretical concepts. Theories and subsequent studies provide the best available evidence, which nurses translate to practice to develop nursing best practices. In this process, nurses always focus on quality improvement.

Research findings give nurses opportunities to improve their best practices and interventions continuously for overall quality management (Mitchell, 2013). Nurses rely on sound theories to give research frameworks for reliable evidence and best practices for adoption.

It has been generally observed that nurse practice is negatively impacted by poor implementation of evidence-based practices to support quality improvement and patient outcomes (Chassin, Mayer, & Nether, 2015). Quality improvement in healthcare strives to integrate evidence-based practices into best practices in practical settings for enhanced quality of care. Tools such as lean management, Six Sigma and change management have been successfully applied for quality improvement in healthcare settings (Chassin et al., 2015).

Healthcare settings require constant change management to account for rising costs of treatment, nurse shortage, nurse professional obligations such leadership and ethical practice, and the need for continued research, rising number senior citizens, the need for patient satisfaction and safety (Chassin & Loeb, 2013). It has however been observed that nearly 70 percent of change initiatives fail, less than 50% of quality improvement implementation has been realized, and the adoption of research findings into nurse practice can take over two decades (Jones, 2012). These observations imply that change management and quality improvement in healthcare settings face major challenges.

Role in Developing and Implementing Change Management Project

It is imperative for nurse leaders to understand their roles in change management projects. Nurse leaders have the role to develop a case for change. That is, they must challenge the status quo by effectively involving other stakeholders to recognize the relevance of change (Jones, 2012). Nurse leaders must also take part in formulating structural change by exploring issues and understanding them deeply to start a meaningful change process. In addition, they should engage other stakeholders in the change process to ensure commitment and support. Nurse leader also implement and sustain change using a suitable plan for assessment and feedback. Finally, nurse leaders should facilitate and assist other nurses to develop their own capabilities. They must constantly challenge others to look for better alternatives while providing necessary support.

Further roles of nurses require them to integrate organizational strategies with operations and link management and professional cultures to promote change. This approach ensures that change management project is aligned to unique characteristics of an organization. Change management project implementation requires collaborative and participatory approaches (Chassin et al., 2015). As such, the identified solutions can be effectively implemented to improve quality of care. This role also gives nurses an opportunity to challenge the status quo with the aim of improving the quality of care through evidence-based practices. Nurse leaders must also strive to ensure that individuals affected by change receive sufficient support, including training and skills acquisition.

Components or Tools Pertinent to Effective Change Management

It has been noted that effective change management requires components or tools that facilitate change management project execution. These tools ensure that nurses and hospitals embrace, implement, and sustain change. Nurses can also sustain change when they continuously learn new materials and implementing evidence-based best practices. When change management is promoted as managed learning where nurses conduct studies and implement findings, then it can empower and transform them positively.

Nurse leaders should conduct readiness assessment to determine readiness for change. The assessment should include organizational, culture, staff, and history of change assessments. Further, readiness assessment also involves assessing the scope of change and possible impacts of change on the organization.

Effective communication should address change discrepancy to emphasize the need to change. It must demonstrate appropriateness and show the preferred solution is the best while demonstrating efficacy to cope with change based on staff abilities. Nurse leaders must also communicate their support for change and show personal valence that change is in the best interest of nurses, patients and the organization.

Training and knowledge acquisition are considered the drivers of change with can assist to mitigate change resistance. Nurse leaders must address even minimal elements that can lead to resistance to change.

Once change has been implemented, it is imperative to gather feedback for improving various processes while recognizing successes and appreciating staff. Overall, all change projects require effective review to determine success and failures (Jones, 2012).

Some Risk and Quality Considerations in Change Management Project and Role in Managing Them

The major risk posed to change in hospital is always attributed to human elements with regard to change and resistance (Thorpe, 2015). Nurse leaders should address apathy, uncertainties, and identified discrepancy (Jones, 2012).

Nursing goals for change and quality improvement is always driven by safety to minimize possible harm to patients, timeliness to combat waiting times and delays, effectiveness to enhance care reliability, efficiency to cut costs of care provision, equity to enhance healthcare accessibility, and patient centeredness to improve patient participation in the care process.

Evidence suggests that change management projects succeed when nurse leaders take active roles in engaging all stakeholders to advance change (Maragh, 2011). Further, they must also engage nursing executives and policymakers to embrace change while working across the organization to ensure inclusion. In addition, change can only be successful nurse leaders understand its influence on organizational systems, budgets, delivery strategies and care models (Lúanaigh & Hughes, 2016). Hence, nurse leaders must apply their expertise, critical thinking skills, knowledge and interpersonal skills to promote change.

How Current Evidence-based Practice Research will Direct Change Management Project

Research has revealed that organizational readiness for change is a vital factor that determines the success of a change implementation process. Experts, therefore, recommend that any change management project should assess the magnitude of change and the readiness of the organization (Zhang, Flum, West, & Punnett, 2015). The assessment activity will involve assessing the extent of change, the number of people affected by the change, the size of the change, the probable resistance, and the organizational culture.

Communication plays a vital role in the change implementation process. Health practitioners and change experts have emphasized on the need to make information available to the appropriate stakeholders for the purpose of creating desire and building awareness. Using the different theories, hospitals have used communication as a tool to enhance change management. For instance, communication has been key in implementing a number of technological changes (Neumeier, 2013).

Evidence-based research has linked failure in implementation of changes to lack of proper preparation of stakeholders. Therefore, the project will emphasize on training employees in order to equip them with the skill required to work under new changes. Second, all the stakeholders will be involved in the realization of the change vision. It is worth noting that involving employees may result in making them champions for the change.

Further, research has shown that employees will oftentimes prefer maintaining status quo. The project, therefore, will be directed to reassuring those affected by the change and improving their attitude.

Research endorses proper planning for the success of any change management. However, implementing the planned change is always difficult with a considerable percentage of failure evident. Therefore, selecting the most appropriate theory framework is vital and augments the chance of success (Rinkoo, et al., 2013). Studies, therefore, direct change projects in selecting the most appropriate theory of change development, for instance, Lewin’s theory and consequently follow the prompted steps as the theory and the type of change suggest.


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Jones, S. (2012). Change management: A classic theory revisited. Nursing Review, (12), 15-18.

Lúanaigh, P. Ó., & Hughes, F. (2016). The nurse executive role in quality and high performing health services. Journal of Nursing Management, 24(1), 132–136.

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Thorpe, R. (2015). Planning a change project in mental health nursing. Nursing Standard, 30(1), 38-44.

Zhang, Y., Flum, M., West, C., & Punnett, L. (2015). Assessing Organizational Readiness for a Participatory Occupational Health/Health Promotion Intervention in Skilled Nursing Facilities. Health Promotion Practice, 6(5), 724-732.

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