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Kendall Regional Medical Center’s Change and Negotiation Plan


This paper is a change and negotiation plan. It aims at determining central aspects of a change implementation design. The problem under consideration is the severity of complications and frequency of PICC line reinsertions in Kendall Regional Medical Center. Therefore, preventing complications and reinsertions is a proposed change that will be crafted. The eight-step theory developed by Kotter is a theoretical foundation of this change plan. Together with fostering communication, training staff, and motivating doctors to improve their skills and knowledge, developing a detailed plan of action for each step and patient-centrism is a strategy for introducing the proposed change. Central stakeholders are senior leadership, department managers, doctors, and nurses. Creating a ‘we’ culture is a central model of communication and negotiations.

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The effective implementation of change requires the involvement of all team members. Even though the whole process is initiated by a group of people with enough authority and knowledge, achieving desirable results is impossible without the trust and engagement of everyone working for the medical center. Therefore, this plan aims at determining the details of a recommended change and negotiation strategies required for introducing it. The initial audience for this design involves senior leaders, leading doctors, and department managers because they have enough authority and influence to inspire others. Later, other doctors and nurses will supplement this group. Both full-time and part-time staff will be addressed.

Analysis of the Practicum Problem

Kendall Regional Medical Center that is located in Miami, Florida, is a full-service hospital. It provides care in different areas of professional medical aid such as surgeries, trauma, diagnostic services, behavioral health, etc. This medical center is in the Top 100 Hospital rating developed by Thompson Reuters. Its overall ratings are relatively high. It means that it is a safe place to seek medical aid at and only professionals work there (Kendal Regional Medical Center: About us, 2016).

Nevertheless, studies show that there is a severe problem of complications after being treated in this hospital unit. Even though the overall rate of complications is lower than the national level (except for complications after hip and knee replacements), Kendall Regional Medical Center should focus on eliminating this problem. The rationale for pointing to the necessity of this change is the fact that, on average, around 10 to 20 percent of cases end with complications and only 58 percent of patients would recommend choosing this medical center (Kendal Regional Medical Center: Overview, 2016). As for PICC line reinsertions, it is a common challenge for all hospitals. Because at Kendall Regional Medical Center, the rate of infections and clots-related complications is high, decreasing the frequency of reinsertions might be a way to solve this problem (Kendal Regional Medical Center: Overview, 2016).

To sum up, although this hospital is highly rated, it is recommended to pay significant attention to implementing changes that would prevent complications and PICC line reinsertions.

The 8-Step Theory Developed by Kotter

Most plans are susceptible to failures if the significance of a holistic approach to bringing a plan to life is ignored. That is why it is paramount to have a comprehensive view of the change process. This change plan will be based on a theory developed by Kotter. The rationale for choosing this theory is the fact that it applies to any organizational environment and the stage of its development. This approach is a combination of eight strictly sequenced steps with a determined set of activities for each phase of the change process.

The first step centers on the necessity to create a sense of urgency to initiate the change process. It should be noted that urgency is not synonymous with setting deadlines. Instead, the focus is made on identifying threats and opportunities of the project and using them as change accelerators. The second step is building and developing a guiding coalition made up of people with different skills and occupying different positions, but having enough authority to lead the change project. The third phase implies the formation of the change vision, i.e. the desired outcome of the project, and identifying appropriate strategies to achieve it. The fourth stage is sharing the vision with everyone involved in the implementation of the proposed change and stakeholders.

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Fifth, it is imperative to empower broad-based action, i.e. to eliminate as many institutional and organizational barriers as possible to make change implementation smooth and flawless. The sixth stage is generating short-term successes of the plan and highlighting them so that everyone is informed of breakthroughs and achievements. The seventh step is never letting up, i.e. continuing to implement change regardless of the remaining barriers and any problems. Finally, the eighth phase determines the embedding of the new way of working or thinking. It means that organizational culture is altered to make the change lasting and productive and guarantee that its effect is permanent (Kotter, 2014).

Proposed Change and Strategies

Keeping in mind what was identified about the problems of Kendall Regional Medical Center, the central idea for the proposed change is the prevention of complications and PICC line reinsertions. The objective of this change is to improve overall performance and ratings of the hospital unit and provide patients with better care. Moreover, bringing this change to life will contribute to enhancing the social perception of the medical center and its brand.

To implement this change, it is imperative to realize that everyone should be motivated to become a part of the change process. That said, designing a unique plan broken down into eight steps is a strategy selected for introducing the proposed change. Because Kotter’s theory is a comprehensive approach, it is the best option for overcoming the existing problem. As for additional strategies, facilitating communication, motivating doctors, and nurses to obtain new knowledge and develop new skills, and training will supplement the eight-step technique. Altogether, they will make up a ‘patient-first’ strategy, i.e. focusing on the needs of patients and improving provided services (Kotter, 2012).

Stakeholders and Their Role Within the Change

The role of stakeholders in achieving the desired outcomes of the change project should not be underestimated. According to Kotter (2014), it is imperative to create a guiding coalition that will drive the whole change process. The members of this coalition are the primary stakeholders of the process. It is recommended to include senior leadership of the medical center, department managers, and leading doctors in this group. Their role in achieving progress is critical because they have rich personal experience and are competent. Moreover, they have enough authority to inspire others to enhance personal development, thus implementing change. Also, other doctors and nurses are as well as stakeholders. Their role is in supporting the change and making it happen. The rationale for choosing only internal stakeholders is the fact that the existing problem is related to competence instead of inadequate technical supply. That is why external stakeholders are not mentioned (Kotter, 2012).

Proposed Change Process

The plan for the change process will be developed based on the eight steps mentioned above. Before initiating this plan, it is paramount to remember that some people might be unwilling to change. It means that some staff losses are possible (Kotter, 2014).

  • Step one. Assess the environment and point to the existence of severe problems that should be addressed immediately. Here, it is imperative to recognize that there are both threats and opportunities related to the change (Kotter, 2014). For instance, unwillingness to develop and switch to patient-centrism is a key threat. On the other hand, improving the social image of the medical center and the quality of the provided services are opportunities.
  • Step two. Assemble a coalition of most powerful leaders of the medical center.
  • Step three. Craft a vision. For instance, ‘we develop to achieve our initial social obligation – serving people.’
  • Step four. Communicate a vision. This step is one of the most challenging because it is susceptible to high risks of opposition and unwillingness to change. That is why team building and training are crucial elements of this stage (Farrar, 2015).
  • Step five. Encourage others, removing existing barriers, e.g. investing in staff’s personal development and designing schedules with enough time for attending team-building sessions and training.
  • Step six. Emphasize and celebrate each short-term winning, e.g. slight decreases in frequencies of complications or PICC line reinsertions as well as developing new skills, etc.
  • Step seven. Assess the environment to find out whether the plan works out and change is implemented. If some segments demonstrate poor results, replacing coalition members with more powerful and influential leaders may be an option (Farrar, 2015).
  • Step eight. Make constant personal development a part of the medical center’s corporate culture and assess the environment on a timely basis to make the change lasting and effective (Farrar, 2014).

Communication Plan for the Change

Each step of the plan is closely connected to communication. There are two channels of communication – between coalition members and between the coalition and other stakeholders. It should be noted that coalition members should possess strong interpersonal communication skills, be open, and inspire others because they contribute to the outcome of the project. Moreover, it is crucial to pay attention to the needs and ideas of the staff, i.e. recognize the overall responsibility for the change. Finally, creating an atmosphere of trust and openness is critical to avoid rivalry and support a new way of working. Finally, the significance of language should be emphasized (Ritchhart, 2015).

Tactics and Styles for the Negotiation Process

The foundation of the negotiation process is language. The emphasis should be made on creating a ‘we’ culture. It is based on mutual trust, listening to all team members, seeking connection with them, supporting others’ needs, contributing to a mutual vision of the future, etc. The primary idea is to recognize that unique concepts and recommendations can be proposed by ordinary nurses. That is why their voice should not be ignored (Glaser, 2012). The focus should be made on switching to phrases that would signal interest in personal opinion or experience and ideas for overcoming existing problem (e.g. What is your perspective? How do you think the problem can be solved? What, in your opinion, might help our team become more united?) because they highlight staff’s significance in all work-related matters (Glaser, 2016). So, scare tactics should be replaced with trust tactics (Kotter, 2014).

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To sum up, this change and negotiation plan is based on the significance of having a detailed strategy and open communication for achieving desired results. The emphasis is made on short-term actions and recognizing small winnings as well as ignoring the belief that only senior leaders have enough potential to generate brilliant ideas and ways to bring them to life.


Farrar, F. C. (2015). Transformational toolkit for front line nurses. Philadelphia, PA: Elsevier.

Glaser, J. E. (2012). 42 rules for creating WE. Cupertino, CA: Superstar Press.

Glaser, J. E. (2016). Conversational intelligence: How great leaders build trust and get extraordinary results. New York, NY: Routledge. ‬‬‬‬‬

Kendal Regional Medical Center: About us. (2016). Web.

Kendal Regional Medical Center: Overview. (2016). Web.

Kotter, J. P. (2012). Leading change. Boston, MA: Harvard Business Review.

Kotter, J. P. (2014). Accelerate: Building strategic agility for a faster-moving world. Boston, MA: Harvard Business Review.

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Ritchhart, R. (2015). Creating cultures of thinking. San Francisco, CA: Jossey-Bass.

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