Change Initiative: Implementation, Evaluation, and Sustainability 

Change Initiative: Implementation, Evaluation, and Sustainability 


Change Initiative: Implementation, Evaluation, and Sustainability

Change is an essential organizational aspect. Organizations embrace change to achieve their desired performance goals. Change helps health organizations to respond to current and unforeseen shifts in their markets (Holten et al., 2019). Healthcare organizations identify effective strategies that can be used to drive excellence by implementing change innovations. While change is an essential aspect in an organization, performance evaluation is critical for effecting change in healthcare. The purpose of this paper is to evaluate the performance of the Adult Intensive Care Unit department to find out an area that would significantly benefit from initiating a change.

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The Issue of AICU Nurse Under-Staffing

An adult intensive care unit (AICU) is a specially designated area where adult patients with severe illness or injury receive care. The AICU environment is extremely busy with very hectic functions and genuinely involve people in it with all sorts of stimuli. Similarly, nursing in AICU is quite a demanding practice that poses high emotional and physical risks in providing care to very ill patients and often fighting for their lives (Abdelmagid et al., 2021).

The Adult Intensive Care department area that would benefit from initiating a change pertains to the nurse staffing. The understaffing of nurses that take care of critically ill aged patients is a challenge in the department. The understaffing has led to nursing burnout and exhaustion, leading to medical errors and a high mortality rate in the facility. The crisis of nurse understaffing has led to the burden of workload for nurses. The nurses have a greater responsibility concerning their patients in ICU. The understaffing of nurses has led to the anxiety arising from the impossibility of offering patients inadequate service (Sweileh, 2020).


The burden of work overload, overtime,and compulsory shifts results in burnout and nurse turnovers. In the AICU department, turnover occurs typically due to a hard-working environment occasioned by understaffing. Nurse turnover disrupts the department’s services, staffing, leadership, managerial, health organization finances, and inflated operation costs. Similarly, turnover has led to a shortage of nursing staff that adversely affected patient satisfaction and outcomes (Magbity et al., 2020). Studies have shown higher employee turnover rates are directly connected to higher patient mortality, leading to work dissatisfaction and burnout among nurses and an increased risk for medical errors.

Internal Driving Forces Extrapolating Nurse Understaffing in AICU

The Internal forces refer to the immediate environment in which the healthcare services are provided and the resources required for delivering the service. The driving forces that affect nurse staffing include inadequate financial resources, the chain of command, leadership styles, information sharing, and quality control processes (Chen & Nates, 2020). These internal forces have contributed to lowering the quality of care in one way or another. Moreover, the external driving forces refer to healthcare organizations’ environment that affects the ICU department’s performance and quality of services. The department has been impacted by external factors such as governmental regulations and insurance plans.

The contributing issues to the challenge of under-staffing of nurses in the AICU comprise inadequate financial resources, which inhibit the hiring of enough nurses to cater to the needs of the patients adequately. The issues have led to burnout leading to dissatisfaction or stress at work.In addition, the assessment also underscored the problematic working conditions that lead to turnover hence the nursing shortage (Chen & Nates, 2020). The most affected people are the patients who are not well attended to and given proper care. In addition, the nurses working in the AICU are also adversely impacted psychologically and physically. Further, the leaders and nurse managers are also affected. They often have to address the crisis of turnovers; recruiting new nurses and training them consumes time and depletes the organization’s finances. Similarly, the patients’ families are mentally, psychologically, and financially in the event of death or extended stay in the facility’s inadequate service provision (Chen & Nates, 2020)

The Stakeholders Involved and how they are affected by the change

The stakeholders involved include the organizational leaders, nurse leaders, and managers. In addition, the patients and their families will also be interested in the change process. Corporate leaders are the decision-makers and have the organization’s vision; hence, their involvement in the change process is pivotal (Melnyk & Fineout-Overholt, 2019). In addition, the leaders in the department for both specialized physicians and the nurse leaders and managers are critical stakeholders since they are directly affected by the inadequate nurse-patient ratio. Moreover, the patients and their families who are directly impacted by the nurse-understaffing must be involved; their inputs are essential in terms of patients’ satisfaction. The stakeholders will be affected by their support for implementing change and overcoming resistance. In addition, stakeholders will be actively involved in implementing the change, which will include their time and intellectual contributions. Furthermore, the stakeholders will be

affected as they will have to align with the expectation of the change strategy (Melnyk & Fineout-Overholt, 2019).

My Role and Responsibility as Change Leader and the Leadership Theory to Guide the Change process               My role and responsibility as the change leader will be to steer the change implementation process and advocate. In addition, I will assume the role of liaison personnel between the stakeholders and the change agents. I will promote the change vision, develop the change plan, and manage resistance and conflict throughout the change. The environmental leadership theory requires the nurse leader to act and utilize the patient’s environment to assist in patient recovery: I will apply the leadership theory to the initiative and configure environmental settings appropriate for change to restore the patient’s health and safety (Gilbert, 2020). In addition, the environmental theory suggests supervision. I will supervise the change process for the achievement and adherence to best practices and procedures in the department. Similarly, the theory will assist me in offering guidance to nurses during crises, addressing patient safety concerns, and monitoring compliance with policies and regulations (Pishgooie et al., 2019).The Change Agents to Implement the Change               The individuals to implement the change initiatives will include those who in the past have led change. The change agents will consist of: The crucial role of the organizational leader will be decision–making as it pertains to the adoption of the change process. In addition, the organizational leader will act as the overall change process coordinator between all the stakeholders in the change implementation process (Rowse, 2018).Similarly, the role of the chief nursing officer in the change process will be organizing and carrying out administrative work, i.e., compiling and storing all the notes on the change process taken by other agents of the change team to inform the outcome.                  The role of the nurse leaders in the change process will be to make decisions to address the understaffing challenge. They will also organize training as required in the change model, manage professional development sessions, and prepare budgets. Further, the nurse leaders will oversee nursing teams in the AICU to ensure change procedures to realize desired change outcome (Rowse, 2018). Moreover, the role of the nurse managers will be managing human and financial capital, ensuring clients’ and employees’ satisfaction, maintaining a safe environment for staff patients, ensuring standards and quality of care are maintained. Further, they will be aligning the change outcome with the organization’s strategic goals. The change leaders’ experience, knowledge, and skills will be valuable to implementing and managing the proposed change initiative (Rowse, 2018).                The role of the change agents will be to advocate the change and play the role of a catalyst for the change management process. They will aid the organization and the AICU to transform how it operates by inspiring and influencing other staff and all the stakeholders in the change process (Ockene et al., 2019)The Change Model

The change model comprises assessing the AICU to determine the current and future Unit needs and the stakeholder views and perceptions about the Unit issues that should be addressed to promote excellence. In addition, the second step of the model is planning. Planning will seek to develop strategies to achieve the desired change outcomes concerning resources required to effect the change (Sharma et al., 2018). Further, the model will involve training to ensure change leaders and adopters have the desired competencies to implement the change; similarly, it will inhibit resistance to change. Implementation of the model will provide a complete change outcome (Sharma et al., 2018). Moreover, the change model will have a phase of monitoring and evaluation to determine the effectiveness of the implementation and the set outcome of the change. Further, the model will have decision–making to determine whether the change will be incorporated into the Unit practices or rejected by the organizational leaders.


               The change model is relevant to my organization. It focuses on the incremental and systematic implementation of change. The systematic implementation of change ensures that the existing systems and processes adapt to changes. The other relevance of the shift in the organization is that it emphasizes the need for stakeholder preparedness for the difference. The model also fits with the organizational culture. It promotes excellence and continuous improvement, focusing on the organization’s culture (Sharma et al., 2018).               The strategic aspects include identification for the change initiative, engagement with critical stakeholders, a roadmap for the change initiative, putting the plan into action, removing obstacles, and finally, initiation and tracking the change progress to realize the desired outcome.In addition, the reason for the Change Initiative: The first strategic aspect refers to the reason for the initiation and implementation of the change. Essentially, the ‘why’ for the change in the AICU is to change the department’s current state of nurse understaffing. All stakeholders are involved, including organizational leaders, nurse leaders, and managers (Chen & Nates, 2020).The action to be taken comprise of provision of financial resources, human resources, and technological support. In addition, engagement with core stakeholders refers to the organizational leaders who are the primary decision-makers. They need to support the change initiative.               Further, the roadmap for the initiative is a communicative design that avails a simple illustration of how the change process will evolve. The people involved include change adopters and implementers. Similarly, operating the change into action, removing the obstacle, and initiating and tracking the change aspects are the functional stages of the implementation and assessment for the success of the change process. All the stakeholders are involved (Chen & Nates, 2020).Potential Barriers to Change               The possible barriers include a lack of clarity regarding a clear vision for the change process. In addition, ineffective or lack of change communication may impede the change process. Furthermore, strategic shortcomings and lack of organizational buy-in for the change may prove quite a challenge. Similarly, change fatigue and lack of governance could also manifest as barriers to change implementation.  The possible ways to reduce or undo resistance to the change will be through stakeholder support to overcome resistance. Several strategies will be explored to overcome resistance through open communication. Open communication will be essential in building the desired trust between the stakeholders involved in the change process. The second strategy is active stakeholder involvement. The stakeholders will be actively involved in implementing the change (Rowse, 2018). Active stakeholder involvement will ensure the staff has the desired knowledge and skills to implement the change. Competency development among the adopters will minimize the risk of resistance to change.

Several methods will be adopted for the successful implementation of the change. One of the strategies is communicating the change initiative through the right people. The change will be communicated through team leaders, managers, and organizational leadership to create awareness and interest among the managerial staff. Using the right people to share the change will ensure that the nurses and other teams in the AICU trust and support the need for the change in their practice. The second communication strategy is consistency and clarity. The change information should be communicated consistently and straightforwardly to the employees to increase a sense of urgency. Consistency in communication raises awareness among staff about the need for adopting behaviors that align with the goals of the change (Rowse, 2018).

Assessment Methods to Determine the Level of Success of Change Initiative

Several metrics will be applied to determine and evaluate the success of the departmental change. The forms will include departmental performance. An increase in performance often confirms the success of a change initiative. The other method will be by analyzing departmental and organizational competitiveness (Schmidt & Brown, 2021). A rise in corporate competitiveness indicates the change in the existing systems and processes to maintain its competitive edge in the market. Moreover, the approach to evaluating the need for change is to analyze resource utilization in the organization. A rise in resource utilization within the set standards fosters change and strategy maintenance to promote resource utilization effectively and efficiently. Similarly, the nurse satisfaction with their jobs will also be employed in the evaluation. Staff satisfaction raises organizational effectiveness (Schmidt & Brown, 2021).

Proposed Strategies to Anchor Change or Support Continuous Change

The strategies to anchor the change initiative or the continuous will be through securing organizational support. Organizational support in human resources and financial aid will be sought to implement the change successfully. The other strategy will be creating teams to lead the implementation of the change. Teamwork in the performance of change addresses barriers and promotes collectivism in realizing the change objectives. Open communication will also be used as part of the implementation strategies. Open communication will increase trust among the staff involved in the implementation process. It will also ensure that their views, concerns, and ideas are incorporated into the change implementation process (Lumbers, 2018).

In addition, Sustainability Strategy will be employed to foster continuous change. The sustainability of change initiatives is essential in healthcare, as it ensures continuous improvement in systems and processes. Several sustainability strategies will be applied for the change initiative. There will be constant feedback on success and issues in implementing the change. Feedback will inform improvement strategies for the change. The change stakeholders will also be motivated (Fagerström, 2021). The other approach to promote change sustainability will be improving the outcomes and effectiveness of the change. The plan will be revised continually to ensure optimum change outcomes. Furthermore, the other method will be encouraging change ownership by the stakeholders. The stakeholders will be encouraged to play a proactive role in examining additional strategies to address the weaknesses of the change. Advocacy will also be employed to get adequate resource support from the organization. Adequacy in resource support will ensure that the long-term goals of the change are achieved (Fagerström, 2021).

How Change Plan Supports the Organizational Mission/Goal               The change plan will work well with the organization’s culture. The program recognizes the need for utilizing only the best strategies in change implementation. The focus on best practices aligns with the organization’s culture where the healthcare providers are encouraged to use evidence-based interventions in the patient care process and satisfaction. The plan also aligns with the organizational leadership. Similarly, the project also supports using best practices to promote continuous quality improvement. As a result, change implementation incrementally leads to the overall improvement in organizational performance(Fagerström, 2021).Conclusion               The focus for the change will be placed on ensuring that the interventions used in the change process are improved regularly. In addition, the sustainability of change initiatives will ensure continuous improvement in the department through securing organizational support and the stakeholder. The change initiative will be given administrative support to foster. Continuous change since the change model aligns with the organization’s mission.               



Abdelmagid, K., Bree, K., & Christopher, H. (2021). The Impact of under-Staffing of Nurses on Sedative/Analgesic Agents Administration in Pediatric Intensive Care Unit [PICU]. Pharmaceutical Science and Technology, 5(1), 7.

Chen, K., & Nates, J. L. (2020). ICU staffing, models, and outcomes. Oncologic Critical Care, 33-42.

Fagerström, L. M. (2021). Leading Change When Implementing Advanced Practice Nursing. In L. M. Fagerström (Ed.), A Caring Advanced Practice Nursing Model: Theoretical Perspectives and Competency Domains (pp. 219–233). Springer International Publishing.

Gilbert, H. A. (2020). Florence Nightingale’s Environmental Theory and its influence on contemporary infection control. Collegian, 27(6), 626-633.

Holten, A. L., Hancock, G. R., & Bøllingtoft, A. (2019). Studying the importance of change leadership and change management in layoffs, mergers, and closures. Management Decision.

Lumbers, M. (2018). Approaches to leadership and managing change in the NHS. British Journal of Nursing, 27(10), 554–558.

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Ockene, J. K., Lindsay, E., Berger, L., & Hymowitz, N. (2019). Health care providers as key change agents in the Community Intervention Trial for Smoking Cessation (COMMIT). In International Quarterly of Community Health Education (pp. 223-237). Routledge.

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Assessment Description
You will utilize your change model for this assignment. Review the feedback submitted by your instructor on your previous change model assignment. Make any changes or modifications necessary for the submission of this assignment.

Evaluate the performance of your organization or department. Identify an area that would significantly benefit from initiating a change. Write a paper (1,500-1,750 words) in which you describe the particular area you propose to address through a change initiative. Include the following for your company:

1. Discuss the issues in this area and the current outcomes as a result of the issues.
2. Describe the external and/or internal driving forces, contributing issues, and the people affected.
3. Evaluate the stakeholders involved and discuss how they will be affected by your change initiative.
4. Clarify your role and responsibility as a change leader. Discuss the leadership theory (or theories) you will use to guide the change process.
5. Discuss the change agents you need to recruit in order to successfully implement your change. Describe the roles of these change agents.
6. Utilize your change model to develop strategies: (a) Explain the relevance of this model to your organization; and (b) Present the strategic aspects using your model. Be sure to clearly define the purpose of each aspect, the people involved, and the actions that need to be taken.
7. Identify, or predict, the potential barriers to change. Discuss possible ways to overcome these obstacles, including methods for dealing with emerging or unforeseen circumstances that could impede implementation.
8. Describe the evaluation methods you will use to determine the level of success of your change initiative. Discuss what metrics or measureable determinates you will use.
9. Propose strategies to anchor change or support continuous change.
10. Establish how your change plan supports the organizational mission/goal, genuinely addresses stakeholder concerns, and will serve as an equitable contribution for the community or society overall.

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