Making Changes

Why is change so hard?  Whether it is something as simple as adding a new skill to our “tool box”, or a big project such as Baby Friendly Hospital designation, it can be hard.  It puts us outside of our comfort-zone.  That safe feeling of confidence, security and being free of risk.

For some of us, adapting to change is easy.  It may be uncomfortable for a short time, but basically not a big deal and we move on doing things the “new way”.   We are sometimes called the “innovators, or the early adopters”.   We view a new way of doing things as a challenge and we find it exciting.  We welcome the change.

For others of us, adapting to change is difficult.  And down-right scary.  We find any and every reason not to make change.  We are in the group called the “late adopters or the laggards”.  We dig in our heels and won’t listen to reason. 

There is, of course, the group in the middle who see the majority of people making the change and who will go along with the crowd.

My mother-in-law was a late-adopter.   Microwave ovens have been common place in kitchens since the 1960’s.  She refused to have one.  Even when her adult children bought one for her at Christmas years later, she refused to use it.  It sat in the garage.  “I can’t see any reason for it.  The stove works just fine”.    No way would she explore what benefits it might have for her.

So when change is thrust upon us by our supervisor, or maybe by the management’s decision to become Baby Friendly, how do we handle it?  Embrace it or resist it?  Or maybe wait to see what everyone else thinks first.

Getting un-stuck

• Know why you are making the change
  • Gather the relevant research and review it.  Discuss it in a committee meeting.  Decide how the research aligns or doesn’t align with your current policies and procedures
  • What could be the upside of making the change?
• Know how to make the change
  • Let people vent and grieve the loss of the old way
  • Change policies and procedures based on your analysis of the research
  • Get needed resources whether those are people resources or equipment
  • Orient staff to the new policy and procedure
  • Start small – make a small change, then several small changes, then you will have a big change
• Avoid failure.  Nothing is more discouraging than working on a project just to have it fall apart.
  • Plan carefully to avoid unintended consequences
  • Be ready for set-backs whether in the form of the laggards who give you resistance or the administration who change their support/resources.
• Making it stick
  • Keep the enthusiasm going with staff meetings, supervisory sessions, posters,
  • Use peer support for those who need coaching
  • Use peer pressure for those who are resisting

Example:

Let’s look at the concept of delaying the newborn bath that is usually done soon after delivery.   I have heard nurses say, “We do the bath when the mom is transferred to her post-partum room.  She can’t hold her baby then anyway”.  Or, “Moms don’t want to hold a gooey baby”.  Or, “how could a bath make any difference in initiation of breastfeeding?”

Why should a hospital make the change to delaying the bath?  Search up the research.  Here are a couple of specific articles, but there are many more on the consequences of delaying skin-to-skin contact for mom and baby.  Skin-to-skin is essential for a good start to breastfeeding and it is often delayed or interrupted for the baby bath.

A delayed newborn bath was associated with increased likelihood of breastfeeding initiation and with increased in-hospital breastfeeding rates.

Preer G, Pisegna JM, Cook JT, Henri AM, Philipp BL.  Delaying the bath and in-hospital breastfeeding rates.  Breastfeed Med. 2013 Dec;8(6):485-90.

In this review of the literature, procedures beneficial to initiating breastfeeding such as drying, skin-to-skin contact, delayed cord clamping, and delayed bathing were either omitted or inappropriately sequenced in the time immediately after birth in a significant number of institutions.  Sobel HL, Silvestre MA, Mantaring JB, Oliveros YE, Nyunt-U S.  Immediate newborn care practices delay thermoregulation and breastfeeding initiation.  Acta Paediatr. 2011 Aug;100(8):1127-33.

Does the research support the policy and procedure on the timing of bathing?  If not, what is the best way to modify it.  Delay the bath for two hours or for four hours, wait until the baby wakes up from his first deep sleep, wait until the nurses routine bathing time, wait for 24 hours, or wait until hospital discharge?  A bath demo could be done with the parents in the discharge teaching.  What will work for your hospital?  Maybe little steps would be a good start.  So start with a delay of 2-4 hours.  When that is working well, make it 24 hours or at hospital discharge.  Explain to parents what the policy is and why you bath babies the way you do.  Enlist their support.  The vernex is good for the baby’s skin and can be massaged in.

What could be the upside of changing to delayed bathing?  It saves nurses time, babies don’t have to spend extended periods of time under the radiant warmer warming up after the bath and the bathing procedure can be used as a teaching tool with new parents.

If there are several people who are not embracing this new procedure, let them vent.  Acknowledge that change is difficult and the old way of doing things seemed to be working well.  Help them move past this.

Have your pediatric committee or breastfeeding committee review the policies and procedures based on the research that was reviewed and make the needed revisions.  Communicate the revision to the staff so everyone is aware of the change.

Think about what resources might be needed.  Are there any?  How can in-servicing of the new procedure be done most effectively?  Will you use staff meetings or have a skills station?  Posters?

What unintended consequences may happen?  Do your homework.  Know what pitfalls there could be and plan to avoid them.  Will babies become chilled?  Make sure that babies are dried and placed skin-to-skin immediately after birth.  Are warmed blankets available?  What other unintended consequences might arise?

Involve everyone in evaluating how the new procedures are going.  Make any adjustments that are necessary.   Maybe you can give your laggards a key role in supporting the new procedure.  That just might help them become your strongest innovators.

Keep the ball rolling!  Who are your innovators who can give encouragement and training to the rest of the staff?  Have them lead by example.  And then you can use a little peer pressure to bring around the rest of the staff.