Blog 4: Applying a Change Model Reflection

This Blog will address the application of ADKAR a change model to Sylvia O. Quality Improvement project. Nurses are change agents and they participate in different types of change.  These changes can occur at work, within the working environment and while caring for patients. Nurses assist clients who need certain adjustments for health purposes and are finding it difficult to adapt. These adaptations are some changes nurses are involved in. For instance, a client with coronary heart disease might find it difficult to comply with the required diet regimen, but a nurse can help educate the patient to realize the need to abide by it and assist them on ways to achieve this while providing support. These actions by the nurse could bring “the change” to effect.

In the Sylvia O. QI project, an increase in the missed appointments of patients was a problem. This led to the decrease in revenue which was a serious issue in the ambulatory care center. One of their goals was to lower the missed appointments to no more than 5%, thereby cutting down on the “no show” rate. To achieve this, some changes could be made using the ADKAR model of change. The ADKAR model consists of five components that are required for a successful change. The components are as follows:

Awareness, Desire, Knowledge, Ability, & Reinforcement.

These components facilitate change and will be applied to the Sylvia O. QI project.

Awareness: The staff of the ambulatory care center should be aware of the changes to be made and the reason for them. Sylvia needs to communicate effectively with the staff involved on the need to reduce double booking. This was affecting patient outcomes and causing prolonged waiting time between patients. Effective communication will create an awareness and the scheduling unit will be aware of the change as well as the reason for it. The staff also need to be aware of the “no show” rate issue and the changes to be made such as the increase in the reminders for appointments. If the staff are aware of the positive impact of an updated address and an effective reminder system, then they would desire it.

Desire: When the staff knows the reason for the change and the negative effect on the revenue, they will desire and support the change. Once there is desire and support, the staff will be willing to participate in the change. For instance, the staff in charge of scheduling will be willing to do what is required in an effort to reduce double booking. If the desire is there and an obstacle arises, the staff will be willing to go the extra mile to resolve the issue. For example, if Sylvia experiences any technical or IT issue, a staff who knows about it might willingly volunteer to check the system or even say “Let’s call the IT to quickly help us get this straight.” Having the desire for a change facilitates it.

Knowledge: Sylvia has the responsibility to help the staff understand how the changes will take place. The knowledge of this will help the staff prepare. She needs to be sure that they have the knowledge required to facilitate the change. For instance, to reduce the “no show” rate, the staff involved needs to know the various ways reminders can be sent to patients as well as how to operate them. Also, a knowledge of the plan on how to get the addresses updated will also be necessary for this project.

Ability: For a successful change to occur, Sylvia needs to assess the ability of the staff to implement the change. She will work on ensuring that the necessary materials needed are provided. Having the ability and positive behavior will enable the staff to implement the change. For example, If the schedule will be changed to reflect less of double booking, the staff involved should be willing to effect the change and should have the ability to be able to update the schedule in the system. For the set up of reminders, the staff should also be skilled and be able to program it as needed.

Reinforcement: The aim of reinforcing a change is to make sure it stays in existence the way it should, by supporting it. Sylvia should reinforce the changes made from time to time to be sure things are in order. And if adjustments are needed, she will be able to catch it early enough before it further impacts the revenue of the Ambulatory Care Center. The Patient satisfaction comment card should also be used to know if things are getting better with the change or there are still some other issues. Reaching out to physicians will also help to know if the changes are decreasing the waiting time and if they have the required time needed to achieve quality patient care.


Quyen Wong. (2019). Leading change with ADKAR. Nursing Management50(4), 28–35.







Author: florence

I am in the RN to BS program through the SVCC-VCU co-enrollment program. I am excited as I am learning a lot about the Nursing Profession

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