By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
Changes are happening so fast in healthcare environments that many leaders report some staff are just shutting down. We know that quality improvements require change. Performance improvements require change. Reimbursement requirements require change. Nurse want to see change that will result in both better patient outcomes and working conditions. But often what staff see is a stream of new initiatives some of which don’t work and conflicting changes in direction. The rapid turnover of senior leaders often does not help the situation as new leaders often arrive with pet projects that will define their leadership vision.
A manager recently told me about three major changes that were rapidly implemented in their health system simultaneously. When she announced them at a staff meeting – there was dead silence with no questions. She pushed for a reaction and one nurse finally said, what do you expect us to say – we have no control over any of this and are just tired. The manager felt tired herself. There was very little consideration given to the timing. She said that when she questioned change before, she was urged about the need to be more agile and adaptable in her thinking. Yet we know that continuous change over time creates symptoms of fatigue, and burnout, which can ultimately affect the quality of care. Additionally, each new initiative can be additive to the nurse’s workload.
Over time, the chaos in healthcare may subside but maybe not. In the interim, it is important to help staff cope with their change fatigue.
Five Strategies to Help Staff Manage Change Fatigue
- Frame the change so it is easily understood. Change efforts often fail because of problems with communication. Simon Sinek urges leaders to always start with the WHY before you move to the what or how.How leaders use language to frame people, situations, and events has important consequences for the way individuals make sense of the world and their actions.
- Meet them where they are in the acceptance/transition process. Rosabeth Kanter, a Harvard Business Professor, has observed that nobody likes change when it’s something that’s done to us. But change that we think up or embrace on our own is different—that kind of change we never grow tired of. So while the leadership that designed the change may quite enthusiastic, you should not expect that it will be accepted the same way at all levels in the organization. Not all of us accept change in the same way or on the same timeline. Research indicates that change becomes more difficult as we age. This is because we have more to unlearn and then relearn with each new change initiative. To avoid frustration, it is important to meet people where they are in the change process and be supportive not dismissive.
- Involve staff in the process of implementation. As a manager, you may have no control over whether something is implemented or even the timing. What you do have some control over is how it will be implemented in your unit or department and this is where staff input becomes key. Take the leadership on this and don’t behave as a victim in implementing new initiatives.
- Help them identify where and how they can fit into the change. In most situations where we are asked to change, we are substituting the old for the new and unfamiliar. This can make us feel insecure about our work and is often personally exhausting. The response of leaders to change or turbulence has a powerful effect on their staff. There are always possibilities in change that can lead to a new, brighter future and this needs to be conveyed. Leaders who remain calm, truthful and optimistic in their communications help to prevent the spread of misinformation and reduce staff anxiety.
- Give them hope. The Gallup organization has identified the ability to give hope as one of the four key expectations that staff have of their leaders. There are silver linings in any situation and the leader needs to be the first to help everyone see what they are. An optimistic attitude and outlook can be very energizing and contagious. It will motivate your staff to do their best. You need to expect success if you are to achieve it.
Read to Lead
Kotter, J. (1996). Leading Change. Boston, MA: Harvard Press.
Sinek, S. (2011). Start with Why. New York: Portfolio Books.