Organizations do not change-people do (Kinsey Goman, 2000). Successful implementation of a major organization-wide change is a complex process that takes careful planning and effective communication. At the Medical University of South Carolina (MUSC) hospital, a decision was made to standardize scrub color by the health provider's role for all clinical staff. The change was to be implemented 1 year later as the MUSC opened a new hospital. The purpose of the change was to emphasize the unique role of each healthcare discipline involved in direct patient care without inhibiting personal freedoms. The goal was to promote an atmosphere of professionalism, increase the confidence of patients and families, and provide them with a means to identify their healthcare providers.
The first step in the change process was the formation of the dress code task force. The task force consisted of representation from all disciplines (e.g., nursing, pharmacy, radiology, laboratory, and therapeutic services). The task force reviewed the literature and the qualitative data from MUSC patient satisfaction surveys. Other institutions throughout the country that had enacted similar dress codes were queried.
The task force recognized the importance of seeking input from staff members of all disciplines to be affected by this change. If staff members do not buy into the reason for change and are not included in the planning, there will be no successful change regardless of how brilliant the strategy is (Kinsey Goman, 2000). A voting process was recommended. With guidance from the task force, each discipline group selected specific colors from which the staff members could choose. Scrubs in all available colors were displayed in the hospital lobby for 2 days. A Web-based voting tool was developed giving all staff members the opportunity to vote on their choice of scrub color. Employees of each MUSC discipline voted on their first, second, and third choices of scrub color. A network identification password was required to vote to ensure a fair voting process.
The leadership realized that changing to a dress code scrub color by role would be a sensitive issue and raise many questions and comments. Skorupski and Rea (2006) verified a connection between what nurses wear and the image their uniforms project to patients. All generational groups identified the individual who wears a white uniform as a professional nurse and individuals wearing the print uniform suggested an approachable, caring, and friendly image (Skorupski & Rea, 2006). Feedback from MUSC staff indicated that a combination of a solid color and print top was preferred. A decision was made to allow staff members to choose to wear solid-color scrubs or to wear solid-color bottoms with a print top having a background color of the primary color selected for their role. Registered nurses can also combine white with their color or print top. This decision was well received. It provided staff members the ability to express their individuality.
The votes were tallied and results announced. A poster with pictures of MUSC staff members wearing their role-specific scrubs was developed to communicate the selected colors. The patients and family members are informed of the role-specific scrub schema via the GetWell Network, a product that provides patients and families access to the Internet, entertainment, education, and communications via their hospital-room television.
A Web site was developed to display the scrub colors, frequently asked questions, and the dress code policy. Each staff member was given a one-time stipend of $100 to aid in the purchase of two sets of scrubs. Three scrub sales were held on site by different vendors to facilitate the purchase of new scrubs. Payroll deduction was offered as a means of payment.
Although many staff members were opposed to changing to the new dress code, throughout the entire process, a number of them voiced a "change of heart" after implementation. A psychiatric liaison nurse stated that she was initially opposed to the plan to require all nurses to wear the same color of scrubs and felt that it would be a "dissatisfier" that would have a negative impact on nurse retention. She now appreciates the ability to identify at a glance all of the different healthcare professionals by the color of their scrubs. As a consultant with responsibilities on units throughout the hospital, she is now able to immediately identify the patient's nurse and clinical associate as well as the respiratory therapist, physical therapist, and so forth. As leaders make rounds on units or see staff members in the hallways, it is easy to identify and quickly connect with the staff members.
As with any change, lessons were learned along the way.
1. Views on uniform requirements are many and packed with emotion. Be patient and listen to staff comments.
2. Give all staff members a voice in selection of the uniform. Web-based voting was an effective and efficient method.
3. Set a short time frame for implementation and do not let the process take months to accomplish. Deadlines longer than 4 months can add to the opposition and a belief that the change will not occur.
4. Answer staff questions in a timely manner and develop a communication tool such as an intranet site accessible to all staff members, keeping the process transparent.
Today, the scrub color tells the story of the outcome of this change process at the MUSC. Our workforce projects a role-identifiable professional image that makes us proud.
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