"One does not discover new lands without consenting to lose sight of the shore for a very long time." - -Andre Gide
How many of you would consider yourself "type A" personalities? My guess would be that if you work in Neonatal Intensive Care, you are at least a little bit type A. If so, you might agree that you like to be in control of what is happening in your personal and professional life and in the circumstances around you. If you like to be in control, you may like things to stay the same-familiar, predictable, and reliable. You like to be able to anticipate events and establish expectations based on what is likely to happen. Like many of us, you don't like unexpected, unpredictable change, and you especially don't like the kinds of change we deal with in healthcare-ongoing and constant.
The field we work in requires us to be confronted with change all the time-ever-advancing technologies and research, new policies and procedures, mergers and reorganizations, and constantly shifting duties and responsibilities.1 Knowledge acquisition is happening at a faster rate. Advances in genetics and healthcare technology create new ways of detecting and treating disease but raise ethical issues we are unprepared to deal with. Communication happens electronically, rather than face to face. There are limited resources to provide the type of care we would like for our infants and families. There is increasing competition among hospitals that disrupts long-standing referral patterns and patient populations. Too much change in too short a time puts us at risk for decreased morale, decreased effectiveness, and emotional distress.
We can look at this level of change as a warning sign of inevitable and impending doom, or we can look at it as an opportunity to improve how we approach our everyday work, both professional and personal. It is a myth that efficiency, effectiveness, and quality are always made worse by change. It also is not true that those who embrace change are always heroes and those who resist are villains. Rather, change can be managed so that it can be properly assimilated and managed for improvement, rather than disaster.
We can cope with change in a variety of ways. We can choose to be a victim of change or its architect if we understand the personal transition process underlying change and find constructive ways of working through it. Think about the following characteristics as outlined by Bushy and Kamphuis.2 How do you approach change? Are you an innovator, thriving on change and innovation? Perhaps you are a member of the "early majority." You don't like to initiate change, but you adapt to it quickly. Others look to you for advice and wait to see your opinion of the change. Members of the early majority may not lead but are usually supportive early on and adapt to new ideas before most people in the organization. The "late majority," the followers, go along in response to peer pressure or because of economic necessity. "Laggards" tend to be suspicious, like tradition, and tend to slow the decision-making process. "Rejecters" openly oppose innovation and encourage others to oppose it. Sometimes they sabotage the change to prevent its implementation. For most of us, we can move a little bit between these categories, depending on what the change is (not all change is positive, after all). But if you find yourself constantly in the laggard or rejecter category, you might think about why change of all kinds is so difficult for you.
Change is not comfortable, and it is often risky. It requires setting off for a destination without knowing exactly what it will look like. It means losing site of the shore for a while. Sometimes, venturing out when you don't know what the outcome will look like is what is necessary to create something that we don't yet know exists. People who propose things that are different, often make more conservative people very nervous.3 When Hal Sperlich first came up with the idea of the minivan, no one at Ford or General Motors would listen to him. After all, no one had asked for a minivan, therefore the need must not exist.3 He took the idea to Chrysler, and it became their best-selling vehicle for the next several years.
However, not knowing the exact outcome doesn't mean that you lose site of your purpose. As we embark on this journey with a new publisher and new editor, we do not know everything about the shore we will end up on, but our purpose remains clear. The goal of our editorial staff, our publisher, and our organization is to provide information to help our readers do their best job possible for the infants and families in our care. The mission statement of Advances in Neonatal Care remains the same; the journal is "Dedicated to advancing the art and science of newborn care through the publication of scientifically sound and clinically relevant articles that enhance interdisciplinary care."
Madge Buus-Frank and the editors and authors who have worked with her the past 6 years have done an amazing job in making that vision a reality. Everyone who has participated should be proud of the work done. I believe those who follow will continue to work hard to maintain our vision, just as all of our readers work hard to be their best when taking care of our small patients.
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