Tuesday, January 14, 2014

Enrolling Others in Change

There are nearly 4,000 of us who work in the GBMC HealthCare System as employees, volunteers or physicians in private practice. When I think of all the improvements that we have made on our way to our vision, I am amazed at how many of them started with only one or two of our people in action and then spread to many more people. A fantastic example of this is the work that has been done by our nurses at reducing pressure ulcers.

It has now been more than seven months since the last pressure ulcer at GBMC! Those of us who don’t have to turn debilitated patients every two hours to prevent these can only imagine how hard our nurses and nursing technicians have been working to prevent them. Our people have always understood that they needed to help patients avoid pressure ulcers but only after a few folks started the movement to guarantee standard work in assessing who was at risk for skin breakdown and then delivering the measures shown to prevent it reliably, have we improved our performance.

Why is it that some change initiatives achieve great results and others don’t? There are a number of reasons but I think the single biggest reason is failed enrollment. We often hear: “People don’t like change.” Doug Krug, the author of the book Enlightened Leadership, makes the point that this is not true. Krug says that people change all the time; just think of all of the people that got rid of their flip phones and Blackberries to get iPhones, for example. The true statement according to Krug is: “People don’t like to be changed.”  We humans need to see and accept the need for the change and we need to feel that we have played a part in the design of the change or at least have chosen to make the change and have not had it forced upon us.

We have achieved zero pressure ulcers at GBMC because the overwhelming majority of our nurses and nursing technicians have been enrolled in the change. They understand the reason for the standard work, they now know what the work is and they have accepted that it must be done to prevent harm to their patients.

It is hard to get everyone enrolled in any change initiative in a large complex organization. The GBMC System is not presently making the same degree of progress on some of our other goals. From me on down the line we need to do a better job of enrolling others to achieve these goals. The enrollment starts with a conversation about the need for the change – what we are trying to accomplish. It continues with a discussion of what is expected of the person being enrolled. Then the enrollee must have some time to ask questions, voice any concerns, and be heard. Finally, the person doing the enrolling needs to hear from the enrollee that they have understood and that they are in!

I am very grateful for everyone’s hard work and particularly for everyone that enrolls others in change.

Finally, I'd like to congratulate two of GBMC's nurse leaders on recent accomplishments: Jody Porter, RN, DNP, Senior Vice President, Patient Care Services and GBMC’s Chief Nursing Officer, has been re-elected to the board of directors position of Treasurer of the Maryland Organization of Nurse Executives and CJ Marbley, RN, has been named to the same organization’s board of directors as a Member-at-Large. These individuals are certainly enrolled in creating positive change right here at GBMC and throughout the nursing community. Thank you for your commitment to excellence!


  1. Thank you for sharing your insight. Change is inevitable; however, our attitude towards it and how we embrace (or "enroll" in) it makes the difference. Congratulations to Jody and C.J. on their elections!

  2. Congratulations to Jody and CJ. CJ has been a great addition to the leadership at GBMC. He has a true talent for developing and mentoring nurses and staff. Jody and CJ both are crucial members to GBMC

  3. Your analysis of resistance to change is spot on. That's why our lean events are key components in change management. Once we "own" a process, we have willingly and effectively "auto-enrolled." Ongoing monitoring of results reinforces the benefits of the change to the enrollees and encourages continuous improvement.

  4. This was a great blog about change, it definitely is a culture shift. Congratulations to Jody and CJ! I love seeing CJ's leadership and the way he has made a leadership path for himself.


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