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Transformational leadership: drive change for better wound care with this 4-step model

Take charge of change management with a practical strategy that combines nurse skills and emotions.

There are myriad change management theories out there. You may even have a favorite, whether it’s John P. Kotter’s eight-step change model, Kurt Lewin’s unfreeze-change-refreeze model, or Chip and Dan Heath’s elephant (emotional)/rider (rational) sides of change.

Theories are great—in theory. But initiating and then sustaining change in care settings can be a Herculean task with no guarantee of success.

After hearing from skin and wound care specialists about their journeys of change, Healthy Skin Magazine outlined its own, informal change model. We’re calling it HELP.
Hear them out.

Empower the frontline.

Lean into the micro-culture.

Persist!

Why HELP?
In short, it’s the team that makes someone’s vision of change a reality. That team includes frontline staff.

It’s time to take a fresh look at frontline staff—to see them as more than mere implementers of change. Start to truly understand their daily choices in providing care to patients and residents. Then consider how their choices affect patients’ skin health.

Stories of change
Two examples of how change initiatives in skin and wound care can make a difference. Download Healthy Skin Magazine to read more:

• To combat pressure ulcers (PUs) developing in the operating room, ICU nurses at Hartford (Connecticut) Healthcare got the entire pre-op care team, including surgeons and anesthesiologists, to turn patients and offload their heels.

• It took 18 months for a wound care nurse at Swedish Medical Center, Denver, Colorado, to convince the administration to switch from using linen pads to dry pads. Once done, the hospital saw a precipitous drop in the number of patients with moisture associated skin damage (MASD).

H-Hear them out
Nurses are so overwhelmed that they feel compelled to prioritize their work. They’re left with hard choices over how to care for patients—and how not to care for them, says Lillee Gelinas, MSN, RN, CPPS, FAAN, senior fellow, nurse executive, University of North Texas Health Science Center in Fort Worth, Texas.

Lillee Gelinas, MSN, RN, CPPS, FAAN, senior fellow, nurse executive, University of North Texas Health Science Center, Fort Worth, Texas
“Nurses are hammered with so many different practices and new policies. They’re just trying to get through the day.”

Zena Moore, Ph.D., MSc, professor of nursing and director of the Skin Wounds and Trauma Research Centre at the Royal College of Surgeons in Ireland, agrees, saying frontline nurses need to be viewed differently, more empathically. “In order for us to move the culture of change forward, we need to walk in the shoes of people who are providing the care every day,” she says.

Make a shift

Emphasize:
• Nurse mindset
• Decisions on protocol implementation

Downplay:
• Electronic health records
• Conformability
• Regulatory issues

Source: Lisa Corbett, DNP, APRN, CWOCN, Advanced Practice Nurse, Hartford (Connecticut) Hospital

E-Empower the frontline
In her previous position as CNO of Northern Michigan Regional Health System (now McLaren Northern Michigan), Mary-Anne Ponti, RN, MSN, DBA, FACHE, set out to raise spirits and empower weary nurses after a four-year strike. She went big—aimed for and achieved Magnet® status at her facility, a designation only 8 percent of hospitals meet.1

“It was really about shaping a new path,” says Ponti, who now serves as system chief nursing executive at Central Maine Healthcare in Lewiston, Maine. “We focused on the environment and on building habits,” she says. To do that, Ponti created a clear vision, rallied her “troops” and developed a strategic plan that empowered nursing leaders by assigning them Magnet chapters.

True empowerment means having the ability to choose—and that takes possessing knowledge and power, Moore adds. Without knowledge, “nurses stick to the ways they’ve always done it, thinking that nothing too terrible will happen. They are afraid to change. When you change, we have to accept accountability for the outcomes that result from that change.”

Mary-Anne Ponti, RN, MSN, DBA, FACHE, system chief nursing executive at Central Maine Healthcare, Lewiston, Maine
“We started communicating. We always went back to vision, purpose and strategy to get people excited. What are we doing? What’s the purpose? Why did we go into nursing?”

L-Lean into the micro-culture
To understand how human factors get in the way of nurses providing care, Gelinas suggests leaders observe frontline staff working in their micro-culture or unit. “It allows you to see what is driving their day and causing them to skip certain care that leads to skin breakdown,” she says.

At the very least, ask nurses what they think. Their answers may surprise you, says Kara Couch, MS, CRNP, CWS, CWCN-AP, director of inpatient wound care at George Washington (GW) University Hospital, Washington, D.C. When Couch surveyed wound care nurses at GW, she learned many agreed with the statement, “PU prevention is not as important as
treatment.” She found it stunning, but considered it the start of a needed conversation.

P-Persist!
Change takes time. It took Ponti four years to help achieve that Magnet designation, which
she attributes to setting a clear vision and creating a sense of urgency. She says that even if you don’t attain your ultimate goal, the journey will lead to incremental wins, which you should celebrate.

“Change takes persistence and patience,” says Kristin White, RN, CWON, Medline Skin Health clinical education specialist. “If it’s something you believe in, just keep pushing for it. There are a lot of people who resist change, but it’s the way of the world to make things better. Go with it, embrace it and be a part of it.”

You can HELP lead the change
Whatever change management theory works best for you, the HELP acronym is a useful reminder to put yourself in the shoes of frontline nurses, empower them with both knowledge and accountability, understand their micro-culture, and then keep pushing for that change. Find out how to get more help on leading your staff toward a culture of prevention, and download Healthy Skin Magazine to read the full article.

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