Appropriate Leadership Style to Implement Change

Leadership quality combined with evidence-based innovation serves as the primary power behind nurse practice development in continuous improvement frameworks. Patient safety together with care continuity depend on specific structured communication procedures in the stress-filled Post-Anaesthesia Care Unit (PACU) setting. The assignment reviews a front-line patient handover change strategy that introduces ISBAR (Introduction, Situation, Background, Assessment, Recommendation) as an organizational communication approach for PACU units.

The proposed protocol aims to fix the unsystematized handover standards because this deficiency leads to communication failures and nursing discontent and patient separation during care handovers. Based on transformational leadership principles this project evaluates what effective leadership accomplishes for staff member involvement and responsibility and practice adoption success. This discussion examines the implementation approach between transformational and transactional leadership.

It will set forth logical reasons for choosing the transformational leadership style as an appropriate framework to direct PACU team members through this change initiative. The assignment evaluates the effects of leadership conduct on team relationships as well as staff encouragement and work-related conversational behaviours in healthcare environments (Prochaska & Velicer, 1997).

Implementing the change will benefit from a selected change management model that will direct all stages of planning, execution and assessment to maintain structured and sustainable performance. The implementation of Kotter 8-Step Change Model demonstrates strategies to establish urgency and transmit vision and sustain momentum. The SWOT tool and Force Field Analysis will serve as supporting elements for anticipating challenges which will improve stakeholder participation while decreasing change resistance (Nilsen, 2015).

This change proposal bases its rationale on a thorough analysis of modern nursing literature and national policy documents which show support for patient-centred care and better nursing communication practices. Post implementation, the initiative will be evaluated for its effectiveness by means of staff feedback, clinical audit, and patient satisfaction surveys. The assignment will end with a reflective account of key learning points and their implications for future leadership practice in healthcare organizations.

Identifying the Need for Change and Evidence Base

Proper handover communications between PACU nursing staff during shifts plays an essential role for maintaining safe patient care continuity. The current systematic transfer approach in PACU does not utilize standardized handover protocols for the high-risk anaesthesia recovery patients among staff members despite nurses handling these patients with elevated medical requirements. Despite time pressures healthcare professionals perform handovers either at distant locations or at random points and under the influence of workload demands. Documented communication discrepancies create information gaps between staff members which can produce misunderstandings and decrease patient involvement thus endangering both safety and professional duty.

Multiple research investigations demonstrate the negative effects that result from unstructured clinical handovers. Studies establish that inadequate handover communication contributes to critical information miscarriages which leads healthcare providers to experience adverse events. The lack of standardized shift reporting practices according to Baker (2010) causes information to break into separate pieces thus creating time delays for care while reducing nursing accountability. The fast post-operative care environment and patient anaesthesia-to-consciousness transition in the PACU multiply the safety risks experienced by patients.

Teams seek to improve bedside handover using ISBAR framework because this standardized approach both includes patients and strengthens the accuracy of exchanged clinical data. A communication system known as ISBAR (Introduction, Situation, Background, Assessment, Recommendation) has gained extensive approval because it creates structured logical guidelines for clinical discussions (Grol et al., 2013). Medical professionals using ISBAR save patients from communication errors and increase nurse confidence in transfer sessions (Cairns et al., 2013).

Several studies confirm bedside handover provides benefits as a patient-focused practice which promotes transparent communication and quality transmission of clinical information. Patient satisfaction improves while safety incidents decrease and staff becomes more accountable through the practice of bedside report formats according to Sand-Jecklin and Sherman (2014). According to Gregory et al. (2014) bedside handovers enhance nurse-patient trust in recovery units where patients become confused or worrying about their condition. The built trust between nurses and patients helps both care delivery and patient satisfaction levels.

The national and international quality improvement and person-centred care standards support the implementation of bedside handover practices. The NHS England (2016) Leading Change Adding Value framework highlights the essential role of reducing preventable care variations while it directs organizations to deploy practices that boost communication quality and enhance safety measures and clinical results. The World Health Organization (2021) establishes nursing leadership as essential for implementing evidence-based practice approaches which significantly boost healthcare quality and patient protection systems.

The current state of practice in the PACU contrasts significantly with these recommendations. Nurses present handovers using fragmentary notes and from their memory while new staff members receive limited verification and patients have no involvement. The inconsistent approach causes confusion for receiving staff members that leads to poor continuity of care while also decreasing the responsibility level of the delivering nurse (Puri, et.al. 2023). Patients usually do not participate in handover processes thus preventing their involvement in their recovery plans.

Bedside handovers guided by ISBAR represent an acceptable evidence-based strategy for resolving current delivery problems. Such a system provides continuous clinical information through a standardized framework while promoting teamwork responsibilities between staff and addressing patient needs directly. This change is expected to produce better accurate communication between nurses and better social cohesion between staff teams with enhanced patient involvement and positive work environment (Lucas & Nacer, 2015).

The feedback collected from PACU staff aligns perfectly with published literature because members of staff need improved structured communication systems specifically for shift handovers. The initiative will undergo a six-week pilot phase supported by staff training and feedback tools to establish both sustainability and realistic operation of this change. This methodology will permit successive refinement and ensure stakeholder buy-in prior to complete implementation.

Overall, the absence of a standardized handover process within the PACU is a significant threat to nursing practice and patient safety. Implementing bedside handover based on the ISBAR model is a needed and evidence-based intervention that must be applied to close the gaps. The sections that follow discuss how strong leadership and evidence-based change management can facilitate and measure the impact of this intervention.

Leadership Styles

Leadership effectiveness remains essential for achieving a successful outcome of healthcare-related change implementation. The implementation of bedside clinical handovers using the ISBAR framework in the PACU demands leadership efforts in building team collaboration and resistance reduction and accountability promotion (Gillen, et.al. 2008). The implementation of change in healthcare through leadership styles depends largely on the use of two standard approaches which include transformational and transactional leadership.

Leaders who practice transformational leadership inspire their followers by creating visions as well as offering inspiration and individual backing. The leadership approach of these leaders emphasizes team growth alongside group goal setting along with innovation development (Boamah et al., 2018). The leaders promote analytical thinking through their support of participation during organizational change procedures while creating a supportive workplace culture that grants staff the authority to become actively involved with change initiatives.

Transactional leadership follows an organized policy of incentives and disciplinary actions. This leadership style works well to establish organizational rules while establishing performance standards and operating standard procedures. The approach fails to meet staff members’ emotional and motivational requirements during change implementation processes (Aldoory & Toth, 2004).

For better comprehension of these distinctions a breakdown has been prepared within the table below.

Table 1: Comparison of Transformational vs. Transactional Leadership in Change Implementation

Feature	Transformational Leadership	Transactional Leadership
Core Approach	Inspires through vision and motivation	Focuses on rules, supervision, and performance
Focus	Team empowerment and innovation	Efficiency and task completion
Communication Style	Open, inclusive, and collaborative	Directive and structured
Motivational Techniques	Encouragement, inspiration, and recognition	Rewards and penalties based on performance
Best Used When	Implementing change, fostering engagement	Maintaining existing systems, managing compliance
Application to This Project	Encourages PACU staff buy-in and participation	May promote compliance but not intrinsic motivation

The implementation of structured bedside handovers demands transformational leadership as the appropriate style because of its connection to the organizational changes. The successful implementation of ISBAR demands a double transition between new operational procedures and organizational changes that strengthen both patient engagement and institutional openness as well as nursing responsibility.

Staff involvement in the new process becomes more likely when transformational leaders create trustworthy environments while linking changes to organizational shared values and giving employees the means to actively contribute. Transformational leadership directly impacts nurse engagement and leads to enhanced patient safety results and better quality improvement achievements. Staff in the PACU setting must maintain these qualities because they help create coherent teams that communicate effectively (Lewin, 1947).

In summary, although both styles have advantages, transformational leadership provides the vision, encouragement, and team-oriented style needed to effectively direct the bedside handover initiative. The following section will discuss how this style can be integrated into a formal change model to drive implementation and maintain results.

Change Model and Implementation

SMART Objective

The PACU will use the ISBAR framework for bedside clinical handovers with this SMART objective to guide its implementation during six weeks.

“The implementation of bedside handover with ISBAR in PACU during six weeks aims to achieve 40% improved accuracy according to post-audit results and staff feedback surveys.”

The specified objective targets ISBAR handovers specifically with achievement possible through 40% improvement measurement within six weeks of necessary training implementation and relevant to patient safety and nurse accountability (Huang, et.al. 2024).

Selected Change Model: Kotter’s 8-Step Change Model

The 8-Step Model developed by Kotter functions as an organized approach to lead organizations through change efforts. Through this framework leaders generate essential urgency and activate teams to execute new methods which become integrated into continuous improvement practices (Kotter, 1996). Healthcare environments draw advantage from this particular model when employees need leadership to overcome change-related resistance during transition processes.

Steps 1–8: Creating the Foundation for Change

Step 1: Create a Sense of Urgency

Organizations need to establish a strong feeling of importance for implementing standardized bedside handover procedures. The current risks related to unstructured communication become more evident by using data from incident reports together with near-miss documentation and staff interview records. Staff meetings should include this evidence to increase awareness of patient safety priorities and demonstrate the need for the proposed change according to Burnes (2004).

Step 2: Form a Guiding Coalition

The change initiative needs a collective team of healthcare professionals who will lead its implementation. A diverse team consisting of senior PACU nurses together with charge nurse and patient safety officer and a junior staff representative forms this change implementation squad. Achieving staff ownership and strengthening project credibility emerges when various levels of staff participate. Transformational leadership strengthens inclusive decision-making and team collaboration thus supporting this process effectively.

Step 3: Develop a Vision and Strategy

The guiding coalition will establish an organizational vision which states their commitment to achieving safe and accurate and person-centred clinical communication in PACU facilities using structured ISBAR bedside handover routines. The strategy will detail how training and auditing operations and when communication methods are activated. A shared vision serves to link individual motivations with the organizational goal according to Hiatt (2006).

Step 4: Communicate the Change Vision

The implementation of understanding and support for the change will involve using team huddles along with staff notice boards and emails and training workshops. A transformational leader performs a crucial function in reinforcing the message through their behavioural example toward anticipated staff conduct. Through repeating messages throughout the process employees develop lasting trust in operations (Cameron & Green, 2019).

Step 5: Empowering Staff for Broad-Based Action

The team will succeed in implementing its plan through empowering staff members with training sessions that focus on ISBAR and bedside communication. These sessions will include:

• Role-play simulations.
• All staff members will use ISBAR templates that combine printing with laminating for standardization.
• Nurses can build their confidence through shadowing experienced senior nurses during their patient care activities.

The change team along with management will establish an environment of honest feedback while providing security to nurses who wish to share their concerns. The full participation requires resolving staff concerns about both patient presentations and work deadlines. Clinical practice compliance rates substantially increase when nurses receive both educational empowerment and practice freedom.

Step 6: Generate Short-Term Wins

Celebrating early successes builds momentum. The implemented six-week pilot phase requires the monitoring of these identified aspects for recognition purposes:

• Improved documentation quality.
• The ISBAR format shows proper implementation by staff members.
• The number of positive patient remarks regarding transparent handover communication

Successes will be reported weekly during team meetings, and celebrations will be provided through shout-outs and being featured in the unit newsletter. These small wins illustrate progress and assist in breaking down resistance (Kotter, 1996).

Step 7: Consolidate Gains and Produce More Change

The change team proceeds to expand the initiative after accomplishing initial short-term successes.

• The team plans to show obtained outcomes to all surgical units throughout the hospital.
• Framework changes through the implementation of ISBAR into surgical unit orientation materials and policies.
• Encouraging champions from within the staff to mentor others.

The practice will optimize its processes through staff feedback and audit results to maintain its responsiveness and relevance throughout this phase.

Step 8: Anchor the Change in Organisational Culture

The implementation of bedside handover remains in place by establishing it in PACU protocols with staff checklists and as part of performance appraisal procedures. The standard communication practice ISBAR will be presented as part of new nurse orientation during staff membership entrance procedures (Hussami. 2008). The practice’s value will be kept strong through ongoing quality improvement cycles that merge with the unit identity and professional standards under leadership oversight.

As per NHS England (2016) the permanent integration of change into systems alongside cultural adaptation leads to sustainable results when leaders back up these initiatives at all organizational levels.

Introducing Change Tools

The adoption of this change will receive support through two influential analytical systems:

• Internal and external success factors will be analysed through SWOT Analysis.
• The implementation team will use Force Field Analysis for identifying the workplace driving forces with restraining forces.

The tools aid in measuring change preparedness while spotting potential obstacles ahead of making essential strategic choices.

Table 2: Preliminary SWOT Analysis of Bedside Handover Implementation

Strengths	Weaknesses
Supported by evidence-based research	Initial resistance from staff
Enhances communication and patient safety	Time constraints in PACU workflow
Encourages nurse accountability	Requires training and supervision

Opportunities	Threats
Aligns with NHS and WHO quality priorities	Staff turnover during the change period
Potential for hospital-wide implementation	Risk of reverting to old practices post-pilot

The SWOT highlights some strategic concerns for introducing the bedside handover through the use of the ISBAR model into the PACU. The positive factors like the evidence-based foundation and conformity with national safety outcomes offer a positive basis for progressing the change. These factors could be used on initial communication and training stages in order to make urgency and employees’ buy-in. In contrast, issues like time deficits and training needs are problems that can be addressed through targeted planning and resource allocation. For instance, scheduling protected time for handovers into shift rosters and making ISBAR tools readily accessible will serve to minimize these issues.

There are opportunities for scaling up the practice to other units and showcasing leadership in quality improvement if the pilot program delivers quantifiable gains. Yet, challenges like staff turnover and falling back into old patterns highlight the necessity of reinforcement, continuous education, and leadership visibility. By anticipating these problems in advance, change leaders can employ proactive measures, including change champions and audit feedback loops, to enhance long-term sustainability. Ultimately, the SWOT analysis provides assurance that the change effort is not only based on theory but attuned to the actual realities of the clinical setting.

Monitoring and Evaluation

Monitoring of change success will happen through both quantitative and qualitative methods.

• Staff members will receive assessments about communication methods before and after the implementation process to test clarity and satisfaction.
• Patient feedback on their involvement in handovers.
• Audit tools function to determine both the consistency and completeness factors within ISBAR handovers.
• The compliance of bedside reports will be monitored through observation checklist processes.

Evaluation of the project will occur at intervals 2 weeks apart during the pilot phase and will then resume at the end of 6 weeks. The identified gaps will be used to create further training plans and adjust existing systems.

Table 3: Force Field Analysis – Implementing Bedside Handover with ISBAR

Driving Forces	Restraining Forces
Evidence-based improvement to patient safety	Staff resistance to new routine
Enhances communication clarity	Time pressure during shift change
Aligns with NHS and WHO strategic goals	Concerns about patient confidentiality at the bedside
Staff interest in professional development	Inconsistent staff availability for training sessions
Strong leadership and change champion presence	Habitual reliance on informal, off-bedside handovers

The success of this implementation depends on enhancing enabling conditions by promoting leadership backing combined with training programs alongside deploying solutions that include time management technology alongside adaptable staffing arrangements paired with peer mentorship services (Anstey Watkins, et.al. 2018).

A comprehensive implementation of bedside handover in the PACU using ISBAR benefits from Kotter’s 8-Step Model combined with transformational leadership and SWOT analysis and Force Field Analysis as structured tools. Empowering the staff, creating tangible wins, and institutionalizing the change into everyday practice will lead to sustainable improvement. The final section will wrap up the assignment by summarizing the most important lessons learned from this change effort.

Staff Engagement and Resistance Management in Change Implementation

Any healthcare change implementation demands close examination of staff engagement dynamics and resistance behaviour especially when working in high-pressure areas like PACUs. The implementation of evidence-based initiatives may fail when staff members neither participate nor receive adequate support during their development. The successful leadership of changes depends on thoroughly knowing personnel issues then balancing inclusion with strategic strategies to deal with opposing forces with compassion.

Several elements cause PACU staff to resist changes which include hesitation towards new practices and increased workloads and doubts about ISBAR utility as well as worries about Patients’ privacy during Bedside Interactive communication. The authors Cameron and Green (2019) explain that resistance towards change does not necessarily represent negativity because it often demonstrates underlying problems which require resolution. Medical staff members can use their resistance experience as a diagnostic tool to identify potential implementation hurdles which otherwise could affect the implementation effort (Department of Health And Social Care, 2021).

The leadership style of transformational leadership demonstrates exceptional capability to transform resistance into productive outcomes. To build trust, leaders should establish an environment for candid discussions which allows them to both accept employee feedback together with concerns and work alongside staff members to develop solutions. During the pilot period nurses identified that busy handover times lead to time-based pressures. Team-oriented planning of shifts and the redesign of ISBAR practices can emerge from valuable staff feedback obtained through this analysis (American Nurses Association, 2021).

These modifications allow team members to develop ownership while proving leadership’s dedication to staff suggestions. The selection of peer change champions serves as an effective engagement tool because these influential staff members demonstrate desirable behaviours which others respect. Such staff members function as communication bridges between leadership and peers by enabling better connections while promoting team involvement and lowering the uncertainty in operations. Staff confidence together with adoption rates improves during quality improvement endeavours according to Ovretveit (2009) when there are change champions present.

After initial handovers healthcare staff should use reflective debriefings to identify strengths and areas that require improvement. The sessions should remain brief yet focused on specific points with no judgment while promoting learning through continuous adaptation. These reflections give leadership staff performance insights which enable process optimization and recognition of accomplishments to enhance operational motivation.

The second technique consists of detection methods supported by reward strategies. When healthcare staff or teams show consistent skill in using the ISBAR framework you should reward them because it strengthens team morality and demonstrates that you value their work. A collection of basic expressions that include personal appreciation through notes and staff meeting acknowledgment alongside depiction of inclusion audit victories serves to create team fulfilment (Sackett, et.al. 1996; Spoon, et.al. 2020).

The implementation of resistance management needs practical organizational support. Leaders need to establish that personnel receive the equipment together with allocated time and training which enables their success. The implementation of ISBAR templates should be effortless to access alongside planned shift handover time and sustained monitoring of staff performance. Individualized support must be provided to workers who maintain their hesitance since it will help reveal their personal barriers and enable trust building. Lastly, constant open communication is essential to engagement. Employees must understand not only what is changing, but why it is important, how they will be assisted, and what the anticipated outcomes are (Anderson, et.al. 2015). Constant updates, visual cues (e.g., posters or handover checklists), and common success metrics create a sense of common purpose and responsibility.

In short, successful staff engagement and resistance management are key to successful embedding of ISBAR-based bedside handover practices within the PACU. By employing a mix of transformational leadership, peer mentorship, reflective feedback, and pragmatism, nurse leaders can foster an environment in which change is not merely tolerated but owned and maintained by the team. Proactive management of resistance guarantees that the change initiative does not merely get done but becomes an integral part of values and habits of nursing practice.

Conclusion

Using ISBAR in bedside clinical handover practices within PACU leads to significant improvements regarding communication precision and patient security and nursing staff responsibility. The study defines the purpose of this change through analysis of existing unstructured handovers that result in information failure and decreased staff responsibility and patient relationship weaknesses. An evidence-based program receives support from two key national policy documents namely Leading Change, Adding Value (NHS England, 2016) as well the initiative ties into research showing structured handover practices lead to better care results.

The change process required strong leadership to succeed significantly. Research revealed transformational leadership proved better than transactional styles to achieve staff inspiration as well as collaboration development and cultural evolution in the field of clinical communication. The project needs to engage and motivate staff therefore transformational leadership provides the proper approach for implementing shared vision and expressing support alongside recognition.

Through its implementation of Kotter’s 8-Step Change Model the change initiative received systematic direction between planning and cultural adoption. The model laid out approaches for building urgency and supporting actions and achieving preliminary achievements. The assessment tools of SWOT and Force Field Analysis helped strategy developers to recognize future challenges which enabled preparation of suitable strategic reactions. The team concentrated actively on staff engagement approaches that included peer champion programs alongside reflective meetings and regular information sharing sessions because they understood the natural occurrence of resistance to change.

These initiatives made sure that staff members obtained both information-based awareness and opportunities to actively participate and drive the transformation process. Through evidence-based practice and strong leadership together with inclusive staff engagement this initiative outlined a sustainable patient-centred nursing care improvement process. Knowledge gained from this initiative will guide additional quality improvement projects and the advancement of my role as a nurse leader.

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