NU710 Unit 7 Lewin Implementation Plan Example

Unfreezing a Charting Habit: A Unit 7 Lewin-Based Implementation Plan for an Insulin Readiness Flag in the Electronic Record

[Student Name]

Purdue University Global

NU710: Advanced Health Information and Technologies

Unit 7 Technology Implementation Plan

[Instructor Name]

[Date]

The hospital, its build, staff and figures are composite and illustrative; the theory and studies cited are real.

The Change

Until now, a nurse documented insulin teaching in a free-text note. Nobody else could see at a glance whether a return demonstration had happened, the bundle's analyst had to read notes to measure it and the readiness rule could not be enforced. The build adds three elements:

1. An insulin start flag, set automatically when a first basal or mealtime insulin order is signed for a patient not on insulin at admission.

2. A return demonstration entry, a short structured form recording the date, the device, whether it was the patient's own pen, whether the dose was dialed and injected correctly and who was present.

3. A readiness banner on the patient's header, showing "Insulin teaching: not started," "in progress" or "complete," visible to nurses, hospitalists, pharmacists and case managers.

Why Lewin

Lewin (1947) described change as moving a group's equilibrium: first unfreezing the current state, then moving to the new one and then refreezing so that the new state holds. The model is simple and sometimes criticized for treating organizations as static. For a charting change, its simplicity is useful. Nurses have a habit, free-text teaching notes, that is comfortable and that nothing currently disturbs. A new field will be ignored unless the reason to change is felt, the change itself is easy and the new habit is reinforced until it becomes the default.

Hong and Han (2024) tested a structural model of clinical nurses' commitment to organizational change built on Lewin's theory, using surveys from 220 hospital nurses. Transformational leadership influenced commitment both directly and through perceived organizational support, positive psychological capital and job crafting, and job crafting, nurses' own reshaping of how they do their work, directly influenced commitment. The finding suggests that nurses commit to change when they see support from the organization and have room to shape how the change fits their work, which the plan builds into each stage.

Stage One: Unfreezing

The goal of unfreezing is to make the current state uncomfortable enough that change feels worth the effort.

1. Show the problem in the units' own data. At each unit's staff meeting, the champion will show two numbers: how many patients went home on new insulin last quarter, and in how many charts an analyst could find evidence of a return demonstration. On the pilot units, the second number was 61 percent before the bundle.

2. Tell one story. The near miss in which two patients were taught on one pen and sent home with another will be told briefly, with the point that nobody could see what had been taught. Informatics teams learn from safety events only when events are reported and analyzed together (Recsky et al., 2024), so the story will be told with the event analysis that followed it.

3. Ask nurses what would make the entry easy. Champions will collect suggestions before the build is finalized. Two have already shaped it: the form opens from the medication record, and the device field defaults to the pen pharmacy dispensed.

Nurses will not unfreeze a habit to fill in a field; they will unfreeze it to stop the near miss they already fear.

Stage Two: Moving

Moving introduces the change and supports people through it.

1. Test before go-live. Six nurses from three units will use the form in the training environment with three scripted patients, timing each entry and noting confusion. The target is under 60 seconds per entry.

2. Go live in waves. The two pilot units first, then the units in the order of the spread plan, two at a time, two weeks apart.

3. At-the-elbow support. For each wave's first week, a champion or informatics nurse will be on each unit for four hours a day.

4. Remove the old path. Two weeks after go-live, the free-text teaching note template will be retired on that unit, so that the structured entry becomes the only route.

5. Make the banner useful to others. Hospitalists will be shown the banner at their monthly meeting, and case managers will use it in discharge planning rounds, so nurses see that the entry is read.

Stage Three: Refreezing

Refreezing makes the new state the norm.

1. Feedback. Every month the huddle board on each unit will show the share of patients on new insulin with a completed entry before discharge, displayed on the unit's huddle board.

2. Recognition. Units above 90 percent for two consecutive months will be recognized at the nursing quality council.

3. Policy. The insulin discharge policy will be updated to name the structured entry as the required documentation.

4. Orientation. New nurses will learn the entry as part of orientation, not as a change.

5. Job crafting. Champions will gather adaptations nurses make, such as completing the entry during the demonstration on a tablet, and share the good ones.

Measures

Four numbers will show whether the change took hold: completion of the structured entry before discharge for patients on new insulin, with a target of 90 percent by three months after go-live; median time to complete the entry; the share of entries recording the patient's own pen; and, as a balancing measure, nurses' rating of documentation burden on a single-item survey, asked once in the month before launch and again in the third month after it.

Risks

The main risk is that nurses complete the entry without doing a real demonstration, turning the field into a box ticked. The monthly audit of 20 charts will compare entries with nurse and patient reports at the 72-hour contact. A second risk is that the banner is ignored by other disciplines; case manager use in rounds will be tracked.

Conclusion

A charting field is a small technology, but it will change practice only if nurses feel the reason for it, find it easy and see it used. Lewin's three stages give the implementation that shape: unfreezing through the units' own data and a near miss, moving through testing, waves and support, and refreezing through feedback, policy and orientation, with room for nurses to shape how the change fits their work.

References

Hong, M., & Han, S. (2024). Commitment to organizational change in clinical nurses: A structural model applying Lewin's change theory. Journal of Korean Academy of Fundamentals of Nursing, 31(1), 38-50. https://doi.org/10.7739/jkafn.2024.31.1.38

Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103

Recsky, C., Rush, K. L., MacPhee, M., Stowe, M., Blackburn, L., Muniak, A., & Currie, L. M. (2024). Clinical informatics team members' perspectives on health information technology safety after experiential learning and safety process development: Qualitative descriptive study. JMIR Formative Research, 8, e53302. https://doi.org/10.2196/53302