Planned Change

Paula Ponder MSN, RN, CEN

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 isnt sabatoged

Re-energizing and empowering a workforce.

Historically change has been viewed as coming from the top down, but new research shows that this kind of change doesnt work well.

Who better to ask how to change things for the better than the people actually working, doing the job

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 dont know theyre happening Overt occurs with awareness, we know theyre 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 theyre not biased and the organization wont 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

Lewins 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

Lewins 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!

Lewins 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
Economic gain improve situation Challenge Future impact Growth, recognition, achievement, and / or improved relationships

Restraining Forces
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 agents 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, its 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, its 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 systems longterm 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? Were 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

Rationalempirical
Assumes that people are rational and receptive to change when given adequate facts

Normativere-educative
Change will only occur when attitudes and relationships are altered

Powercoercive
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

Not all resistance is bad; it may be a warning that something needs readjusting or clarity

Fear a loss of status, power, control, $$, job, whatever. There are misconceptions about the change (inadequate information).

Viewing the nurse or resistor as the solution versus the problem helps reframe the issue

If youre 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.

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 peoples 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 doesnt 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?