Planned Change

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Planned Change

• Paula Ponder MSN, RN, CEN

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Objectives

• Discuss reasons for change
• Define change agent
• Discuss change agent strategies
• Review the natural and expected response to
  change

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The significant problems we face cannot be
solved at the same level of thinking we were at
when we created them.

Albert Einstein
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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.

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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

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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

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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

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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

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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!

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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.
  

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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.

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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

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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).

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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).

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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).

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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.

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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.

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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.

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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.

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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)
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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)
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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.

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Characteristics of Nurse Innovators

• Self-confident
• Conscientious
• Ambitious
• Motivation to learn
• Perseverance
• Initiative
• Tenacity
• Determination

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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

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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).

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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).

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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).
• 
  

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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

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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

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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.

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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

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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

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During Change

• Leadership skills
• Vested interests
• Opposing group values
• How coalitions form
• Strongly held views
• Existing relationship dynamics disruptions

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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

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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

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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).

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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).

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Leadership and Management Implications

• Organizational transformation
• Reimbursement for care
• Information system used for care documentation
  and assessment
• Nursing shortage
• National health care reform

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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

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Attempting Change

• Change should never be attempted unless the
  change agent can make a commitment to be
  available until the change is complete.

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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).

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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).

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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).

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Good Reasons for Change

• Change to solve some problem
• Change to make work procedures more efficient
• Change to reduce unnecessary workload

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Organizational Development

• Developmental or maturational a result of
  physical /psychosocial changes during the life
  cycle
• Birth
• Youth
• Maturity
• Aging

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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
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Everyone thinks of changing the world, but no one
thinks of changing himself

-Leo Tolstoy
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Questions?