Inclusive approach seen as easing 'change fatigue' in Alberta hospitals

“Change fatigue” among front-line hospital nursing staff may be affecting efforts to reduce health-care costs in Alberta, says a professor at the Haskayne School of Business.

“It’s a phrase that came up during the interviews for our study,” says Dr. Jaana Woiceshyn, PhD. “There is yet another top-down initiative and they’re told, ‘We have to do this,’ and they feel really burdened trying to get all that done while trying to take care of their patients at the same time.”

As part of a University of Calgary team that included researchers at the Cumming School of Medicine (CSM), Woiceshyn led a study that was recently published in the Journal of Change Management. Its conclusions are based on interviews of 25 nursing staff and their 12 front-line managers in six units spread over a total of five hospitals in Calgary and Edmonton.

Staff part of the process

The study gathered their perceptions about the response of their units to an initiative in 2012 by the then-provincial Minister of Health. He ordered Alberta Health Services to lower health-care costs by finding ways to reduce the amount of time patients stayed at hospitals (as of 2018, the province was spending $59 million per day on health care).

“In the more efficacious hospital units, staff said managers started by invoking their shared nursing values — which is ‘what is best for the patient’ — and then they invited their staff to be part of the implementation process from the get-go,” says Woiceshyn.

“They explained it early to their staff, rather than saying: ‘OK, this is the way I am going to do it, and this is how I am going to tell you how to do it’ and all that. They said, ‘Let’s ask some of these people who actually have to implement these changes how they would go about it, and we'll discuss it.’”

Although this inclusive approach involved greater deliberation and planning, making it more time-consuming, the nursing staff interviewed in the study regarded it as ultimately providing better results than more forceful, top-down methods focused on quicker turnarounds, says Woiceshyn.

“The initiative was taken quite early in the successful units to get people engaged and involved in implementing the changes, and then they practised these things together,” she says. “They did some iterative implementation activities together, and they did them gradually over a longer period of time.”

Method seen as vital

This relational approach likely helped alleviate change fatigue within successful units, says Woiceshyn, adding such fatigue is a probable factor among managers of less successful units, not just their staff.

“The manager says, ‘Oh, no, here’s another change that I have to impose on my staff. We just have to get it done quickly.’ Of course, it wasn’t their intention not to do things well, but the way they approached the situation made it more difficult to successfully implement change.”

As part of the study, staff ranging from registered nurses and licensed practical nurses to nursing aides were interviewed in 2015 at units involving cardiology, internal medicine and surgery. Although the hospitals containing these units cannot be identified in order to protect respondent confidentiality, Woiceshyn says four of the units were in Calgary, with the remaining two in Edmonton.

She says it is revealing that most research into health-care change looks at the role of leaders and middle managers, not staff.

“Where the rubber hits the road is really at the front lines of health care, which is among staff at the hospital units,” she says. “We have all these problems with escalating costs, aging populations and increasingly bureaucratic organizations, so I think health care can use all the help it can get from research such as this.”

Besides Woiceshyn, the study was co-authored by Dr. Jo-Louise Huq, PhD, an adjunct assistant professor at Haskayne; Kenneth Blades, previously a research associate at W21C at CSM; and Dr. Sachin R. Pendharkar, MD, an associate professor in the Departments of Medicine and Community Health Sciences at CSM, and a member of the O’Brien Institute for Public Health.