Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Rozina Bhimani


Doctor of Nursing Practice


Change is occurring rapidly throughout healthcare. The effects of these changes are felt at the global, national, state, and organizational level. At a large, Midwest teaching institution, there are many initiatives that must be implemented throughout the organization quickly. In this organization, eight cardiac operating rooms are constantly experiencing change. Successful implementation of changes in policies, procedures, and practice is essential to providing the best possible care for the patients in cardiac surgery.

The purpose of this system change project was to increase staff involvement in the change process by discussing barriers to implementation, and allowing cardiac surgery staff to successfully implement, embed and sustain change within a system. The staff included the registered nurses, certified surgical technologists, and certified surgical assistants that work in the cardiac operating rooms.

The project utilized action research and a quality improvement framework using mixed methods. It involved two phases. Phase I was a qualitative design used to gain an understanding of the perceptions of registered nurses, certified surgical technologists, and certified surgical assistants in the cardiac operating rooms about the current process for communicating and implementing changes in policies, procedures, and practice. Phase II involved implementing the solutions identified by the cardiac surgery staff and evaluating the outcomes.

The three solutions implemented were (a) to provide staff information on changes before they will be implemented, (b) to utilize electronic resources for surgeon preferences, and (c) to implement a communication board in the cardiac office. Only the effectiveness of the process for updating surgeon preferences (x

2 = 18.83; p=.001) was found to be statistically significant. Although not statistically significant, there were positive trends for all of the solutions.

Understanding how the process for communicating and implementing changes affect staff can help guide future initiatives. Integrating individuals in the process of change from the beginning provides the opportunity for staff engagement. When staff feel they have ownership of the process, successful adoption of change is likely to follow.

This systems change project has laid the groundwork for future work in change implementation, and provided an opportunity for future improvements in the cardiac operating rooms. Additional research is needed to understand what creates resistance in groups. Also, more information is needed on how change processes should occur. It will be essential to continue work related to change implementation to build the knowledge base as to what works best for the organization, so the best care is provided to patients.