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RESEARCH
Design research can play an important role in change management, as seen in one academic medical center's transitionfrom a centralized to decentralized care model in its medical/surgical unit By Kara Freihoefer, Sarah Cypher, and Pamela Scherjf
The design of a new medical/surgical unit can cause mixed emotions among users of the space: excitement from knowing that an improved work environment typically equates to improved workflow but also anxiety regarding changes to staff processes and delivery of care. A classic example of this can be found in transitioning from a centralized to a decentralized model.
The existing body of knowledge on decentralized models is littered with research studies demonstrating improved working conditions, such as reduced travel distances and more time spent in patient rooms. However, it's also acknowledged that users may experience a disconnection with colleagues due to an increased physical distance from one another and find that supplies often aren't restocked appropriately.
Similar implications were experienced during the build-out project of an academic med/surg unit at Froedtert Hospital and the Medical College of Wisconsin in Milwaukee. Staff were used to working in a traditional environment and were skeptical that an update could make a difference. However, the project team used research, along with John Kotter's eight-step change management theory, to aid the staff in adapting to changes in care delivery and the physical space. The unit was transformed from being centralized, where a majority of the supplies, medications, and charting/team stations were located at the elbow of the L-shaped unit, to decentralized, where these areas are now located at the bedside or right outside the patient room.
Kotter, the Konosuke Matsushita Professor of Leadership Emeritus at the Harvard Business School, introduced change management theory in 1996. His research found that organizations make eight common mistakes resulting in change failure. He transitioned these mistakes into eight steps that are needed for organizational transformation. The first three support a climate that promotes change by gathering buy-in from staff, creating a comprehensive project team, and working toward a shared vision. Steps four through six address the need for communication, information sharing, and supporting the team to think creatively by removing barriers. The final two steps make sure change is continuously improved and implemented. For this...