NURSING MANAGEMENT & LEADERSHIP

INITIATING & MANAGING

CHANGE
 OBJECTIVES

At the end of this lecture students will be able to:

• Identify change & change process
• Recognize the different types of changes
• Discuss the difference between Planned change & Unplanned change
• Identify the Change agent
• Differentiate between the internal and external Change agent
• Explain the change process
• Identify the Driving & Restraining Forces of change
CONT.,

• Discuss Reasons for Resistance to change and how to overcome the change
• List Principles of change
• Recognize the techniques for dealing with change and unplanned change
• Demonstrate how the nurse can be an effective change agent
• Recognize the different level of change
• Discuss change steps
• Explain manager role in implementing the change
PLANNING FOR CHANGE
 Understanding Change
Change affects every aspect of life; taking a
proactive/positive approach to change is the only
way, either as an individual or as an organization.
 Understanding Change
o For organizations: its is the way to grow and stay
competitive.

o For the individual: its developing careers and

personal life.
 DEFINITION

• Change is the “process of making something different

from what it was” (Sullivan & Decker, 2001).

• Change is a dynamic process by which an alteration is

brought which makes different.
 TYPES OF CHANGES

• Minor change:
Unable to be noticed because of smallness or slightness.
• Major change (obvious):
It can be easily recognized by others.
• Planned change
• Unplanned change
 UNPLANNED CHANGE
1- Haphazard change: Sudden/random with no preparation in advance (e .g arrange
staff due to absenteeism)

2- Power/Coercive change: utilizing the authority to order for change for

improvement or to solve problem non mutual goal sitting, unbalanced power (hold
all vacation during COVID)

3- Developmental change: tend to be sequential, with one phase orderly leading into
another. Occurs through the natural development of people, groups, or organizations.
(e. g. change staff to senior staff then to head nurse)

4- Spontaneous or natural change occurs in response to natural, uncontrollable

external events outside the system being affected. (e .g increase number of sickle
cell patient in winter season )
 PLANNED CHANGE
• is intentional, thought out, planned process and include
goal setting (e.g: change documentation system next
month )
• It is easier to manage, so the nurses must understand the
process of planned change to become skilled in
managing the change.
 CHANGE AGENT

• Is the individual who initiates the change process

until it is complete.
• This person generates ideas, introduces the change/
innovation, develops a positive environment for the
planned change by identifying potential sources of
resistance, developing strategies to overcome them,
and identifying aspects for acceptance of the change.
 INTERNAL CHANGE AGENT
A person from the organization.
Advantage:
• He/she will be familiar with the target group and may establish a
trusting relationship with them.
• He/she will be familiar with the policies, procedures, and
organization system.
Disadvantage:
• Can be influenced by vested interests and bias.
• Can be affected by group impressions of their ability, by their past
experience with hem/ failures.
 EXTERNAL CHANGE AGENT

• Is known as an external "consultant" from outside the

organization in order to assist the group during the change
process.
Advantages:
• The person can be completely objective about the situation.
• There is no bias to the members within the group.
Disadvantage:
• Needs time to assess the target group as they didn't know
each other.
 CHANGE PROCESS

• Kurt Lewin’s (1951) theory addressed three phases of

change:

1. Unfreezing

2. Moving

3. Refreezing
 1- UNFREEZING

• Identifying the problem or the area for improvement

• Collect information to allows people to know what is

going on and what is being considered.

• In contrast, when people do not know what is happening

and the reason for it, they strongly resist change.

• Managers should not be surprised when people resist to

change. (unfreezing usually takes a great deal of time)
 1- UNFREEZING
• There are two practical rules to be used in this
process:

1. Do not try to implement the change until unfreezing

has taken place.

2. Provide Psychological safety for people involved in

the change.
 2-MOVING
• Unfrozen people are eager to move after they know the reason
and they examine all options , which allow the actual
implementation of the change to occur.

• The manager should lead and have a plan in place to

accommodate and support the staff needs.

• Problems and mistakes may occur. Mistakes should not be

criticized but instead used as positive learning experience.
 3- REFREEZING

• This is a great time in the change process

because the actual change has happened.

• What is needed in this phase is the ability to

stabilize and integrate the change so it becomes
a part of the regular work of the unit, team,
hospital, or agency.
 REFREEZING

• This requires support systems such as polices and

procedures that allows the change to be firmly
embedded and to be permanent in the organization.
DRIVING & RESTRAINING FORCES
• Driving forces move people in the direction desired
by the change agent.
• In contrast, restraining hold the change cycle.
• Change occur when one force out weight other in
making change.
• It is important to identify the driving and restraining
forces, (people who oppose or support), time,
financial, knowledge, habits, or traditions.
 REASONS OF RESISTANCE TO
CHANGE
1- Threatened/ interfered with self-interest:
• An employee when feels her job security, status, or payment is at
risk, resistance can be expected.
2- False perceptions:
• When an individual does not understand the implications of the
change or when these inaccurate perceptions are shared with
others who hold inaccurate ideas, resistance to change will occur.
• Leader should ensure that everyone has a clear understanding
about change.
3- Objective disagreement:
• When some people truly believe the change will not benefit the
organization, this occurs when the change agent and resister
individual have different information about the objective of
change.
4- Psychological resistance:
• When people feels negative about the change and they are
unable to explain the reasoning behind their viewpoints, they
are psychologically resisting.
• Psychological resistance also occur when individual has low
tolerance to change, or mistrust.
 NOTE
• Not all resistance to change is bad, it may guide the
leader to assess the idea carefully before implementation.
OVERCOMING RESISTANCE TO CHANGE

The management can use the following strategies to overcome

resistance to change:

• Effective communication.

• Educational and training.

• Negotiation.

• Rewarding or emphasis on threat.

• Facilitation and support.

 PRINCIPLES OF CHANGE
1. Change must be useful
2. Change must be planned
3. Change must be supported from top management
4. Change must be communicated
5. Affected persons must be involved in goal setting
6. Benefits of change must be stressed
7. Change must be gradually
8. Timing of change is important
9. Resistance to change must be anticipated
10. Plan of change is kept open for revision
 DIFFERENT TECHNIQUES FOR
DEALING WITH CHANGE
1-Participation
• As manger be involved to support change.
• This decreases resistance of staff as they feels secure in changing
situation.
• Encourages employees to discuss, communicate their suggestions.
2-Education/ training
• Providing needed and clear information to people will reduce
resistance and facilitate the change process.
3- External agent (normative educative strategy)
• By giving an example of the same external change process as
a positive result was obtained and explains how each
individuals benefits as a result of the change.
4-Incentives / rational strategies
• To emphasis on the rewards for employees in the change
situation especially when resistance resulting from threatened
in self-interest.
• Both economic and psychological rewards are useful, a
payment, promotion or personal needs satisfaction .
5- Gradual introduction
Introducing change gradually will reduce resistance
Also, providing enough Demonstration before implementation
is essential.

6- Power coercive strategy

is the strategy that uses the authority to influence people
which is the faster way, and people will generally do what
they are instructed to do by senior authorized management.
 HOW TO DEAL WITH
UNPLANNED CHANGE?

1. Be calm
• Think very well while dealing with the situation of unplanned change.
Control your feeling and do not react immediately.
2. Analyze the situation:
Identify the reason why the change is occurring
Determine the positive impact of the change
Consider the Restraining and the driving forces.
Work with the accurate information you have available at the time.
3. Reprioritize
Include the tasks to the “Priority list” and order it according to importance
Share your plans or analysis of the situation with all staff members who will be involved in
this change.
4. Identify the resources needed.
Both human and material resources are available to make change.
5. Evaluate the situation continuously
Its important to monitor the progress of the unplanned change which
helps the manager to identify the obstacles and supervise the progress of
the team or individuals involved to provide them with support needed.

Note: Be the role model, when staff members see how you are coping
with unexpected changes effectively, they will do the same.
CHANGE LEVEL

Personal

Professional Organizational
 PERSONAL CHANGE:

• Change made voluntarily for a particular

reasons.
 PROFESSIONAL CHANGE:

• Made voluntarily and planned change in a job

position or obtaining credentials (training or
education) to further career goals.
 ORGANIZATIONAL CHANGE:

• Planned change undertaken to improve outcomes,

financial standing or to meet some organizational goals.

• Changes in organizations may take employees by

surprise if plans are not clearly communicated.

• Organizational change that is not handled well causes

increase in staff stress and resistance & often mistrust
of management (Sebastain, 1999 & Anderson, 2003).
 NURSES OFTEN ACT AS A
CHANGE AGENTS:
A. In institutions:
• Nurses have a role in length of stay for patient in the
hospital.

• Nurses determine cost and quality of care provided.

As Nursing is the largest part of any organization’s

personnel budget (quantity of nurses and quality will
make different)…
 NURSES OFTEN ACT AS A
CHANGE AGENTS:
B. Outside institutions:

• Promote healthy living by educating community.

• Develop and manage prevention programs that will

make change in people health and treatment cost.

• Fill service gaps after people leave institutions (home

healthcare).
CHANGE IN NURSING ENVIRONMENTS

• The basic reasons to introduce change:

 Solve a problem.

 Improve efficiency.

 Reduce unnecessary workload on a person or group.

 Utilize Technology.

 Advances in treatment & medications.

 Biomedical update. Marquis and Huston (2000)

 CHANGE AGENT
CHARACTERISTICS:
• Ability to combine ideas from a variety of unconnected
sources.

• Ability to energies and motivate others.

• Well developed interpersonal skills including group

management and problem solving skills.

• Ability to work with system details while keeping the “big

picture” in mind.
 CHANGE AGENT
CHARACTERISTICS:
• A balance of flexibility.

• Confident and not easily discouraged.

• Ability to think realistic and strategically.

• Ability to inspire others’ trust in them.

• Ability to handle resistance from those who oppose change.

 CHANGE STEPS

1-Assessment:
1. Identify the problem or opportunity.

2. Collect or analyze data about change.

3. Data are derived from both internal and external sources.

4. Data analysis should have both the need for change and
potential action selected.

5. Set the goals for what the change can accomplish.

 2- PLANNING

• Determine who will be affected by the change and

when the change will occur.

• Examine all potential/possible actions.

• Should include how change will be implemented

• Prepare an evaluation component to assess if the

change met the original goals for change.
 3- IMPLEMENTATION

• Most organizations use the effective strategies to

make the change depend on the change type.
 4- EVALUATION

• Determines if the change is effective, based on outcomes

(goals) identified during the assessment & using the evaluation
method established during planning.

• Many organizations overlook this step but it is very important,

so that modifications can be made when needed.
 5- STABILIZATION

• Using policies and procedures to make the

change as standards policy to follow.

• This should occur as soon as possible to

complete the change process.
 MANAGER’S ROLE IN
IMPLEMENTING CHANGE

• Maintaining support and confidence

• Emphasizing the positive outcomes from initiating

change.

• Finding solutions for problems that are obstacles to

change.
THANK YOU