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.
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 doesnt 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 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 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 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 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? 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
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 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.
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 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?