Nurse executives are critical to the successful planning, implementation, and adoption of technology to support the workflow and documentation needs of nurses and other end users. Informed by key principles of complexity theory, the enormous task of broad-based implementation of a standardized electronic medical record can be accomplished through the thoughtful development of flexible structures and change management principles that promote intelligent decision making and adoption by key stakeholders.
To achieve Magnet recognition designation, an organization must demonstrate a framework for nursing practice. However, successfully incorporating and sustaining frameworks and theories into practice are not easy undertakings. The authors describe how leaders and staff in a healthcare system created and implemented a conceptual framework for nursing practice to guide nursing practice for the system.
In today's complex healthcare systems, transformation requires 2 major efforts: (1) a fundamental changes in the underlying beliefs and assumptions that perpetuate the current system and (2) a fundamental redesign of the multiplicity of diverse and complex subsystems that result in unpredictable aggregate behavior and outcomes. Through an Intelligent Complex Adaptive System framework combined with an innovation process a transformation process and cycle was created for a large healthcare system that resulted in both small- and large-scale changes. This process not only challenges the underlying beliefs and assumptions but also creates new possibilities and prototypes for care delivery through a change-management process that is inclusive and honors the contributions of the entire team.
Health care leaders are responsible for oversight of multiple and competing change interventions. These interventions regularly fail to achieve the desired outcomes and/or sustainable results. This often occurs because of the mental models and approaches that are used to plan, design, implement, and evaluate the system. These do not account for inherent characteristics that determine the system's likely ability to innovate while maintaining operational effectiveness. Theories exist on how to assess a system's readiness to change, but the definitions, constructs, and assessments are diverse and often look at facets of systems in isolation. The Systems Transformation Framework prescriptively defines and characterizes system domains on the basis of complex adaptive systems theory so that domains can be assessed in tandem. As a result, strengths and challenges to implementation are recognized before implementation begins. The Systems Transformation Framework defines 8 major domains: vision, leadership, organizational culture, organizational behavior, organizational structure, performance measurements, internal learning, and external learning. Each domain has principles that are critical for creating the conditions that lead to successful organizational adaptation and change. The Systems Transformation Framework can serve as a guide for health care leaders at all levels of the organization to (1) create environments that are change ready and (2) plan, design, implement, and evaluate change within complex adaptive systems.
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