Emergent Change

Journal Article

Luiking, M. L., van Linge, R., Bras, L., Grypdonck, M., & Aarts, L. (2015). Intensive insulin therapy implementation by means of planned versus emergent change approach. Nursing in critical care.


Prospective comparative study introducing a new insulin protocol in an ICU in the Netherlands. Measurement of compliance within two teams of nurses.


Looks at Emergent Change (EC) implementation versus Planned Changed (PC) implementation.

  • EC-implementation involves a new working method protocol with the nursing team driving improvements and change.
  • PC-implementation involves a new working method driven by management in a centrally directed “top-down” manner.


EC-implementation change process had improved nurse compliance and shorter time to achieve treatment objective.

Key Points

  • Translation of evidence base into practice and that nurses frequently need to change working practices.
  • Organisational culture of change.
  • Transformative change.
  • Engagement of the team is required for effective change implementation.
  • The team find ways to achieve goals and standards.


For those interested in the glucose control and insulin discussion, I would advise reviewing NICE-SUGAR and VISEP trials for current evidence based approach. This article was used for its fantastic change management merits.

For critiquing articles Joanna Briggs Institute and BestBets.

Facilitating Emergent Change in a Healthcare Setting: Dr. Peter Dickens