Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
Department of Health Management and Policy, University of Iowa, Iowa City, IA, USA.
J Nurs Manag. 2018 Jul;26(5):571-578. doi: 10.1111/jonm.12584. Epub 2017 Dec 17.
To examine how the process of change prescribed in Kotter's change model applies in implementing team huddles, and to assess the impact of the execution of early change phases on change success in later phases.
Kotter's model can help to guide hospital leaders to implement change and potentially to improve success rates. However, the model is under studied, particularly in health care.
We followed eight hospitals implementing team huddles for 2 years, interviewing the change teams quarterly to inquire about implementation progress. We assessed how the hospitals performed in the three overarching phases of the Kotter model, and examined whether performance in the initial phase influenced subsequent performance.
In half of the hospitals, change processes were congruent with Kotter's model, where performance in the initial phase influenced their success in subsequent phases. In other hospitals, change processes were incongruent with the model, and their success depended on implementation scope and the strategies employed.
We found mixed support for the Kotter model. It better fits implementation that aims to spread to multiple hospital units. When the scope is limited, changes can be successful even when steps are skipped.
Kotter's model can be a useful guide for nurse managers implementing changes.
探讨科特变革模型中规定的变革过程如何应用于实施团队碰头会，并评估早期变革阶段的执行对后期阶段变革成功的影响。
科特模型可以帮助医院领导指导变革，并有可能提高成功率。然而，该模型的研究还不够充分，特别是在医疗保健领域。
我们对 8 家实施团队碰头会的医院进行了为期 2 年的跟踪研究，每季度对变革团队进行访谈，询问实施进展情况。我们评估了医院在科特模型的三个总体阶段中的表现，并考察了初始阶段的表现是否会影响后续阶段的表现。
在一半的医院中，变革过程与科特模型一致，初始阶段的表现影响了后续阶段的成功。在其他医院中，变革过程与模型不一致，其成功取决于实施范围和采用的策略。
我们发现科特模型的支持存在差异。它更适合旨在扩展到多个医院单位的实施。当范围有限时，即使跳过步骤，变革也可以成功。
科特模型可以为实施变革的护理管理者提供有用的指导。
