Mariano Marcos State University

Laoag City
Master of Arts in Nursing

A successful management of change process requires significant front-end planning that
makes the implementation go much more smoothly.
There are internal and external forces that influence change.
 Internal forces originate from inside operations that may result from external
changes and include changing priorities, need for increased productivity, need for
cost containment, staffing pattern changes, shifts in philosophy, work process
changes, and need for quality of work life.
 External forces include health care economics, technology, restructuring,
diversity and changing demographics.
Leaders are visionary role models who focus on the future. Managers process the changes
and understand future directions.
Is visionary in identifying needed change
Assesses the driving and restraining forces
Is a role model
Identifies and implements strategies
Is sensitive in timing initiatives
Seeks subordinates input
Is creative in identifying solutions
Supports and rewards individual efforts
Focuses on the future
Understand future directions
(Carr DK Johansson)
Whether working with individuals, groups or systems, the nurse manager is sure to be
involved with management of change. Several strategies for managing change have been

Empirical-Rational Strategies are based on the assumption that people are rational and
behave according to rational self-interest. It follows then that people should be willing to

adopt change if it is justified and if the people are shown how they can benefit from change. people must believe there can be an improvement before they are willing to change. inservice education. and relationships in addition to providing information. continuing education and formal degree programs is encouraged. and directions of more powerful individuals. and skills. Even if a problem has been identified. operations research and implementation of research findings are consistent with the empirical-rational. Organizational development programs are fostered. training groups. negotiations. and administration decisions and rulings are power-coercive strfategies. The managers pay attention to changes of values. plans. sit-ins. Use of strikes. Nurse Managers who use empirical-rational strategies are likely want the appropriate persons for specific positions. give data feedback and analysis to appropriate people. philosophy. and train managers and internal agents. These strategies do not deny the intelligence and rationality of people or the importance of their values and attitudes. the manager fosters the development of staff members through means such as personal counseling. and it is typical to collect data about the organization. Coercion and the introduction of guilt and anxiety have been . PROCESS OF CHANGE Lewin’s framework for the three phases of change are unfreezing. Unfreeze  Move Refreeze Unfreezing is the development through problem awareness of a need for change. The intelligence and rationality of people are not denied. and nurse managers give considerable attention to recruitment and selection of personnel. System analysis. Believing that the basic unit of social organization is composed of individuals. but rather they acknowledge the need to use sources of power to bring about change. conflict confrontation. but attitude and values are also considered. plan ways to improve the system.  Power-Coercive Strategies involve compliance of less powerful people to leadership. small groups and experiential learning because people need to participate in their own reeducation. attitudes. as is long-range futuristic planning. Staff development through independent study. moving and refreezing.  Normative-Reeducative Strategies are based on the assumption that people act according to their commitment to sociocultural norms. Desirous of having people perform jobs for which they are well qualified. The relationship of internal change agents with other personnel can be a major tool in reeducating others.

punishment and humiliation for undesirable attitudes. Moving is working toward change identifying the problem or the need for change. Refreezing is the integration of the change into one’s personality and the consequent stabilization of change. imbalanced power ratio.         Coercive Change non-mutual goal setting. and rewards for desirable attitude effect change. . momentum to perpetuate the change. Parties may be unconsciously committed to changing one another. an equal power ratio. defining goals and objectives. The effectiveness of the change may depend on the amount of involvement in fact finding and problem solving of all personnel. but no deliberativeness characterizes interactional change. When there is greater deliberativeness on the power side. Socialization Change is directly related to interactional change. They involve no goal setting or deliberativeness. TYPES OF CHANGE The variables of mutual goal setting. and deliberativeness. and is deliberative.  used for unfreezing. Change may begin at a point of stress but ordinarily should not be started at the point of greatest stress. A technocraft merely reports the findings of the analysis to bring about change. planning how to accomplish the goals. change becomes indoctrination. Related changes in neighboring systems. Points of stress and strain should be assessed. Emulative Change transition is fostered through identification with and imitation of power figures. and structural alterations that support the procedural changes are stabilizing factors. Frequently personnel return to old behaviors after change efforts cease. has an imbalanced power ratio. exploring the alternatives. Subordinates are instructed in the belief of power sources Interactional Change mutual goal setting. Natural Change includes accidents and acts of God. and implementing the plan for change. Removal of people from the source of their old attitudes to a new environment. fairly equal power. the power ratio between change agent and the client system. Technocratic Change is collecting interpreting data bring about change. Planned Change involves mutual goal setting. Indoctrination uses mutual goal setting. It is most appropriate for it to start with a policy making body that considers both formal and informal structures. Stress may cause dissatisfaction with the status quo and become a motivation factor for change. and the deliberativeness of change are differentiating factors in the change process. An individual conforms to the needs of a social group. and one-sided deliberativeness characterized coercive change.

Dependency is the major factor determining when the relationship will end. as the change agent. must identify with clients problems while remaining neutral so that they can remain objective. Stabilization renewal and 4. and indicate that a more desirable state of affairs is possible. Gaining acceptance 5. Building a relationship 2. help the client become aware to problems. Next. Diagnosing the problem 1. rewards for the change and related procedural and structural changes increase the stabilization. Selecting progressive change objective 5. The problem must be identified and clarified. The success of planned change is evaluated by the implementation of the plans. The refreezing process occurs during the sixth phase – generalization and stabilization. It is the ative work of modification that completes the moving process. Trial self- helping Ronald Lippitt. Maintaining change 7. Alternative possibilities for change should be examined. The spread of change to neighboring systems and to subparts of the same systems aid in the stabilization process. positive evaluation of the change. Goals and objectives are planned. Jeanne Watson and Bruce Westley (1958) have identified seven phases of planned change. Change momentum. Ronald Havelock’s sixth and Everett Rogers’ five can all be clustered to Lewin’s three. The success or failure of most planned action will depend largely on the quality and workability of the relationship between the change agent and the client. Assessing motivation and capacity for change 3. Moving 3. Choosing the appropriate role for the change agent 6. Diagnosing the problem 2. All too often clients slip back to their old ways after change effort cease. The change agent assesses the client’s motivation and capacity for change and the change agents motivation and resources. the client must feel a need for change. Unfreezing 2. The manager. First. The client’s emotional and material resources are examined. Freezing LIPPITT HAVELOCK 1. Acquiring the relevant resources 4. Awareness 2. ROLES OF THE MANAGERS CHANGE AGENT . and the moving process begun. Terminating relationship the ROGERS 1. Interest 3. Managers. Assessing change agents motivation and resources 4. Lippitt’s seven phases. or a different type of continuing relationship is established. Choosing the solution 3. Adoption 6. the helping relationship must be established. Strategies for change are determined. The helping relationship ends.LEWIN 1. Evaluation 5. Thus unfreezing occurs. as change agents. Collecting and analyzing data can facilitate this process. can stimulate an awareness of the need. The change agent needs to be viewed as an understandable and approachable expert.

determines alternatives. Which are the major factors toward or resisting change? Which are important or moderately important? These might be listed in columns under “driving” and “restraining” and ranked. assesses the clients’ motivations and capacities for change. STATUS QUO Restraining forces Status quo Driving Forces Once the driving and restraining forces have been identified. Restraining forces include conformity to norms. perception of economic threat or threat to one’s prestige and homeostasis. explores ramifications of those alternatives. Havelock indicates that change agents facilitate planned change by being a catalyst. desire for security.As a change agent. assesses resources. the manager identifies the problems. and chooses and implements techniques for planned change. FORCE-FIELD ANALYSIS Lewin’s force field analysis provides a framework for problem solving and planned change. process helper and resource linker. determines appropriate helping roles. and change will occur when the relative strength of the opposing forces changes. and regularly mechanisms for keeping the situation fairly constant. the manager should identify the restraining and driving forces and assess their strength. recognizes the phase of the change process and guides the client through them. and belief that the change will improve the situation. Driving forces may include pressure from the manager. perception that change will improve one’s self-image. the managers determine their relative strengths. when planning changes. Consequently. solution giver. morals and ethics. . Status quo is maintained when driving forces equal the restraining forces. desire to please the manager. establishes and maintains a helping relationship.

write in keywords to identify the forces. mission and assumptions. and draw arrows toward the status quo line to represent the strength of the forces.Scale: 1=little strength. STRENGTH OF DRIVING AND RESTRAINING FORCES Conformity Security Economic threat Threat to prestige Improve self-image Improves situation Restraining forces Status quo Driving Forces Pressure from manager Please manager Next. In a dysfunctional culture members continue behaviors that have worked in the past but no longer effective. Managers may do some experiential learning exercises to facilitate the change of the group norms. the manager can draw a diagram. 2=moderate strength. Culture ruts occur when members do not adapt to change and continue to function out of habit even when success is not forthcoming. explain each person’s role in the change with emphasis on security. . the managers plan strategies for reducing the restraining forces and strengthening the driving forces. Culture shock happens when the members realizes that the organization is out of touch with its setting. Steps should be taken to improve self-images. the stronger the force. 4=major strength DRIVING FORCES RESTRAINING FORCES Rank Factor Rank Factor 1 Pressure from manager 4 Conformity 4 Please manager 4 Security 2 Improve self-image 2 Economic threat 2 Improves situation 3 Threat to prestige To help visualize these forces. CULTURAL CHANGE IN ORGANIZATIONS In adaptive culture members of an organization supports each other’s efforts to identify and solve problems. 3=important strength. The longer the line. The members believe they can manage the problems. and provide some status symbol to reduce the threat to workers identify how the change will improve their situation. have confidence and enthusiasm. and are receptive to change.

Next managers examine their personality types.norms related to helping others. The culture track helps explain organizational differences in decision making and actions. they can. Because one personality type determines how one will assimilate information and make decisions. 2. For instance. Culture Management skills Team building Strategy structure Reward system The five tracks require implementation in order to be successful. 4.1. so removing the cultural barriers has to be accomplished before proceeding to another tract. To establish decided norms they think would lead to organizational success. FIVE STAGES OF ORGANIZATIONAL PLANNED CHANGE (Kilmann) Initiate the integrated program of cultural changes Diagnose the problems Schedule the tracks Implement the tracks Evaluate the results FIVE TRACKS OF CULTURAL CHANGE 1.norms related to performing new activities. using self-expression.  Personal freedom – norms for pleasing oneself. managers should be aware of their style and the styles of associates so they can compensate for their natural inclinations and acknowledged limitations and develop strong work teams. Adaptive cultures have internal control. one needs to clarify the actual norms. 5. 5. and concern for efficiency  Task innovation . 2. The culture track reveals the norms of the organization. one could ask members to list current dos and don’ts. 4. It exposes culture and helps create a new culture. much as personality explain differences in individuals. Closing the culture gaps then become an issue. Culture gaps are generally largest at lower levels in the organization. If managers and associates decided than changes should occur. Without an adaptive culture it can be impossible to make improvements. trying different approaches. and being creative  Social relationship – norms about mixing business with pleasure band socializing with coworkers. First. . manager are taught the five steps of problem management: (1) sensing problems. (2) defining problems (3) deriving solutions (4) implementing solutions and (5) evaluating outcomes. Culture gaps are often related to:  Task support . The member can then list what they want the norms to be and identify the culture gaps. 3. 3. and exercising discretion. information sharing. Control is social reality but not necessarily an objective one. In management skills track.