Abstract
The end goal of a design and construction project is the successful transition of people and processes into the new space. It is not always easy for people to adapt to the new space because everything changes including how time is spent; how people interact with one another; how work is distributed and delivered; how supplies, medications, and equipment are stored, distributed, and used at the point of service; and how people come and go within the environment. Because the transition is so important, the planning process for the transition to a new space should begin years and months in advance of the actual change or move (Stichler, 2009a). There are companies and consultants who specialize in guiding the planning for transitions, moving and occupancy, and retrospective reviews of how the process worked (Stichler, 2015). The move into a new space or facility is the ultimate example of the change process, and we all know that change is rarely easy.
Change theorists have captured the pain or challenges experienced in a change. Most change theories describe process steps and how to facilitate moving through each phase. Every leader recognizes that the application of a change theory or theories is critical in helping staff move through the transition process.
Change in Theory
Lewin describes three steps of change: (1) unfreezing, where you begin the process of letting go of what you know to be the usual, normal, or customary; (2) the transition, action, or change itself where you view the situation or circumstance from a different perspective; (3) and finally, the refreezing or accepting the “new normal” (Lewin, 1951; Shirey, 2013).
Ajzen (1991, 2002) describes change process slightly differently. Ajzen indicates that people’s attitudes toward anticipated change must be positive for the change to actually occur; otherwise, you will have various forms of rejection that may delay or interfere with the final outcomes expected of the change. An individual’s social environment affects how individuals accept and transition through the change process, so “group think” may influence people in how they accept and manage the change. As an example, if some in the group voice approval of the change, then others will likely be accepting of the change. Ajzen’s (1991) theory of planned behavior included the concept of perceived control over opportunities, resources, and skills necessary to perform the new behaviors and willingness to let go of old thinking or behaviors. Finally, Ajzen indicated that change requires an emphasis on the individual’s self-efficacy or confidence and ability to take action, which creates the transition from the old state/place to the new state/place with new perspectives and behaviors.
Environmental influences, personal factors, and anticipation of the attributes of the change itself (what comes after the change) affect the change incentive and actual process. Several change theorists (Bartunek & Moch, 1987; Bennis, Benne, & Chin, 1969; Lippitt, Watson, & Westley, 1958) speak of the rewards and incentives motivating individuals to move through the change process or actualizing the end goal that reinforces the change (or refreezes it using Lewin’s theory).
Applications to Practice
Although the planning, design, and construction teams may enthusiastically champion and endorse their creative vision and design, there is a distinct possibility that the end user may not be as enthusiastic or prepared to live and work in the new environment. The early months of moving into a new facility can be challenging for clinicians trying to adapt to the new environment, find equipment and supplies necessary for care delivery, and alter traditional communication patterns (both face-to-face and computerized documentation/ordering systems). In some projects, more time is spent in the planning and design of the facility than discussing how the new facility will change workflow processes or communication processes. The lack of anticipating the effects of the design on the work and care environment and planning accordingly can lead to major post-occupancy challenges.
Although nurses and other clinicians may have been involved in the design process, changes may have occurred during the value engineering process altering what they thought would be built (Stichler, 2009b). Typically, clinicians are not involved in value engineering, so surprises at move in are common leading to the dissatisfaction and discontent often expressed by clinicians (“no one asked me”). Wise and astute leaders will plan ahead and address the change process with as much detail as the planning for the new facility, knowing the BIG CHANGE will affect organizational and unit culture, care delivery processes, communication, staffing, employee and patient satisfaction, and nearly everything in the daily world of those providing or receiving care in the new facility.
Meticulous transition planning is key to minimizing the trauma often described by clinicians when moving into a new space. Clinicians are often told that the confusion in the workflow occurring after a move is temporary, but in some projects, clinicians ask, “when will the transition end” after months/years of occupancy (Davidson, 2017). As Davidson and Nadkarni stated, “We have entered a third state of being. Not the past that we know or the future that we predicted, but something different. This third state is not bad or worse, just different” (Davidson, 2017, p. 153; Nadkarni, 2017).
Applications to Life
Of course, BIG CHANGES occur in our personal journeys as well as in organizations. We can meticulously plan for some of the big changes or transitions, but others may be unplanned and catch us by surprise. I prefer the planned transitions! We can apply the same change theories discussed earlier in this article to our personal changes recognizing that emotional energy is involved in every change.
In some situations, we simply need to “move on,” but how to move on is rarely discussed in career planning classes or books! Moving on requires “letting go” of the familiar and embracing a new state of being. The need to unfreeze former positions, daily activities, priorities, and even our own self-identity is required to transition or move to a new state (Shirey, 2013). Moving on is not easy, but as Ajzen (2002) stated, an individual’s attitude toward the change and a supportive social environment facilitate the change process.
The essence of this editorial is to announce that I will be moving on, letting go, and leaving my role as a founding co-editor of HERD. This decision comes with significant reflection recognizing that HERD is a part of my very being and personal identity. I have had such a fabulous journey with an incredible partnership with Kirk Hamilton, who shared a vision for the need for a scholarly journal for the healthcare design field. Together, we created a proposal for such a journal, consulted with Debra Levin at the Center for Health Design, and negotiated a publisher to launch the new journal. In HERD’s infancy, we had the privilege of working with and being mentored by an incredibly wise and talented managing editor, Jane Garwood, who taught us how to be editors. So many of our brilliant colleagues in architecture, interiors, social sciences, and healthcare supported us as members of the editorial advisory or editorial review boards, peer reviewers, or authors of scientific papers.
The journal has grown in importance, prestige, and purpose, and a new publisher, SAGE, transitioned HERD to a new level in our ninth year of publication. The new managing editor, Andrew Thompson, has been an incredible support, readily sharing his knowledge and expertise in the publishing world to expand our knowledge and capabilities. Similarly, the Center for Health Design with Debra Levin and Jill Glaser has been a constant support for our journey. HERD’s mission has always been to be an interdisciplinary journal. Recognizing the critical aspect of nature in healing spaces, we added a third co-editor, Naomi Sachs, a well-recognized author and scholar in landscape architecture. As co-editors, we have had the wonderful support of a number of Kirk’s graduate students who have served as editorial assistants. These individuals assist in tracking the submissions, ensure that the papers are American Psychological Association compliant and meet our editorial guidelines, and assign each article to the most appropriate co-editor. Every Monday morning, we meet as an editorial team to keep HERD running smoothly.
In a book about career transitions providing instructions on how to move on, the authors stated, “we all ask ourselves this question and hope (deeply) that we have made a contribution and a difference to others and the organization. Truth be told, however, we may never know the impact we have had” (Malloch & Porter-O’Grady, 2016, p. 44). Truth be told, I do know that we have made a difference, and Kirk and I were humbled and honored to be acknowledged for making a difference with the esteemed Changemaker Award in 2016.
Marie Curie was quoted in this same book as saying, “one never notices what has been done; one can only see what remains to be done” (Malloch & Porter-O’Grady, 2016, p. 44). Much has been done, and major milestones have been accomplished in the past 12 years: (1) entry into PubMed giving us an international search presence; (2) institutional subscriptions expanding HERD’s availability to clinicians, leaders, students, practitioners (design and healthcare), researchers (practice and academia), faculty, and scholars; (3) a substantial growth in the numbers of research papers submitted; and (4) a very respectable increase in our impact factor from 0.5 to 1.5 over 5 years.
Handoffs
When we hold on too tightly or for too long to things we are passionate about, we minimize the opportunities for others to enjoy those same passions. An important aspect of moving on is “handing off” important functions to someone who will fill our place. In the spirit of HERD’s interdisciplinary mission, Debbie Gregory, DNP, RN, was chosen to be my successor. Debbie is both an RN and an interior designer. She received her bachelor of science in nursing from Vanderbilt University, an interior design degree from Watkins College of Art and Design, and her doctorate of nursing practice in health innovation and leadership from the University of Minnesota. She has extensive experience in facility planning, designing, commissioning, and transitions. Currently, she is a senior clinical consultant with Smith Seckman Reid, Inc., an engineering, commissioning, and technology firm, and an adjunct professor at Vanderbilt University’s School of Nursing and Clemson’s School of Nursing. Debbie embraces the core values that make HERD so successful. As a strong advocate for nurses’ informed and prepared voices in the design process, she is the founder of the Nursing Institute of Health Design, which has been a tremendous resource for nurses, health-care professions, and designers who influence the design of health-care facilities.
My role in 2019 will be to mentor Debbie in her new role as co-editor, so the handoff transition will be smooth and seamless. I am thrilled that she will have the opportunity to assume the co-editor role, and I know she will have the same passion for HERD as I have enjoyed over the past 12 years.
Staying Engaged
HERD will always be a part of me, and I will stay engaged as an editor emerita, a member of the editorial advisory board, and a frequent manuscript reviewer. My work with HERD has been an incredible, enjoyable, and satisfying journey, and I am assured that as I hand off this role to my colleague, she and my other HERD partners will continue HERD’s legacy and contribution to the science of health-care design.