Managing Change: Nurse Managers’ Behaviors in the Course of Systems Redesign

Abstract

Systems redesigns in hospitals are a way of coping with the changing healthcare environment. Redesign may, however, negatively affect nurses and nursing practice.

The purpose of this study was to clarify nurse managers' behaviors during the course of system redesigns. We used a qualitative study design, and conducted a longitudinal study at three time-points, using interviews and observations on hospital wards that were reorganized. We also conducted retrospective interviews with nurse managers who had experienced hospital reorganization. Data were analyzed based on the Modified Grounded Theory Approach.

The main roles of nurse managers during system reorganizations were to "organize the ward". The nurse managers organized the working environment for the medical staff to ensure mutual agreement among staff members, patient safety, and task performance efficiency. To do so, they drew on four behavioral guidelines and 12 behaviors. The four behavioral guidelines were: "Help the staff nurses to develop a schematic image of their new environment, so they can see their work as a series of movements", "resolve conflicts among medical and other staff on the wards and confirm agreements", "seek mutually agreeable improvements", and "support staff nurses so they can perform their tasks effectively". These four guidelines were needed for the duration of hospital reorganizations. To provide better healthcare in the ward during and after system redesign, the managers organized their work using 12 behaviors under the four behavioral guidelines.