Step 2: Engage change agents

This section outlines the importance of engaging with change agents who can assist with implementing evidence into practice. Change agents may be leaders, facilitators or champions; their involvement is pivotal to successful change (Kitson, Alison et al. 1996; Redfern & Christian 2003).

Types of leaders

Not all key stakeholders need to be involved or engaged with a project, but most will need to be aware, have sufficient information to be supportive, and be able to bring resources to bear for the benefit of the project as required. Different kinds of leadership exist, and knowing these types of leadership can assist in identifying whom to inform, whom to engage and whom to invite as active co-participants. Classifications of types of leadership include:

• System leader: This person is an influencer and leads across departments, organisations or sectors. System leaders have the ability to overcome barriers and are able to facilitate and make progress towards change.
• Technical expertise: This person has exceptional knowledge in the subject matter, requiring a degree of enthusiasm and expertise. If the subject is particularly broad, such as vital signs, then technical experts with different backgrounds may be warranted.
• Day-to-day leadership: This responsibility should rest with someone who has time and professional interest/enthusiasm to devote to the project. This person should also be able to recruit others and encourage relevant activity.

Project management

Large-scale implementation projects may benefit from the appointment of a project manager. This person will have the following roles:

• Coordinating group member access to evidence-based healthcare resources needed to undertake the project, such as the JBI clinical audit resources
• Coordinating training sessions
• Managing timelines
• Monitoring data collection and analysis
• Scheduling project meetings to review audit results and preparing strategies for improvement
• Coordinating strategy implementation
• Ensuring feedback has been provided at all steps to the organisation.

Facilitation

In evidence implementation projects, there is often need for a person to play the lead role in achieving change at the point of care. These people are sometimes called champions, change agents or facilitators of practice change. Kitson et al. defined facilitation as “a technique by which one person makes things easier for others” (p.152) (Kitson, A., Harvey & McCormack 1998).

Health professionals face difficulties navigating the change process as it is such a complex phenomenon, and many approaches to managing change exist (Salmela, Eriksson & Fagerström 2012). Some of the essential ingredients for successful change include:

• Organisational commitment
• Active support from key stakeholders
• Recognition of the importance of change
• A credible change agent
• Face-to-face contact with practitioners to promote enthusiasm
• Ensuring targeted staff have ownership of the innovation and are empowered to change (Redfern & Christian 2003).

As you can see, a credible change agent or leader or facilitator is pivotal to successful change (Kitson, Alison et al. 1996; Redfern & Christian 2003). During the change process, these facilitators need to “guide, motivate, set norms and standards; maintain open communication, invite and listen openly and actively to the opinions, attitudes and ideas of others; continuously re-evaluate facts, beliefs and positions; encourage two-way feedback; integrate the efforts of others; promote and sustain efficient performances; and delegate power and authority” (p.424) (Salmela, Eriksson & Fagerström 2012). The steps that can lead to change include reflection, discussion, measurement and strategising approaches to change (Deegan et al. 2005; Munn, Zachary et al. 2016).

Facilitators should ensure they are communicating the purpose of change clearly to all stakeholders. (McGrath et al. 2008). This should be in the form of open consultation and dialogue (Deegan et al. 2005). As Deegan states, “people need to be involved in aspects of change that affect them, because they will only accept changes that fit into their cultures. This implies that, because stakeholders ‘own’ the changes, the processes and the outcomes, they are more likely to accept and sustain the changes” (p.26) (Deegan et al. 2005).

Findings from evaluation studies on facilitation suggested that facilitation which provides face-to-face communication and uses a range of enabling techniques can lead to positive changes in clinical and organisational practice (Harvey, G. et al. 2002).

Go to Step 3: Assess context and readiness to change