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Change within the healthcare setting is inevitable and as a nurse leader understanding how change occurs and strategically determining the change process or model needed to best suit the needs of the change is a valuable skill to possess.  In this situation a change is needed surrounding the current organizational structure at a facility.  This situation indicates that there is an in-proportionate number of leaders to staff creating a “top heavy” environment where multiple people are in charge of a single unit(s).  This type of a change consists of organizational restructuring and can create threats to decision-making strategies, including information flow, relationships, and priority setting (Spiers, Lo, Hofmeyer, & Cummings, 2016).  Restructuring the organizational structure will create a feelings of uncertainty among staff and this type of change should be mapped out and well communicated to ensure a smooth transition.  With a top heavy scenario the goal of the organizational restructuring is to ultimately create a more streamlined and direct line of authority, eliminate any duplicate leaders and flatten out the line to reduce the expense.

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The three change models discussed could theoretically all be used in this scenario however the one I opted to implement is the PDSA model of change.  This scenario requires a rapid change in organizational structure and Kotter and Roger’s are by design a more slow measured change process.  This organizational restructure requires a plan of action which is restructuring the leadership or reducing the number of leaders within each unit/department.  The plan is then implemented by restructuring leadership or by eliminating excessive leadership in order to create a more direct line of authority and lessen the redundancy of leaders.  If a alteration of the plan is needed upon further eval then the cycle continues.  Flattening out the leadership or reducing the number of leaders is difficult but must be done in a precise manner, enacted upon evaluated and then adjusted if needed.  Kotter and Rogers change models could be applied here but in my opinion the PDSA model and the quick four cycle process works best to implement a rapid change in leadership that is needed in this scenario.

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