Implementing a Theory of Change

Purpose:  To describe from a staff nurse perspective the implementation of a new theory of change initiated in a multiple OB/GYN unit at a major academic medical center in an urban setting.  The methodology created a successful change in the work environment, which had a positive impact on patient care.  

Methods:  A lack of accountability for patient care and a poor work ethic combined with a liaise faire attitude by management created dissatisfaction for staff.  Good nurses left to pursue work environments that had more effective management techniques.  Those who stayed were bullied and given an uneven work load by those who led by intimidation.  Attempts to make a positive change had been ineffectual. 

The “tipping point” change theory focused on the top 20% of nurses willing to be positive role models who wanted change.  Core values were identified:  Camaraderie, Professionalism, and Teamwork.  The top performing group felt these would bring the positive change needed for a more effective unit and happier staff. 

The top 20% nurses met and gave each other feedback, encouragement, and ways to work with the middle 60% of nurses that were identified as possible effective change agents.  The bottom 20% was ignored.

Results:  The bottom 20% of nurses left the unit as they were no longer in power.  As they left, the 60% saw the positive changes. The top 20% were much more effective in providing care for patients in an effective and positive work environment.  They became more effective leaders, mentors, and helped “grow” the middle group who wanted to be part of the change.

Conclusion:  The outcome of a more positive and effective work environment is worth the cost and time involved.  The profession of nursing needs to have practices and theories in place that aide nursing professionals in running a unit effectively.