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Vol. 23, No. 11, NOVEMBER 2006

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Taming Runaway Change


To change and to change for the better are two
different things.
—German Proverb

Mary Fran Tracy, RN, PhD, CCNS, CCRN, FAAN
Change. Doesn’t the word make you uncomfortable—perhaps even a bit apprehensive, queasy or downright nervous? Healthcare today is characterized by relentless change, wave after wave of it, out of our control. Change is important, of course, even essential to improve patient care. But unrelenting change leads to change fatigue which, once it sets in, makes it nearly impossible to achieve sustainable, productive change. Employees become distrustful and sabotage may follow.
Eric Beaudan, a principal and highly respected consultant with Healthy Companies International, points to six signs of change fatigue:
• The value and objectives of the change effort are increasingly questioned
• Resources become diverted to other strategic initiatives
• Impatience with the duration of the change effort
• Data and results of the change project are shared with hesitation
• Key leaders no longer attend status updates about the change project
• Change leaders become stressed and often leave
Many changes in today’s healthcare organizations are appropriately intended to improve patient safety. When continuous changes are under way, fewer may succeed; they may recycle and return with a new name. As a result, employees may find it difficult to see the underlying logic or purpose of the changes. Ironically, trying to initiate multiple safety initiatives at once may actually jeopardize patient safety, because overwhelmed staff members develop work-arounds and withdraw from meaningful participation because of fatigue.

With so much change happening at once, there is no time to get input from those affected by it, no time to fully evaluate progress, no resources to make midcourse corrections, no opportunity to adjust before the next change is implemented. Sometimes it seems that we are trying to solve a problem we don’t even have by instituting yet another change, just because everyone else is. The result: Confronted with multiple, sometimes contradictory, change initiatives, we set our own priorities. At best, the changes are superficially implemented. Without a solid foundation, they eventually erode as we revert to previous practices.

Nothing is built on stone; all is built on sand, but we must build as if the sand were stone.
—Jorge Luis Borges

How do we deal with these tsunamis of change? To create solid, enduring improvements, we must harness the energy of the waves and use that momentum to build a strong foundation for each change we make. Sand may change shape as needed, but it also can be solidly packed to build a firm foundation.

Each of us has a role in harnessing an overabundance of change to prevent change fatigue. Sometimes we must tame the trademark energy and enthusiasm that characterize us as high acuity and critical care nurses. The excitement of a new idea often generates startup energy. Anticipating barriers and sustaining energy throughout the project is more difficult. Often, we find another new project to excite us as change initiatives pile up and change fatigue sets in.Runaway change can be tamed by focusing on the “vital few” rather than the valuable many. There are even times when initiating large organizational change may require delaying other initiatives, at least temporarily.

We can’t assume that those who approved a change really know what it entails. (Have you ever explained the complexity of a deceptively simple treatment order to a green physician?) Here’s an example: Based on input from nurses at the bedside and clinical leaders, the chief nursing officer at a major medical center helped her executive colleagues face up to the dangers of escalating change. The CNO presented a compelling case for prioritizing, along with concrete recommendations about how to proceed using examples of success and failure in other organizations to paint the picture. By communicating the value and importance of the resulting priorities throughout the organization, there was buy-in at every level.
Taming runaway change also requires a clear timeline with milestones that are reported to everyone involved in the project. This information may lead to midcourse corrections and reallocation of resources to achieve what everyone has committed to.

Change will always be part of improving patient care. But when change continues at an unrelenting pace, many initiatives will have poor outcomes. Energy and morale will plummet among frustrated staff, placing patient safety at even greater risk.

AACN does not want to contribute to change fatigue. We want to support high acuity and critical care nurses by providing them with best practices resources that ease implementation of clinical improvement initiatives. Are you experiencing change fatigue in your environment? How is your organization harnessing runaway change? What have you and your colleagues done to support those efforts? How can AACN support you in preventing change fatigue? Please send me your answers at insights@aacn.org.
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