The Outcomes of Consultation for Organizational Change in a Hospital: From Experience of the Consultation for Reducing Nursing Turnover Rate

Abstract

In the U.S.A., consultation is an important function for enhancing for quality of nursing care. Since the needs related to organizational change, including improving quality of nursing care, are high in Japan, consultation will be increasing in demand for all nursing fields. This article reports the process of the authour's nursing consultation practice as an outside consultant to the administration of a private hospital in Tokyo, which had opened five years previous to beginning the consultation. After studying the problem, the consultant recommended interventions for reducing the nursing turnover rate. These recommendations were implemented by the hospital administration over three years. The consulting process is described using the method by Lippitt and Lippitt: Phase 1) Engagement and entry; Phase 2) Contract formulation and establishment of a helping relationship; Phase 3) Problem identification; Phase 4) Goal setting and planning; Phase 5) Implementation; Phase 6) Contract completion and termination. The outcomes include changes the organizational structure, reduction of the nursing turnover rate, and increases in nurses' job satisfaction. Lessons learned from the consultation included importance of the establishing a good relationship between consultant and consultees at entry, the formal contract, the supervision for the consultant, collaboration with the physician administrator, and the consultant's role as an advocator.