Innovation and Change in Nursing: Driving Effective Organizational Performance

Understand the need for innovation and change management within an organization. Introducing change can be perceived as doing the same tasks but in a different way to achieve a successful outcome. It is important to accept that change is inevitable and that the key to success is to ensure that the process is effectively managed with appropriate leadership skills. 

Consistent Improvement and Organizational Climate

A different approach is that of consistent improvement, where an organization would continually strive to improve and achieve as an ongoing continual cycle.

It is important to maintain a positive climate for all those involved and show respect and concern, understand the feelings and viewpoints of those doing the implementation and make sure the necessary resources and support are available.

Innovation is essential for any organization as it helps the organization to survive by meeting users changing expectations and increasing efficiency, and reducing waste. Without innovation, individuals can feel demotivated and unappreciated; they may feel their leadership team does not provide an environment in which they can be innovative. Institute of Leadership and Management

Leadership Style and Participative Management

It is important for all leaders to create a positive climate to encourage passion and empower all individuals to come forward with ideas. Leaders must analyze how to motivate and drive individuals to encourage them to drive forward with ideas and promote engagement.

McGregor suggested that there are two fundamental approaches to managing people, an authoritarian approach and a participative management style. My leadership style would be to encourage the participative approach; I do not feel that simply commanding people to perform is effective. If they do appear disinterested and apathetic, I would prefer to find out why and therefore try to change their outlook rather than demanding they do so.

Changes Introduced and Team Dynamics

All of the changes introduced within the last year, from wound care training to the introduction of a mental health triage tool, have been innovative ideas from ED staff members. I am fortunate to have a highly passionate team (which at times can cause friction), but overall, the majority display passion and commitment, which then leads to innovation.Be able to propose innovative solutions to improve organizational performance.

Benefits of Organizational Innovation

Innovation is crucial for any organization as it helps to:

• Bring in new ideas to ensure survival
• Meet users changing expectations
• Drive the industry sector to further innovation
• Gain a competitive advantage
• Ensure regular flow of new products/services or reduced cost
• Increase efficiency/reduce waste
• Meet users changing expectations

One of the stakeholders of the NHS is patients; their demand has increased, and they expect to access Emergency Departments for everyday general practice concerns. National Health Services England (NHSE) recognizes that although they encourage individuals to access primary care services, the majority will still be present in the ED.

Implementing Processes and Encouraging Innovation

Therefore strategy and vision are required by all hospitals to ensure a view of where they want to be in the future compared to where they are now. 

I have implemented multiple processes in the ED to guide the appropriate streaming of patients, for example, primary care patients to GPs, Opthalmology, ENT, and Gynaecology. This encompasses:

• Processes as enablers and supporting a culture of innovation
• Encouragement for innovation from the leadership team
• ·nderstanding the wider context, streaming came forward as an NHSE directive with a financial incentive upon start-up for each Trust
• Refer to ref number of PD for this on the LA system

Addressing ED Overcrowding

Be able to propose innovative solutions to improve organizational performance. An opportunity within my organization for innovation and improvement would be addressing ED overcrowding as an urgent priority. A national document from the Royal College of Emergency Medicine (RCEM), “ How to make Emergency Departments Better,” explains the RCEM Cares campaign.

Emergency Medicine is the field of medicine that deals with all age groups presenting with acute and urgent conditions and injuries that require emergency intervention. It further encompasses an understanding of pre-hospital treatment and encompasses a full spectrum of episodic undifferentiated physical and behavioral disorders.

Challenges and Solutions for Emergency Departments

In the United Kingdom, this system is not fit for purpose; insufficient medical/nursing workforce, bed capacity, and infrastructure do not meet current demand, let alone growing demand. In 2018-2019 over 19 million people across the UK turned to EDs as increasing numbers are living longer with a complex range of medical needs. As our wider Health and Social Care service has not been developed to address this need, EDs are the first port of call for the majority of patients.

National Directives introduced in 2000 by the Department of Health where the waiting hour standard for all patients to be seen, treated, and assessed within four hours has not been achieved within the last five years. The King’s Fund (April 2019) “acknowledged it was both unexpected but unsurprising that in June 2018, the Prime Minister announced a new five-year funding deal for the NHS but also to review the NHS performance targets ( this could be seen as moving the goalposts to present a positive image to the public).

Therefore ED overcrowding became a recognized term and, sadly, is now a 24-hour consistent state rather than an occasional occurrence.

The RCEM Cares campaign provides solutions to address the concerning issues so that ED staff can deliver safe and timely care for patients. The campaign focuses on five key areas.

• Crowding: caused by exit block of admitted patients to beds
• Access: For everyone to have access to same-day emergency care centers and social care
• Retention: reduce understaffing and burnout, appreciate staff, retain the staff you have
• Experience: patient experience should be positive; involve them in plans for improvement
• Safety: current CQC rating for over half of national EDs was inadequate or required improvement.

Fortunately, during our recent CQC inspection in September 2019, we received Good in all five domains, which proved although crowded, we were maintaining an effective and safe level of care.

Staff Retention and Employee Well-being

The area that I have chosen is that of staff retention, how to encourage staff to stay, reduce their burnout, and retain the staff I do have. Health Education England (HEE) has confirmed that it will not be able to supply the health system with enough nurses if trusts cannot cut activity. Without that reduction in demand, HEE has said trusts will continue to struggle to fill vacancies every year to 2020 and beyond. Trusts are planning for activity growth above what is envisaged in the forward view-meaning there is a gap between the number of nurses set to be supplied by HEE and the amount trusts believe they need. Therefore it is imperative that as leaders, we take action both to avoid a crisis and to appreciate and retain the staff we have.

Techniques for Addressing Staff Concerns

I have implemented a range of techniques to assess initially any worries or concerns via an anonymous departmental worry box, opened by a consultant, acted on, and fed back via ED governance. At governance, actions and timeframes are set to ensure compliance and fed back via the ED business manager to divisional governance. This ensures any immediate concerns are addressed and acted on, and the divisional lead nurse and director of nursing are aware of them. I operate an open door policy and have encouraged all my senior sisters to follow suit; this ensures that all nursing staff can access senior support and advice twenty-four hours a which contributes to well-being.

Enhancing Staff Morale and Retention

I am a trust wellbeing champion where we represent each division and work collaboratively to share ideas for improvement and staff engagement; I have introduced weekly coffee and cake in the ED office, six monthly staff catered away days, and three monthly staff days out.

This has proved positive, and staff are keen to meet outside of work; recent feedback has described ED as a “family” who care for each other and offers support. To evaluate success, this will be provided via ED governance and divisional governance, staff retention, and establishment vacancy. If there is a high staff turnover, then rightly so, HR would investigate why.

References:

1. Evaluating Strategic Change Management. P26 M&L Unit 50
2. James Paget University Hospital https/www.jpaget.nhs.uk accessed 20/09/2018
3. Managing Strategic Change, Environmental scanning, p30 M&L Unit 50
4. Safe and sustainable staffing, Nice Guidelines, initial draft (2018)
5. Develop an improvement plan “managing strategic change” M&L 50 p24
6. Phases in managing risk “managing strategic change” p59
7. PRINCE2 “managing strategic change” p5

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