Asking organizations to change the way they conduct their business is similar to asking individuals to change their lifestyle. Change creates uncertainty. Change is unpredictable. There needs to be a commitment from the staff and management, and a specific plan for implementing the change. This article will address the specifics of an implementation plan. The essentials include a strong project manager, an effective project team, and a detailed implementation plan.

 

Figure 1. Project management: A glossary

Project. A project is a temporary endeavor with a defined beginning and end undertaken to meet unique goals and objectives to bring about beneficial change or added value.

Project Manager. Overall responsibility to see that the project gets done.

    Before – gets the team started
    During – keeps the team on track, primary point of contact for the project
    After – make sure team’s work is documented, follows up with new owners of the project

Sponsor. The sponsor is the person who has ultimate authority over the project. The executive sponsor provides project funding, resolves issues and scope changes, approves major deliverables, and provides high-level direction. He or she also champions the project within the organization.

Scope. Scope is the way you describe the boundaries of the project. It defines what the project will deliver and what it will not deliver.  Any changes to your project deliverables, boundaries, or requirements would require approval through scope change management

Stakeholder. Specific people or groups who have a stake in the outcome of the project are stakeholders. Normally stakeholders are from within the company and may include internal clients, management, employees, administrators, etc. A project can also have external stakeholders, including suppliers, investors, community groups, and government organizations.

Deliverable. A deliverable is any tangible outcome that is produced by the project.  These can be documents, policy and procedures, plans, computer systems, buildings, machines, etc.

 

1. Project management

The ideal process for implementing change is to organize and manage the work. This is the definition of project management. Before you start to implement a change or project, it is important to know the overall objectives, scope of work, deliverables, risks, assumptions, barriers, project organization chart, and project budget.

The project manager is the person with the authority to manage a project. The project manager is responsible for the processes used to manage the project. The processes used to manage the project include defining the work, identifying the team members, building the work plan and budget, managing the work plan and budget, scope management, issues management, risk management, and communication plan. These different pieces make up the project plan (see Figure 2).

2. Project team

The project team consists of the full-time and part-time resources assigned to work on the deliverables of the project. A deliverable is any tangible outcome that is produced by the project. All projects create deliverables. These can be documents, plans, computer systems, buildings, educational tools, or other items identified by the team. Internal deliverables are produced as a consequence of executing the project and are usually needed only by the project team. External deliverables are those that are created for clients and stakeholders. The team members are responsible for understanding the work to be completed; completing assigned work within the budget, timeline, and quality expectations; informing the project manager of issues, scope changes, and risk and quality concerns; and proactively communicating status and managing expectations.

3. Implementation plan

The implementation plan tells an observer how the project team will complete the project. It describes the activities required, the sequence of the work, who is assigned to the work, an estimate of how much effort is required, when the work is due, and other information of interest. The work plan allows identification of the work required to complete the change. Once the plan is in place, it guides the team and they perform the work according to the plan.
Once these elements are defined, the team can begin its work.

Organizational steps

Defining the work
Begin the process by brainstorming potential goals, objectives, and activities for the project. Consider what strategies will be used to achieve the goals and objectives, as well as the resources (including staff, budget, equipment, and technical assistance) needed to carry out the plan. Think about the criteria that will be used to evaluate the effectiveness of the plan. How will you measure progress toward your goal? How will you ensure accountability?  

Before creating a new plan of action to address the project, the team should first consider whether there is an existing plan that can be modified. Modification of an existing plan can be as simple as adding activities that would make an impact on the project.

Identifying the project team
The first task in formulating your plan is to identify the project team. Identify the needed skills to ensure the project is a success. Form a team that is representative of the stakeholders. The team member must make a commitment to make time in their workday to attend meetings and submit reports as determined by the team. For example, a team for the project to convert from one type of dialysis delivery system to another should have a representative from nursing, technical department, administration, social services, education, as well as a patient representative (see Figure 3).

Figure 2

Establishing timelines
The second task in formation of your plan is establishing a time frame for implementation. Depending on the size and scope of change needed at your organization, the time frame may extend from weeks to months and at times possibly years. It is important to recognize that this is a complex process, but a project has a beginning and an end. Projects are not an ongoing process. List the major pieces or steps in chronological order. Identify steps that need to be completed before another step can begin (task predecessors). Establishing a timeline allows project team members to follow the tasks and responsibilities required for successfully completing the project. It stimulates accountability by creating milestones or deadlines by which work must be completed. However, keep in mind that although initial timelines are put in place, they may be changed depending on the internal and external factors impacting the project.

Managing the plan
Develop a preliminary plan that outlines each step. Include who is responsible for each step and how long it will take to accomplish. Get feedback from the stakeholders on the preliminary plan. You may need to adjust timelines or deliverables after stakeholder review. Publish the working plan by posting it on the organization’s website, bulletin board, or other sites used by the organization. Work the plan and change as needed. It is not a static document. Monitor the project team’s progress through meetings, calls, and status reports. Document everything; keep track of the changes made to the plan for discussion at project team meetings (see Figure 4).

Figure 3

An example of a project implementation plan may have the following columns:

  • Task – list of project tasks
  • Percentage completed – lists the percentage of each task completed
  • Status – task status such as completed, on schedule, behind schedule, cancelled
  • Day started – date task begun
  • Day to be complete – estimated date of task completion
  • Actual completion date – date task was completed
  • Task assignment – Name of task owner
  • Priority – task priority such as high, medium or low
  • Milestone – yes or no to indicate if this is a milestone task
  • Notes

See Figure 4 for more details.

Figure 4

Risk management
The foreseeable project risks are documented on a risk plan with a set of actions to be taken to prevent the risk from occurring and to reduce the impact of the risk if it should materialize. This is an important activity within the planning phase as it is necessary to mitigate all potential risks prior to beginning the project.

Communication plan
Prior to implementing the plan it is necessary to identify how each of the stakeholders will be kept informed of the progress of the project. The communication plan identifies the type of information to be distributed, the methods of distributing, the frequency of distribution, and the responsibilities of each person on the project team (see Figure 5).

Figure 5

Execution phase
The execution phase is typically the longest phase of the project. It is the phase within which the deliverables are physically constructed and presented for approval. Deliverables may be constructed in a “waterfall” fashion where each activity is taken in sequence until the deliverable is finished or in an “iterative” fashion where iterations of the deliverable are constructed until the deliverable meets the stated requirements. It is important that control processes be in place to ensure the quality of the final deliverable meets acceptance criteria. An implementation plan is no good if there is no accountability. Laying a foundation for monitoring progress and following through is the best assurance that change will be successful and complete. It is very important to develop a system to identify and maintain contact with individuals who have been assigned specific responsibilities within the plan.

Closure
Following the completion of all project deliverables, a successful project will have met its objectives and be ready for formal closure. Once your team has planned, created, implemented, and the change has become part of your daily work (standard operating procedure), you are ready to evaluate the process (see Figure 6).

Figure 6

Critical factors

To ensure your plan is successful, follow these steps.

Clarifying plans: has the process been defined?
The implementation plan tells an observer how the project team will complete the project. It describes the activities required, the sequence of the work, who is assigned to the work, an estimate of how much effort is required, when the work is due, and other information of interest. The work plan allows identification of the work required to complete the change. It is also important to indicate what will not be involved in the project. For example, if the team is looking to convert from one dialysis delivery system to another, senior management may insist that the water system be changed at the same time. This would involve the coordination of teams within the two project plans to ensure the water system is in place prior to the dialysis delivery system conversion.

Providing education: End users understand and use the new processes and procedures
To bring about change successfully, educational material must be developed for physicians, clinical staff, ancillary staff, and patients.

Fostering ownership: End users identify new processes and procedures as their own, rather than regarding them as changes imposed upon them
Ensure that each staff member has had the opportunity to address concerns with the new process. Post the project teams meeting minutes on the company website or newsletter. Involve the entire organization in naming the project. A company-wide contest for the name that reflects the project objective will increase buy-in.

Integrating new practices: Has the change been incorporated into day-to-day operations?
So you've got a new policy. Now what? Your policy won't be taken seriously unless you actually do something about it. In some ways, it is worse to have a policy and not follow it than to have no policy at all. By not following through on the policy, you would send the message that you weren't serious about the policy in the first place. This can actually put your organization at risk, especially during a survey.

Giving feedback:  Judge the effectiveness of the implementation plan
Evaluate the process. Use a formal evaluation as shown in Figure 6. Get feedback from the project team and the stakeholders to determine if the project was managed effectively.

Summary

Change has become a constant in the workplace. Although the staff may resist change and feel it is happening too quickly, leading change is a critical component for nurse leaders. It is important for the registered nurse to take the lead and guide the staff through the process.

Resources

  • American Organization of Nurse Executives (2005). AONE nurse executive competencies. Nurse Leader. 3(1). 50-56.
  • Schiller B, Doss S, De Cock E, Del Aguila MA, Nissenson AR (2008). Costs of managing anemia with erythropoiesis-stimulating agents during hemodialysis: A time and motion study. Hemodialysis International, 12: 441–449. doi: 10.1111/j.1542-4758.2008.00308.
  • Stichler, J.F. (2011) Leading change. Nursing for women’s health. 15(2) 166-170.
  • Sullivan E, Decker P. (2005). Effective leadership and management in nursing. 6 ed. New Jersey: Prentice Hall.