Education leadership in the clinical health care setting: a framework for nursing education development

Effective change management in a regional Sub-acute Ambulatory Care Services setting

Government policies and community expectations in Australia continually lead to calls for healthcare change. These changes are often met with resistance from clinicians and managers. Making change happen requires consideration of the way policies, culture, context, shared vision and leadership can drive or impede change. This reflective case study critically investigates one change process; the evolution of a Sub-acute Ambulatory Care Services (SACS) program in an Australian regional hospital over a 3-year period. The new Community Rehabilitation Services (CRS) program evolved from a merger of Centre and Home Based Rehabilitation (CBR and HBR). Hospital amalgamations, closures and privatisation, and the Department of Health policy relating to SACS, ambulatory care and rehabilitation were some of the key elements explored in this paper. What is known about the topic? Healthcare is an industry constantly focussed on improving services and care to patients. There has been a lot written about change management in healthcare. Change can be difficult to implement and is a dynamic phenomenon. There are many factors which can assist or hinder change. What does this paper add? This reflective case study outlines the change process in this particular regional healthcare setting context within a multidisciplinary team. This paper adds to the body of knowledge by considering the influences of the unique history and culture of the setting, and the complex interrelated nature of factors which can affect change. What are the implications for practitioners? Healthcare service managers need to understand that the change process is complex and can be confusing. Government policy constantly drives change in this industry to improve patient care, but how an organisation works through this is unique to the setting. One size does not fit all, and understanding the organisation, staff, culture and having a vision at that point in time is an essential prerequisite. Any change requires working with people who need time to adapt, up skill and learn new processes and procedures. Reanalysing the change process and being flexible during the journey can assist in reaching the desired change outcome.

Creating a vision for nursing practice in a tertiary medical organization in Israel

Rapid changes in the healthcare system obligate Israeli nursing leaders to reassess current nursing roles and to identify new paradigms that are in line with the demanding needs of acute care settings. The challenge of engaging nurses to achieve the desired changes in nursing role performance and perception can be accomplished by defining a comprehensive organizational vision. The authors present a process creating and implementing a nursing vision intended to empower the nurse's role in a large acute general hospital.