1. Lockhart, Lisa MHA, MSN, RN, NE-BC

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Q: Transitions in the healthcare environment are inevitable, but how can we best manage them?

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A: Certainly, it can be said of the healthcare environment that we're in a constant state of transition. Our daily processes must include how to manage our system in such a way that maintains best practice while being competitive and financially responsible, and attaining the highest quality for our patients and staff. This is a large responsibility and requires continuous action to maintain.


In addition, our current healthcare systems are big business and, therefore, the same rules and stakes apply. Buyouts, company takeovers, and managerial and leadership changes are an unrelenting force driving transition. The effect of transition on staff members at the point of care can be described as stressful and confusing, causing turnover and low satisfaction if not managed properly.


One model of transition management differentiates between change and transition. The key difference? Facilitation. Change is situational, occurring without a transition phase. Transition is a three-stage process that guides people through a change: ending, neutral, and new beginning stages.


The ending is usually associated with anger, denial, and shock, which eventually leads to a neutral zone-a time of ambivalence and skepticism. This is the actual transition in which the leadership team either loses or facilitates passage of the change. The final stage is acceptance during which employees begin to renew interest and cultivate excitement for the next level.


Consider the following pointers for managing successful transitions. Clear, concise, and transparent communication is essential for navigating any process. Be understanding of satisfaction levels with previous initiatives, and educate on why things must change. How will the change affect staff members at the point of care? Assist the team in letting go of what was so that what will be can be embraced.


Have a healthy respect for the grapevine and a clear understanding of the discussions that are occurring to get ahead of gossip by ensuring that facts are distributed. This takes the sense of unknown out of the equation and relieves fears. Acknowledge any actual or perceived losses by the group. Of utmost importance is listening and understanding others' viewpoints, not just hearing to respond. Remember to avoid devaluing what was because this may result in a negative reception and be perceived poorly when presenting new ideas. The past is to be respected as a pathway. Intertwine the new with the old; don't erase the past.


New beginnings are communicated using the four Ps: purpose, picture, plan, and part. The purpose is the explanation of why the change is being implemented. Picture refers to the vision of what will be. The plan is a step-by-step guide to how the team will get there. And part refers to the role of each team member, including the leader's role. In all phases, communication remains paramount.


Transitions are required for growth and quality improvement processes. Managing them appropriately is crucial to an organization's success. If managed properly, large shifts in turnover and decreases in quality and satisfaction can be avoided.




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MindTools. Bridges' transition model.