Planned Change

Objectives
• Discuss reasons for change
• Define change agent
• Discuss change agent strategies
• Review the natural and expected response to
change
“The significant problems we face
cannot be solved at the same level
of thinking we were at when we
created them.”
—Albert Einstein
 Change
• Change is inevitable
• Organizational change can be driven by many forces
• Change is seldom easy
• Leadership skills
– To make sure that the change we are going thru isn’t
sabatoged
• Re-energizing and empowering a workforce.
– Who better to ask how to change things for the better
than the people actually working, doing the job
• Historically change has been viewed as coming from
the top down, but new research shows that this
kind of change doesn’t work well.
 Change
• Planned change – intended, purposeful attempt or
proactive plan by an individual (change agent) or
group to create something new
– Well thought out, deliberate, initiated and coordinated,
require well developed leadership. Require visions and
expert planning skills. Vision is your future goal, the
painting of what you want it to be. An organization will
never be better than the vision that guides it, different
than a mission.
• Unplanned change or change by drift – occurs
without any control or effort
 Change
• Covert – occurs without awareness, we don’t
know they’re happening
• Overt – occurs with awareness, we know
they’re happening
• Developmental or maturational – a result of
physical or psychosocial changes during the
life cycle, not only us, but also the
organization
 Change
• Change agent – a person skilled in the theory and
implementation of planned change, synonymous
with the phrase “change facilitator,” usually an
outsider (because they’re not biased and the
organization won’t have as much resentment for
the outsider)
• Champion – to support, coordinate, and market the
change at all levels of the organization. May or may
not be outsiders, taken aside and taught all the stuff
about the change in advance, and sent back out to
us to explain it and gather support. Like
cheerleaders
 Lewin’s Force Field Analysis
• Kurt Lewin (1951) identified three phases that the
change agent must initiate before a planned change
can occur

• A successful change involves three elements:

– Unfreezing
– Movement
– Refreezing
Data from Lewin (1947, 1951).
Still the basis for how we change things now
 Lewin’s Model
• Unfreezing – Occurs when the change agent
convinces members of the group to change or when
guilt, anxiety, or concern can be elicited.
• Movement – the change agent identifies, plans, and
implements appropriate strategies, ensuring that
driving forces exceed restraining forces. Sets goals,
target dates to implement the change. Whenever
possible we are going to try to implement change
gradually!
 Lewin’s Model
• Refreezing – the change agent assists in
stabilizing the system change so that is becomes
integrated into the status quo. Change agent is
out there being supportive, helping people adapt,
making sure you have the tools you need to
sustain the change, making sure you have the
reasons and that you know why, making sure
everything is stable. Usually takes about 3 – 6
months. We should never attempt a change
unless that change agent can stay there the
entire time.
 Change Agents
• Change agents must be patient and open to new
opportunities during refreezing, as complex change
takes time and several different attempts may be
needed before desired outcomes are achieved.
 Driving / Restraining Forces

• Driving Forces • Restraining Forces

– Economic gain
– improve situation
– Challenge
– Future impact
– Growth, recognition,
achievement, and / or
improved relationships
– Need for security
– Lack of time or energy
– Failure to see the big
picture
– Perceived loss of freedom
– Negative past experience
 Seven Phases of the Change Process
• Diagnosis of the problem
• Assessment of motivation and capacity to change
• Assessment of the change agent’s motivation and
resources
• Selection of progressive change objectives

Data from Lippitt (1973).

Seven Phases of the Change Process

• Choosing an appropriate role for the change

agent
• Maintaining the change once it started
• Termination of the helping relationship with the
change agent

Data from Lippitt (1973).

 Six Elements in the Process
of Planned Change
• Building a relationship
• Diagnosing the problem
• Acquiring relevant resources
• Choosing the solution
• Gaining acceptance
• Stabilization and self-renewal

Data from Havelock (1973).

 Complexity Science
• Complexity science argues that the world is complex,
as are the individuals who operate within it.
– Simple is following a recipe, and complicated is sending a
rocket into space, but complex is raising a child. If you think
about raising a child, there is no specific formula and you
have to adapt to each child differently, it’s a moving growing
thing, and you learn on the job. You follow general
guidelines but sometimes these are changed with
experience.
• Thus, control and order are emergent rather than
predetermined, and mechanistic formulas do not
provide the flexibility needed to predict what actions
will result in what outcomes.
 Complexity Science Systems
• Linear
– Result of change is predictable. Ex. Light work is carrying a
small bag uphill. It will be harder if we carry a moderate bag
up the hill, and it will be even harder carrying an even
heavier bag up the hill.
• Non-Linear
– If we change one factor, it’s not readily predictable, but still
replicable (not every time, but sometimes). It may be harder
to carry the heavier bag, but it may not be. Sometimes a
small change in A results in no change in B, or a huge change
in B, it just depends.
• Random
– Exactly what it says… Even if the same starting circumstances
are replicated, the results are different every subsequent
time.
 Complex Adaptive Systems
• Change should be achieved through connections
between change agents, instead of from the top
down
• There should be adaptation during the change to
uncertainty
• Goals, plans, and structures should be allowed to
emerge instead of depending on clear, detailed
plans and goals
• Nonlinear. Should be achieved thru connections of
change agents, instead of from the top down. We
should adapt during the change for uncertainty.
 Chaos Theory
• Chaos theory is really about finding the underlying
order in apparently random data.
• Chaos theory also suggests that even small changes
in conditions can drastically alter a system’s long-
term behavior, commonly known as the butterfly
effect.
• In a code, everything appears to be very chaotic,
but is there not things that are happening that
should happen? We’re giving drugs, doing CPR, etc.
There is underlying order in the chaos.
• Can drastically change the behavior or the long
term effects on a system.
 Rules That Should Be Followed in
Implementing Change:

• Change should only be implemented for good

reason.
• Change should always be gradual.
• All change should be planned, and not sporadic or
sudden.
• All individuals who may be affected by the change
should be involved in planning for the change.

Lewin (1951)
 Change Agent Strategies
• Rational–empirical
– Assumes that people are rational and receptive to
change when given adequate facts
• Normative–re-educative
– Change will only occur when attitudes and relationships
are altered
• Power–coercive
– Result of an individuals need to please a supervisor, or
fear of losing their job.
(Bennis et al, 1969)
 Innovation Theory
• Innovation refers to the process of bringing any
new or problem-solving idea into use
• Often linked with creativity
• The process of eliminating the obsolete and the no
longer productive efforts of the past
• Organizations need to promote innovation. We
need to view change as an opportunity. Innovation
is often linked to creativity.
 Characteristics of
Nurse Innovators
• Self-confident
• Conscientious
• Ambitious
• Motivation to learn
• Perseverance
• Initiative
• Tenacity
• Determination
 Leaders as Change Agents
• Articulate a clear need for change.
• Get group participation by leaving the details to the
people who must implement the change
• Get reliable information to the implementers
• Motivate through rewards and benefits.
• Do not promise things that cannot be delivered
 Change Management
• Executives do not direct change; they initiate
and influence the direction
• Recipients of change, translate and edit plans
for change
• The main method used by recipients to
interpret change is through informal
communication

Data from Balogun (2006).

 Change Management
• Senior management must monitor and engage
the “informal” channels
• Attention must be given to open discussions
and storytelling in communication about
change
• Recipients of change will mediate outcomes,
managers need to engage activity with them
Data from Balongun (2006).
 Change Management

• Using change agents to help the engagement

may be helpful (especially in large
organizations)
• Senior managers need to “live the changes”
they want to adopt

Data from Balongun (2006).

 Resistance to Change
• Resistance to change should be expected as integral to
the whole change process
• Resistance may be rooted in anxiety or fear
– Fear a loss of status, power, control, $$, job, whatever.
There are misconceptions about the change (inadequate
information).
• Not all resistance is bad; it may be a warning that
something needs readjusting or clarity
– If you’re the change agent and you get resistance, you need
to look into it! Take the person causing the most resistance,
bring them in, and help me solve the problem.
• Viewing the nurse or resistor as the solution versus the
problem helps reframe the issue
 Resistance to Change
• Perhaps the greatest factor contributing to the
resistance encountered with change is a lack of
trust between the employee and the manager or
the employee and the organization
 Crusaders / Tradition bearers

• Crusaders – want to make things better for the

future
• Tradition bearers – preservers of what is best from
the past and present
• These are both ok people, not necessarily
resisters. Put them together and let them work
together.
 Increasing the Probability
for Change
• Explain the rationale for a change so individuals
understand it
• Allow emotions to be worked out
– Needs time
• Give participants all the information they need
• Help individuals cope with change
 During Change
• Time and effort it takes to adjust
• Possibility of less desirable outcomes
• Fear of the unknown
• Tolerance for change capacity
• Trust levels
• Need for security
 During Change
• Leadership skills
• Vested interests
• Opposing group values
• How coalitions form
• Strongly held views
• Existing relationship dynamics disruptions
 Actions to Avoid
• Simply announce a change without laying the
foundation
• Ignore or offend powerful people
– Huge no no
• Violate the authority and communication lines
in an organization
• Rely only on formal authority
• Overestimate your formal authority
 Actions to Avoid
• Communicate ineffectively
• Put people on the defense
• Underestimate the perceived magnitude
of the change
• Ignore the people’s fears about
insecurity or change of status
• Fail to be open to criticism
 Nine Common Mistakes
• Assuming management should keep them
comfortable
• Expecting someone else to reduce the stress
• Shooting for a low-stress work setting
• Trying to control the uncontrollable

Data from Davidhizar (1996).

Nine Common Mistakes
• Failing to abandon the expendable
• Fearing the future
• Picking the wrong battles
• Psychologically unplugging from the job
• Avoiding new assignments

Data from Davidhizar (1996).

 Leadership and Management
Implications
• Organizational transformation
• Reimbursement for care
• Information system used for care
documentation and assessment
• Nursing shortage
• National health care reform
 Leadership / Management
Behaviors

● Models the change they want to see

● Communicates the need for change
● Adapts to change
● Enables change to progress constructively
● Develops mutual goals
● Change is implied in the definition of
leadership
 Attempting Change

● Change should never be attempted

unless the change agent can make a
commitment to be available until the
change is complete.
 Areas of Change Influencing
Healthcare Today
• Population as customer
• Wellness care and prevention
• Cost management
• Interdependence among professionals
• Client as consumer of cost and quality
• Continuity of information

Data from Issel and Anderson (1996).

 Change Drivers for Nursing
• Cultural diversity
• Aging U.S. population
• New services and technologies
• Health care costs
• Public policy of posting information about
quality

Data from Wakefield (2003).

 Core Principles of Change
• Participation is not a choice.
• Life always reacts to directives; it doesn’t obey
them.
• We do not see “reality.” We create our own
interpretation of what is real.
• To create living health in a living system and
connect it to more of itself.

Data from Wheatley (2007).

 Good Reasons for Change

• Change to solve some problem

• Change to make work procedures
more efficient
• Change to reduce unnecessary
workload
 Organizational Development
• Developmental or maturational – a result
of physical /psychosocial changes during
the life cycle
● Birth
● Youth
● Maturity
● Aging
Change is the law of life and
those who look only to the past
or the present are certain to
miss the future.
-John F. Kennedy
Everyone thinks of changing
the world, but no one thinks
of changing himself

-Leo Tolstoy
Questions?