Barbara Norris: Leading Change in the General Surgery Unit

Q1. How well has Barbara Norris done in her first month as nurse manager of
GSU? Was she a good choice for the position?
Barbara Norris had taken up the position of Nurse Manager of the General
Surgical Unit(GSU) of the Eastern Massachusetts University hospital at a troubled
time. The economy had taken a turn for the worse and in response, the
management had enacted a hiring freeze, stopped all over time allowance and
decreased shift differentials. This had made the already short staffed unit
overworked and stressed. GSU already had high turnover and low retention rates
due to a lack of collaborative culture. Two registered nurses (RN) had already quit
in her first month. Credit goes to Barbara to accept the challenge to try and turn
around an already troubled GSU, even when her mentor advised her against it.
She wanted to do the right thing.
The first thing Barbara did on joining was accepting the requests of one to one
meetings from 29 out of 33 staff who were under her. Listening to them provided
her with firsthand experience of the culture of conflict and blaming prevalent in
the Unit. She also discovered that the annual performance review records were
incomplete and inaccurate. She was capable of implementing a fair review
system.
She understood the importance of open communication and a transparent review
system in growth and development of any team. To try to foster communication
among the staff she organized an Off-site for her GSU staff. The exercise was a
beginning in airing the feelings of the team members. A lot of issues came up
and three people put forward their grievances. She also asked for solutions for
these problems from the staff themselves. In addition, she proposed to involve
her staff in all the decision making processes. She made an effort to understand
their problems.
Barbara was passionate about her profession. She had a long experience in the
field and did not give it up even when familial responsibilities came. She came
back to her profession and also acquired a Masters program in Nursing and
Healthcare. Thus, we can say that Barbara Norris was a good choice for the
position of the Nurse Manager at the GSU.
Q2. What changes is she trying to make and why?

A transparent performance review system

This would help in acknowledging good performers for their work and
contribution. As the company is facing economic crisis, the issue of
compensation is difficult to address. Despite this, the step would in turn
provide the staff with constructive feedback, and help in reducing their
discontent and boosting their morale.
Empowering others through inclusion in decisions
This is a critical step in change management which brings a sense of
taking initiative along with a sense of ownership. This would help resolve
the issue of belongingness and make them feel a part of the team. Also,
this step would assuage their concern of not having a say in matters that
affect the workers.
Increase interpersonal bonding between peers

Barbara identified that there was little intellectual transfer and training
that was carried at GSU. Some staff members had to invest their personal
time in acquiring the knowledge required to operate the latest technology.
Hence, the experienced staff could transfer their knowledge to the new
staff. This would help in saving time and ensure a culture of collaboration
and teamwork as GSU was already facing shortage in staff, and increased
work pressure.
Hence, these steps would further help in increasing motivation among
staff through acknowledging their effort and performance of duties
beyond their job specifications despite the lack of financial rewards.
Q3. What are the 3 obstacles that she should anticipate and how should she
address them?
The following table presents the three obstacles that Barbara should anticipate
and address them:
Serial
Numb
er

Obstacle

1.

Changing the processes

so as to make them more
transparent and patient
centered

2.

Resistance to change the

ways by the staff
themselves as they were
set in their ways

3.

Resistance from the

management due to
downturn in economy

Solution
To bring the human quotient back into the nursing
job that the staff was supposed to provide Barbara
needed to formulate a rigorous training program for
the staff including the PCAs and the floating staff.
A training program will equip the staff to provide
better care with less conflicts. Fixed processes also
need to be established to minimize user conflicts
and increase transparency in the process.
GSU is plagued with a culture of confrontation,
blaming and favoritism which will need a strong
cultural shift to become a collaborative and
transparent team. Barbara will need to establish
direct one on one communication link with the staff
aimed at telling how mutual work will benefit all of
them. Despite their hectic work hours, she needs to
instill practices which foster teamwork and faith.
She may come up an incentive system where team
work is rewarded/applauded. A transparent
performance review system which is recorded
timely will help her in gaining trusts of her staff.
Currently faced with a bad economy, the cost
cutting measures have tied up the resources
available to Barbara to turn around the GSU. She
cannot hire anyone nor will be able to provide any
monetary incentives to cultivate teamwork. Thus,
she needs to be creative in devising solutions to
bring a change in the culture. She can look into
alternate forms of acknowledgement like award for
the best team player of the month.
In case she decides that her staff needs are not
adequately met with the current system, she can
represent them at top management level as a

leader to bring change. However, she will need

extensive data to support her demands.
Q4. Device an action plan for Norris based on Kotters 8 steps for change?
Step 1 Create a sense of urgency
To implement a transparent performance review system, Barbara Norris should
approach the top management and create a sense of urgency for her changes to
take form. The General Surgery Unit was already facing a high turnover, and
there was a freeze on hiring. If the current situation of discontent among staff
continued, then there could be more nurses leaving the organization. This would
lead to an increased workload on the nurses which in turn could impact the
functioning and hence, the care received by the patients. This could impact the
image of the hospital and revenues, thus creating a sense of urgency among the
management.

Step 2 Form a coalition

Forming teams of an experienced nurse with nurse who is not highly experienced
will ensure that there is intellectual transfer to the less experienced nurse.
Moreover, the management can be persuaded to allocate a portion of
performance review to the teamwork, i.e. how well the other person is
performing.
Step 3 Develop a change vision
To provide the nurses with an environment conducive to cope with the workload
in the healthcare industry, it is imperative that the nurses work in teams and
help others perform.
Step 4 Communicate the vision for buy in
The situation has to be presented to the top management. The organization is
facing economic crisis and staff shortage and cannot afford to lose any more of
its staff without affecting the care received by the patient. For the nurses, the
teams of nurses should be regularly rotated. Regular Off site meetings with the
nurses.
Step 5 Empowering broad based action
Since the focus in now on the team of experienced and in experienced nurse, the
decisions can be taken with a combination of fresh perspective and experience.
This would also reduce the scope of taking wrong decisions.
Step 6 Generating short term wins
Recognising the efforts of the team of nurses at the offsite meetings with the
acknowledgment of the best team.
Step 7 Dont let up
There is a need of constant improvement while introducing such changes. Hence,
addressing the nurses regularly at the off-site meetings and taking their

suggestions into account should be made the norm. And the practices should be
continually improved through the nurses inclusion in making decisions.
Step 8 Incorporate changes into culture
Make teamwork and collaboration a part of the culture, wherein the emphasis is
on the team goals rather than individual goals. Also, the teams would be
recognised rather than individuals at events like award functions or on founders
day.