reply to this discussion as a classmate?

In this case study, it seems the problem the new DON saw was the nursing home didn't have an organized system for measuring efficiency of care. I can understand why he might want to implement some kind of measurement system. It may help determine more clearly what the successes and deficits are with the way things are currently done at the nursing home. With that information, efficient practices can be maintained, and plans can be made to change ineffective practices. It appears some of the staff are resistant to the implementation of the DON's measurement approach. The staff whose actions were described in this case study would be considered "rejectors." Rejectors actively oppose change (Scott, 2019). Staff are calling off or just not showing up more often. There's an increased number of time off requests. Near-retirees are wanting to retire with benefits as soon as possible. It sounds like this resistance may be motivated by poor communication, uncertainty about how useful the change is, loss of control over the ways they do their work, and/or feeling that the change will take up too much time (Ellis, 2023b).

If I were a staff nurse in this case study, I think I'd be upset, honestly. I would understand the reason behind wanting to have an efficiency measurement system, but I don't think the DON went about the process of implementing a change in the best way. It doesn't sound like he explained his plan and rationale to staff beforehand or included staff in the planning process. His approach clearly isn't going over well with staff. I feel the DON's approach is more of a micromanagement tactic. It's turning what is supposed to be patient-centered care into a rigid, routinized activity. How is talking with families or consulting with other staff members considered a waste of time? If I have a question or want a coworker's opinion on something, I'm going to go ask. Isn't talking with families part of caring for the residents? I'm lost on those two things. And what of this "time not accounted for" business? What if there was some downtime or something? I'd say a new approach is needed.

I would suggest the Lewin model as one possible change management approach. In the unfreeze stage, the DON would educate staff on why a change is needed and what the benefits would be (Ellis, 2023a). He should also communicate and collaborate with staff to come up with ideas (Ellis, 2023a). In the change stage, the DON and managers should continue communicating with staff and involve them in decision-making (Ellis, 2023b). They would also need to provide support for staff having difficulty with the change and be prepared to try other ideas if the current one doesn't work out (Ellis, 2023b). In the refreeze stage, once reached, a system would have to be put in place to make sure the change is still being followed (Scott, 2019). The impact of the change needs to be measured, and staff needs to be informed about progress and success (Scott, 2019).

To increase acceptance of the change in this case study, I think the DON should've connected and built trust with the staff before throwing a change at them like that. Leaders need to be facilitators, listening to staff and promoting sharing of ideas and input (Scott, 2019). In addition to reviewing data with staff, the nurse managers could actively engage staff in the process (Scott, 2019). They should ask staff what aspects of the change are and aren't working for them and the residents. Staff nurses could express their views on the change and propose other ideas if the current one isn't working.