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Managing change using Lewin’s theory

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Managing Change Using Lewin’s Theory

Introduction

Bedside shift reporting is one of the essential activities in nursing. It entails exchanging a

patient's vital information from one nurse to another when changing shifts. Implementing an

efficient bedside shift reporting system has been a subject of discussion in nursing literature, yet

implementation is still challenging in healthcare facilities. Nurse bedside shift reporting is

challenging since it entails transferring vital information, accountability, and responsibility

between an off-going nurse and an incoming nurse with the intention of care continuity.

Delivering best practices is, therefore, the main goal of the change. This change initiative is

geared towards effecting change on bedside shift reporting for efficiency, better communication,

and care coordination and, above all, improving the quality of care in the institution.

Assessment of the environment

There are four types of bedside reporting defined in the literature. The written report

entails the off-going nurse leaving a written notice for the oncoming nurse. A tape-recorded

statement is a recorded message, and a verbal face-to-face is where the nurses meet privately to

discuss vital information about the patient. The Face to Face bedside handoff allows nurses to

hand over at the bedside. These methods have advantages and disadvantages to the quality of

care, communication, and continuity of care.

Currently, the bedside shift reporting system is a written report for the incoming nurse.

The written report contains information on the patient background, treatment, current situation,

and care plan. Although the nurse will get vital information, the reporting doesn't allow for face-

to-face communication with the off-going nurse, the patient, or the patient's family. The

advantage of such a system is that it provides a smooth transition between shifts. It, however,
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limits communication between nurses. It also limits communication with family members and

patients during handoff. A lot of vital information can be exchanged during that communication

during handoff. Change is advocated to improve communication and care for the patient.

Organizational structure

The organizational structure was put in place to support evidence-based practice at the

healthcare facility the structure supports processes and procedures that direct how care is

delivered to patients. The current organizational structure includes a nurse leader that allocates

duties and oversees the activities of other nurses. Communication is open, allowing reporting

directly to the nurse leader. Occasional nurse groups are formed when the need arises to address

specific issues for better care delivery. An issue such as bedside reporting affects all nurses and

calls for the organization to consider better practices that will improve care at the bedside.

Deriving and retaining forces

Change in the healthcare system is necessary to improve the quality of care.

Accountability is one of the factors that facilitate the handover systems. Bedside handovers make

specific nurses accountable and reduce collective handovers. Written handovers, however,

reduce socializing during handovers (Malfait et al., 2019). Socializing during handover is

essential since it gives nurses a chance for socialization, where they share their frustrations and

experiences when handling patients.

Support is an important factor determining the change in an organization. The nurse

leader implements and helps in creating a support method. Head nurses can be the support for

change, but sometimes they can be a barrier to change. When head nurses let other nurses

perform their duties and take responsibility. Often head nurses in a centralized system

accompany physicians during rounds and become the point of information for physicians
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(Malfait et al., 2019). Head nurses can encourage bedside reporting by first allowing nurses to

accompany physicians when visiting patients. The nurses would then adopt bedside reporting

systems that benefit patients, their families, and the nurses as they perform their duties.

Advantage of change

The greatest advantage is that patients will experience positive impacts of the bed shift

report system. With improved communication among nurses, patients will experience improved

care. According to the literature, there is an increase in patient satisfaction where there is an

adequate bedside report system (Dorvil, 2018). A good bedside report system leads patients to be

more informed, and they would be more engaged in their care. In turn, the relationship will entail

an improved nurse and patient relationship that will contribute to patient satisfaction.

Bed shift reporting system also leads to nurse satisfaction. The reporting system will

lead to improved efficiency and teamwork in nursing. It will also lead to improved

accountability, and report accuracy will improve patient documentation practices. Satisfied

nurses will experience an improved visualization of issues and come up with solutions to issues

faster (Dorvil, 2018). Bedside reporting also increases patient-centered care, while engagement

with other nurses, families, and patients helps the nurses in improving the quality of care.

Costs and resources for change

Change is complex and requires that organizations always stay ready for change.

Responding to an ever-changing environment needs resources, and the organization will incur a

lot of costs. Change in the healthcare system is complex and sometimes requires agreements

between disciplines. Lewin’s change management theory is commonly used by nurses for quality

improvement projects such as bedside reporting that transform care at the bedside. The proposed

change follows the three steps according to Lewin’s model. The first step is creating a problem
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and creating awareness of the issue (Wojciechowski et al., 2016). The resources needed are

aimed at educating nurses about existing issues and demonstrating the need for change. The

nurses will be educated in various ways, such as through focus groups, to discuss the issues.

The second step is changing, which entails looking for alternatives and demonstrative the

positive impacts of change. Effecting change may necessitate coaching and training so that

nurses will identify the new opportunities created because of change. It also entails

brainstorming new ways of doing things. The last step is integrating and stabilizing the change

into the system so that it becomes a habit. In the current situation, it means ensuring that nurses

can use a written report at the bedside plus socializing where they interact with the oncoming

nurse and patients at the time of handing over. Stabilizing may entail retraining, monitoring key

performance indicators, and celebrating success. The change will be carried out in a three-month

course. The first two weeks will entail identifying the need for change, where the nurses will

engage in focus groups. In the next six weeks, the nurses will engage in training and coaching to

effect the change, while in the last month, they will be monitored to ensure the change has been

effected and adopted into the organizational practices.

All in all, the situation in healthcare entails a change from time to time. Healthcare

professionals should always be prepared for the change to improve the quality of care and patient

experience. Bedside reporting is a common practice that needs to be improved to improve the

patient experience. With Lewin’s theory, medical professionals need to follow only three steps to

manage change. With only three steps, the organization will be on its way to improved patient

experience and patient care.

References
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Dorvil, B. (2018). The secrets to successful nurse bedside shift report implementation and

sustainability. Nursing Management, 49(6), 20.

Malfait, S., Eeckloo, K., Van Biesen, W., & Van Hecke, A. (2019). Barriers and facilitators for

the use of NURSING bedside handovers: implications for evidence‐based

practice. Worldviews on Evidence‐Based Nursing, 16(4), 289-298.

Wojciechowski, E., Pearsall, T., Murphy, P., & French, E. (2016). A case review: Integrating

Lewin’s theory with lean’s system approach for change. Online journal of issues in

nursing, 21(2).