Table 1.
Some Existing CM Models in Relation to Our Project and the HNT CM Model
| CM Model | Definition | What Fell Short of Our Needs? | How does the HNT CM Model Contribute? |
|---|---|---|---|
| ADKAR | Five “practical” steps for individual or organization level change: Awareness, Desire, Knowledge, Ability, and Reinforcement (ADKAR).3 |
For our goal, a more complex CM model that considers organizational culture and is less prescriptive and more agile was required. | The HNT CM model considers a key task force on CM, the project team of core and ad hoc members, and the institutional culture and regulations for customization. |
| Bridges Transition Model (BTM) | The 3-stage (endings, neutral zone, new beginnings) Bridges Transition Model is based on individuals’ inner psychological process (known as transition) and the support that people need through the change.4 It helps manage the human side of change. | The BTM’s scope is limited as it emphasizes human transition. It is not a comprehensive organizational strategy for CM and was therefore not appropriate to be used independently for our study. | The HNT CM model provides a process framework that provides strategic guidance for both human and organizational transitions. |
| General Electric (GE) Change Acceleration Process Model (CAP) | The GE’s CAP model is used for speeding up the transition state and facilitating a successful organizational change. It emphasizes central leadership and considers the importance of cultural factors. It's 7 steps: Leading Change, Creating a Shared Need, Shaping a Vision, Mobilizing Commitment, Making the Change Last, Monitoring Progress, Changing Systems and Structures, enable a sustainable change.5 | Our project required joint leadership from practice, research, and administration. The CAP model’s central leadership focus could not capture the complexity of our change. | Besides concerted leadership efforts, navigating and adhering to institutional culture and regulations, eg, acquiring committee approvals and considering unionized staff’s perspectives in our case, were crucial CM strategies that the HTN CM model provides to guide CMs that are complex, transformational, and novel-technology driven. |
| Jick’s Model | Jick’s model is a 10-principle pragmatic tactical approach that highlights the fact that implementing change is a dynamic and continuing process in which the strategy and vision of change are its starting points. The change itself and how it is implemented are both important. Jick advised the organizations that are implementing change to overcome the many challenges they would face by developing practical organizational solutions.6,7 | Despite our CM aligning with Jick’s 10-principle approach and the model identifying change as a continuous process, it neither offered expectation or guidance on resolving unpredictable challenges in the process nor provided counsel regarding interdepartmental collaboration to accomplish complex changes. | The HNT CM model identified understanding and predicting challenges as a formal step of CM, its sequential relationship with team assembly and agile planning and execution, and its parallel relationship with accommodating institutional culture and regulations, clinical partner buy-in, and consistent communication. The layout of the model intends to raise the readers’ awareness of the complexity of organizational and transformational changes and to inspire case-driven thinking of applying each provided strategy. |
| Kotter’s Theory | Kotter’s theory introduces an 8-step process for leading organizational transitional change.2 Its core belief of leadership’s importance in creating and sustaining changes, the importance of employees’ engagement, and its stepwise approach were also used in this project’s implementation.8, 9 | Steps such as “develop and form a strategic vision” neither informs possible unpredictability in the process nor guides the user to consider individual institution policy and culture. | Same as above due to the overlap of Kotter’s Theory and Jick’s Model.33 |
| Lewin’s Model | The 3-step Lewin’s model “Unfreezing, Change, Refreezing” provides sequential anchors for a somewhat linear systemic change.10 | Despite a universally applicable model, the broad steps of this model vary depending on institutional situations and interpretations.10,11 It does not offer a direct and structural journey map for CM that our project underwent. | Broadly complying with the 3-step Lewin’s model, the HNT CM model provides a more zoomed-in strategic CM journey map within the health care context. |
| McKinsey 7-S Model | The McKinsey 7-S model describes the importance of the interaction between 7 organizational elements (Strategy, Structure, Systems, Skills, Staff, Style, Shared values)12 in organizational changes for enhanced effectiveness. | When the interconnected 7-S’s in the McKinsey model are aligned, orchestrated changes are under way. However, the model itself does not entail ways to align the s’s.12 This model has been mentioned to be complex and not easy to use in a large organization.13 It is often used to analyze but not to manage changes within an organization. | The HNT CM model intends to map a followable path with strategies that can be applied with customization. |
| Nudge Theory | The Nudge Theory is an application of behavioral economics that uses a choice structure that positively reinforces people’s behavior without forbidding their freedom of choice or imposing mandatory obligations. It has found application among health care professionals in the clinical setting, although requires additional research. 14 | The Nudge Theory can be useful when assisting to achieve the desired outcome unnoticeably when applied in combination with a more enforceable model (eg, the HNT CM model), to facilitate adherence. | The HNT CM model is intended to be used for more structured changes: the changes take place at a planned time and location, and among targeted populations. People have freedom of choice but plan their choices and receive approvals. |
| PDCA | The iterative PDCA model can be applied to implement changes for improvement. It is applicable to changes in complex projects or smaller and more frequent changes.15,16 | Even though it is serving as a helpful implementation guide, it omits the CM process.15,16 | The HNT CM model guides CM, often a component of implementation, on an organizational level and a transformational scale. |
| RE-AIM | The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model has been utilized to plan, evaluate, and review a variety of health promotion and disease management interventions. RE-AIM is only informative if all 5 dimensions are concurrently measured.17,35 | RE-AIM was traditionally applied in public health and behavior change research, and has been increasingly applied in clinical, community, and corporate settings. It was developed to assist translation of scientific advances into practice, although has been proven slow and inequitable.18,19 The purpose of RE-AIM is not aligned with our project’s needs: to manage change associated with implementing novel technology in the OR. | Differing from RE-AIM’s requirement of concurrent measurement of all dimensions of the of model, the HNT model intends to guide CMs via a journey map that leads the project teams to focus on one or a few specific aspects of the project at a time and in a sequence. This semi-sequential approach may assist teams to manage the CM with prioritization. |
ADKAR, The Awareness, Desire, Knowledge, Ability, and Reinforcement; IT, information technology; OR, operating room; PDCA, plan-do-check-act; RE-AIM, Reach, Effectiveness, Adoption, Implementation, Maintenance.