CHANGE MANAGEMENT

by
Shahla Arshad
KMU-INS
 Objectives

At the end of this unit the learners will be able to:

• Define change and Change management.
• Discuss categories and types of change.
• Understand different change theories.
• Integrate any of the change theories in given situation
Lewis's theory and steps of change in a ward situation.
• Learn about the techniques for dealing with
resistance.
• Learn about the skills that a change agent should
possess.
Change

• Organizational change is essential for adaptation,

creative change is mandatory for growth.
(Heath & Heath, 2010).

• Change is a process of making something

different from what it was.
• Change is a process, not an event.
Present state Desire state

Transition Process
Process begin
phase complete
 Change Management

Change management is a systematic approach

dealing with the transition or transformation of
an organization's goals, processes or
technologies.
The purpose of change management is to
implement strategies for effective change,
controlling change and helping people to adapt
to change.
 The Nurse As Change Agent

A change agent is one who works to bring about a

change. Being a change agent however, is not easy.
Although the end result of change may benefit
nurses and patients . initially it requires time,
effort, and energy in the high-stress environment
of health care. Several recent reports document
nurses’ roles in facilitating change.
• Holtrop et al. (2008) found that nurse consultants
improved healthy behaviors in patients in two health
care systems.
• MacDavitt and Walker (2011) report that small
changes in communication resulted in improved
patient satisfaction in a pediatric unit.
• Finally, McMurray et al. (2010) found that nurse
managers played a key role in implementing
successful change in bedside handover in two
hospitals. Changes will continue at a rapid pace with
nursing’s expert guidance.
 Types Of Change

Ackerman (1997) has distinguished between three

types of change:

• Developmental

• Transitional

• Transformational
 Change Theories

Five theories explain the change process from a

social–psychological aspects.

1. Lewin force-field model (1951)

2. Lippitt and colleagues seven-step process (1958)
3. Havelock six-step process (1973)
4. Rogers five-step innovation (2003)
5. Prochaska and DiClemente Five stages(2005)
(Transtheoretical model of behavior change)
1: Lewin Theory of Change (1951)
• Lewin proposed a force-field model.
• That behavior is a dynamic balance force, working in
opposite direction.
• Driving forces facilitate change ----- so they push into
desire direction, but restraining forces impede change ---
they push back in opposite direction.
• If the plan is to change: then someone will analyze the
forces and shift the balance through: unfreezing, moving
and refreezing.
Lewin Theory of Change (1951)
1) unfreezing : change occur by adding new force --- to change
direction and magnitude of any force.
2) Moving: Move strategies ----that increase driving forces --- and
decrease restraining forces.
3) Refreezing: Desired state, Force will be toward change .

Unfreezing

Moving

Refreezing
2:Lippitt and colleagues (1958)
• Lippitt and colleagues extended lewin,s theory into
seven-step process ---- to focus on evolution of
change itself.
• Lippitt does not see the model step by step, He argues
that some can happen at the same time and some of
the phases may become mixed.
• Lippitt method used to introduce change --- that lead
to improvement of quality care and patient outcome –
based on nursing process.
2:Lippitt and colleagues (1958)

Phase 1: Developing a need for change

Phase 2: Assessing motivation and capacity for change
Phase 3: Diagnosing the client system’s problem
Phase 4: Establishing alternative routes
Phase 5: Transforming intentions into actual efforts to
change
Phase 6: Stabilizing change
Phase 7: Terminal relationship:
3-Havelock (1973)

• Havelock (1973) described a six-step process, also a

modification of Lewin’s model.
• Havelock describes an active change agent as ---- one
who uses a participative approach.
• The six steps process ----that acknowledges resistance
to change and the need to carefully plan for change.
Havelock (1973) - Steps

1: Building a Relationship For change –The relationship with system should be

established, this is stage of “pre-contemplation”

2: Diagnose the problem once relationship established – the subject of change

must decide whether or not change is needed or desired.

3: Acquiring resources Gather necessary information – relevant to situations for

change --- process of developing solutions-

4: Choose solution / Select pathway of change --- select available option and
pathway then implemented.
Once change establish --- it must be implemented –
5: Establish and accept
attention toward resistance --- make sure the
change
establishment of change in new routine.

6: stabilization / Change success -- Monitor affected system – make sure

maintenance maintenance till it became “Normal”.
4-Rogers Model (2003) – (Innovation –decision making)

• Rogers (2003) takes a broader approach than Lewin,

Lippitt, or Havelock.
• He proposed five steps process for change (innovation to
decision making).
• His framework emphasis on the reversible nature of
change:
 Participant may initially adopt change --- but later
discontinues or reverse it.
 They may initially reject it but adopt it at a later
time.
Rogers (2003)

 If the change agent is unsuccessful in achieving full

implementation of a proposal, it should not be
assumed the issue is dead.
 It can be resurrected, perhaps in an altered form or at
a more opportune time.
Roger stress that two peoples are the key to change:
1) Key people
2) Policy makers
Rogers (2003)
1: Knowledge an individual becomes aware of an innovation and learns
how it works

2: Persuasion an individual forms a favorable or unfavorable attitude

toward the innovation

3: Decision an individual undertakes activities -- that lead to a choice

to adopt or not adopt the innovation

4: Implementation an individual uses the innovation

an individual seeks information and experiences -- that

5: Confirmation confirm the decision they made, -- or reverse the
previous decision.
5-Prochaska & DiClemente (2005)
• Prochaska and DiClemente (2005) proposed a trans-
theoretical model of behavior change.
• People don't see their behavior is a problem. So no
1-Pre-Contemplation need to change. Client is resistance to change.

2- Contemplation • People recognize a problem and observe a change.

• but haven't yet committed to changing.

3-Pre-Preparation • People decided to change their dysfunctional behavior

4- Action • Plan into action, people work on dysfunction behavior.

• People engaged in new behavior for at least 6 months.

5- Maintenance • Committed to maintain new behavior.
Comparison of Change Models
The Change Process
The change process can be related to the nursing process and is described by Sullivan (2012)
in four steps. Identify Problem

Assessment Collect Data

Analyze Data
Time frame + resources +staff
Plan the resources --- that make the change, establish
Planning feedback .

Supporters + Opposite &coalition

Plan into motion, Managers - key change process actors.
Implementation Interventions made -to gain the necessary results.

Evaluate effectiveness

Evaluation
Stabilized the change
The Change Strategies

Specific strategies can be used, depending on the

amount of resistance anticipated and the degree of
power the change agent possesses.

1 2
3

Power- Empirical–Rational Normative-Reeductive

Coercive Model Strategies
Strategies
 Power-coercive Strategies

Power-coercive strategies are based on the

application of power by legitimate authority.
Changes are made through law, policy, or
financial appropriations.
 Empirical–Rational Model

In the empirical–rational model of change

strategies, the power ingredient is knowledge. The
assumption is that people are rational and will
follow their rational self-interest. It is also
assumed that the change agent who has
knowledge has the expert power to influence
people to accept a rationally justified change that
will benefit them.
 Normative–Re-educative Strategies
In this model, the power ingredient is not
authority or knowledge, but skill in interpersonal
relationships. The change agent does not use
coercion but collaboration. Members of the target
system are involved throughout the change
process. Value conflicts from all parts of the
system are brought into the open and worked
through so change can progress.
Resistance to Change
Resistance to change is to be expected for a number of
reasons:
• Lack of trust,
• Fear of failure,
• Loss of status or income,
• Misunderstanding, and
• Belief that change is unnecessary or that it will not
improve the situation.
• Employees resist to change because -- they dislike or
disapprove the person responsible for change or distrust
on process.
Resistance to Change (Responses)

Rogers (2003) identified six responses to change:

1. Innovators love change and thrive on it.
2. Less radical, early adopters are still receptive to change.
3. The early majority prefer the status quo, but finally
accept the change.
4. The late majority are resistive, accepting change after
most others have.
5. Laggards dislike change and are openly opposed.
6. Rejecters actively oppose and may even sabotage
change.
Resistance to Change (How to Identified)

It can be recognized in such statements as:

• We tried that before.
• It won’t work.
• No one else does it like that.
• We can’t afford it.
• We don’t have the time.
• It will cause too much commotion.
• Every new boss wants to do something different.
• Let’s start a task force to look at it; put it on the
agenda
 MANAGE RESISTANCE

1.Talk to those who oppose the change. Get to the root of

their reasons for opposition.

2. Clarify information, and provide accurate feedback.

3. Be open to revisions but clear about what must remain.

4. Present the negative consequences of resistance (e.g.,

threats to organizational survival, compromised patient
care).
5. Emphasize the positive consequences of the
change and how the individual or group will
benefit
6. Keep resisters involved in face-to-face contact
with supporters. Encourage to opponents,
recognize valid objections, and relieve
unnecessary fears.

7. Maintain a climate of trust, support, and

confidence.
 THE NURSE’S ROLE
1- Initiating Change
change often is not initiated by top-level management
(Yukl, 2009).
Staff nurses often think that they are unable to initiate
and create change, but that is not so.
Making change is not easy, but it is a mandatory skill for
managers. Successful change agents demonstrate certain
characteristics that can be refined and mastered with
practice.
These characteristics include:
 The ability to combine ideas from different sources
 The ability to energize others by keeping the interest
level up and demonstrating a high personal energy level
 Skill in human relations: well-developed interpersonal
communication, group management, and problem-
solving skills
 Integrative thinking: the ability to retain a big picture
focus while dealing with each part of the system
 Sufficient flexibility to modify ideas when modifications
will improve the change.
 Confidence and the tendency not to be easily
discouraged
 Realistic thinking
 Trust
 The ability to articulate a vision through
insights and versatile thinking
 The ability to handle resistance