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hread: Sustaining a Culture of Change What factors do you see as critical to implementing and sustaining a culture of quality? reply one Over the semester, we have learned quite a bit of information about evidence based practice in nursing. This week we cover many factors that contribute to creating a culture for quality. With today’s healthcare environment being so vastly complex and constantly changing, it is critical to implement and sustain a culture of change and quality. Evidence has shown that organizational culture has an impact on the patient safety practices and implications for the culture of safety, blame, and quality (Vogelsmeier, Scott-Cawiezell, Miller and Griffith, 2010). The most important factor that influences change and quality starts with leadership. The leadership of a healthcare organization must guide and support the organization and clinicians through many challenges, such as evidence based practices (Melnyk and Fineout-Overholt, 2019). Evidence based leaders must be grounded in and embrace the evidence based practice processes for decision making. Evidence based leadership is defined as a problem solving approach to leading and influencing organizations or groups to achieve a common goal that integrates the use of best evidence with leadership expertise and stakeholders' preferences and values. One study displayed that leadership deeply influences all levels of workplace culture and inspires change in the organizational culture (Muls et al., 2015). There are many styles of leadership that a healthcare organization can obtain. Innovation leadership, transformational leadership, servant leadership, and authentic leadership. Innovative leaders are leaders who create an infrastructure that weaves innovation into the core of the organization. With innovative leaders, employees are both empowered and encouraged to reach and challenge the status quo and integrate new processes and technologies. Innovative leaders encourage employees to seek ways to operate efficiently and effectively. Transformational leaders are individuals that “find meaning or purpose in their work, and grow and develop as a result of their relationship.”There are four dimensions that make a transformational leader. The four dimensions are idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration. Servant leaders are based on the philosophy and a set of leadership behaviors and skills that establish essential elements. Servant leaders are basing the leadership on trust, empathy, caring, and focus on others. Authentic leaders are defined as leaders who are confident, hopeful, optimistic, resilient, transparent and have high moral characteristics. Authentic leaders use balanced processing, internalized moral perspective, relational transparency, and self awareness in their leadership techniques (Melnyk and Fineout-Overholt, 2019). The Bible teaches us about leaders and the influences that they have. In the Bible, we are taught to pay close attention to ourselves and the flock as the Holy Spirit made us the overseers. This verse is in the book of Acts, this verse is telling leaders to not only observe the followers but to also observe themselves. Proverbs also teaches that we are to be good leaders because if the wicked rule then people will groan and be unhappy (Vogelsmeier, Scott-Cawiezell, Miller and Griffith, 2010). reply two Many health care organizations across the country are moving to a more patient centered care model. A large part of this transition is implementing quality improvement programs. To understand quality improvement one must be able to define quality improvement in health care as "the combining and unceasing efforts of everyone, healthcare professionals, patients and their families, researchers, payers, planners and educators, making changes that will eventually lead to better patient outcomes, increased system performances, as well as, increasing professional development" (Feldman, et al., 2019). Creating a culture of quality within the health care organization means that the organization is committing to patient, safety, and quality. " The culture of care creates the infrastructure necessary for the dynamics and processes of EBP to make a lasting impact and lead to higher levels of quality service and care" (Melnyk & Fineout-Overholt, 2019 p.368). Creating a culture to change in quality is a important step in sustaining the necessary change to keep initiatives and patient centered care at the forefront of the organization. Colossians 3:1 reads "If then you have been raised with Christ, seek the things that are above, where Christ is, seated at the right hand of God" (ESV, 2002). The question can be asked, is culture really important? The short answer is yes it is. Many organizations implement three different levels of culture within the organization. Visible manifestations, shared ways of thinking and deeper shared assumptions are all ways that can help define a culture of change for a organization (Mannion & Davies, 2018). In Colossians 3:1 the scripture wants us to seek the most high, reach for the best. This is a notion that health care organizations can use to help define nd sustain their quality improvement programs. Health care organizations should be striving to obtain the best possible culture of quality obtainable. Visible manifestations of culture may be implemented in ways such as reward systems, staffing changes, staffing dress as well as physical layout of the health care organization (Mannion & Davies, 2018). Crating a culture and sustaining that culture also means embracing the lessons learned from past mistakes. There is knowledge in identifying and understanding where a wrong turn was taking. this helps to not make the same mistake again. This thought process can be tricky and potentially costly with the risk of more than just a financial cost, however taking a deep dive into quality incidents can protect the organization from towing the same line over and over again. Sustaining a culture of change will take teamwork from those with in the health care organization. Not just the policy makers and not just the policy executers.