Change management case study
Eric is a nurse practitioner at one of 10 primary care clinics within a large multi-specialty organization. He has been with the organization for 8 years. Currently, the organization’s culture is focused on the function of care delivery specifically, the volume of daily patient visits. Patients are scheduled every 10 minutes with a no-show rate of around 20%. The current practice is to schedule based on the no-show rate and expected number of daily patient visits to meet profit goals. Overbooking the schedule based on the average number of patients who are “no shows” for their appointments each week is the norm. On a good day, the overbookings and scheduled patients would equal enough patients to meet the profit goal while the no-show time slots would allow time for Eric and his colleagues to catch up. On most days, despite numerous efforts to maximize scheduling, the overbooked patients tend to arrive in clusters which results in lengthened patient cycle times (check-in to check-out). All patients for the day are eventually seen meeting the expected number of patient visits; however, the workday is often extended. The providers, nursing, clerical staff, and patients leave the clinic frustrated. Patient and employee satisfaction scores have begun to decrease over the past three (3) quarters while the number of patient visits and profits remains unchanged. Eric has also noticed turnover among the providers and nursing team members.
Part 1 Instructions:
Using Lewin’s theory of change, discuss the actions the APRN may employ for unfreezing based on the scenario (refer to the table below).
Provide a rationale for each action discussed based on the information provided in the scenario.
Suggest strategies the APRN might use for each action discussed.
Stages of Change and Responsibilities of the Change Agent
(adapted from Marquis & Huston, 2012, p. 166)
Stage 1: Unfreezing
Gather data
Accurately diagnose the problem
Determine if change is needed
Developing a compelling message showing why the existing way of doing things cannot continue
What are the greatest barriers to this change?
What are the strongest driving forces for the change?
Is there support from the executive leadership team?
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