How to be a Facilitator of Change

Change is said to be inevitable, one of the few things in life we can count on. In healthcare, change often becomes necessary because of new technologies, legislation, policy reforms, changing standards of care, or even negative factors like staff shortages. Most healthcare organizations have some sort of process improvement program in place at the management level, with the goal of reducing costs, enhancing efficiency, and improving patient care by correcting bottlenecks and other workflow problems. But where do you fit into all of this?

The ability to facilitate change is an important leadership skill, and you don’t have to be a nurse manager to develop it. Even staff nurses can step forward to identify activities that can make a difference in patient care or help the unit run more smoothly. In fact, many organizational studies have found that successful process improvement plans come not from top management, but from engaged employees who feel like stakeholders in the processes being targeted for change. So if you’re passionate about an issue, you have the ability to emerge as a leader and a facilitator of change.

An Initiative for Change: Transforming Care at the Bedside

Transforming Care at the Bedside (TCAB) is an improvement initiative that began in 2003, as a pilot program at three hospitals. Today, more than 60 hospitals have a TCAB initiative. The Robert Wood Johnson Foundation (, which funded the pilot program, explains the unique ways in which TCAB can empower staff nurses to be facilitators of change:

TCAB takes a unique approach to addressing quality of care issues by supporting nurses and other frontline staff to develop their own interventions, design new processes and adapt ideas from staff that improve care. This is a bottom-up, team-based approach to achieving quality rather than a top-down approach.

If you’re a staff nurse, one of the easiest ways you can begin to facilitate change is to propose that your unit start its own TCAB pilot program. You can find an online toolkit at The toolkit clearly outlines suggested methods for testing the impact of small changes, them implementing them on a wider scale.

A Case Study: Staff Nurses as Facilitators of Change

Nurses at the M.D. Anderson Cancer Center in Houston have successfully used the TCAB program to implement several process changes. Front-line staff nurses were encouraged to generate ideas, and then to test the most promising of them. The tests didn’t have to be extensive – in some cases, testing began with one nurse trying out an idea during one shift. If the process seemed to work, the nurse can share the idea, recruiting others to help test it on a wider scale.

As a result of TCAB, several nurse-generated ideas for change have been implemented throughout the hospital – including a new process to handle patient handoffs during shift changes. Under the old process, nurses were often spending up to an hour updating the incoming shift on the patient’s conditions. Now, a standardized, computerized shift report can be completed in less than 20 minutes.

Another very small change has been to place whiteboards in all patient rooms. These are updated daily with the names of the caregivers on duty that day and a photo of each one. Now, patients and their family members can easily recognize the members of their care team – a patient-centered change that’s easily recognized as a benefit by staff nurses, but was unlikely ever to be targeted by top management.

In Summary: Staff Nurses as Clinical Leaders

As a staff nurse, you already advocate for your patient. Now it’s time to consider the ways you can become an agent of change within your unit. It’s essential to be proactive, rather than living with the status quo, wherever the quality of patient care is at stake. You don’t have to wait for others to identify processes that can be improved upon – you can assume a leadership role at the staff nurse level.

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