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Change Agents

The Role of Nurse Leaders in Change Management
by

alinah kondracki

on 24 July 2014

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Transcript of Change Agents

Define change management and the need for change agents.

Identify leadership standard for change management in healthcare.

Highlight the role of nurse leaders as change agents.

Understand major change management theory and model.

Identify nursing leadership tools and methodologies used to manage change.

Share experiences on change management from nursing executives.

Reflect on personal leadership styles and experiences.
Objectives
Kurt Lewin, 1951
Lewin's Change Theory
"Father of social psychology"

Unfreeze:Move:Refreeze-3 step change model requires learning to be rejected and replaced

Force Field Analysis illustrates behavior as a dynamic balance of forces working in opposing directions
Change Agents
Alinah Kondracki, RN, BSN
Jefferson School of Nursing
July 23, 2014

Alinah Kondracki, RN, BSN
Nurse leaders can be found at any level of the clinical ladder.

"CHECK YOURSELF" strengths and weaknesses can affect outcome of project, perform a self eval and choose an appropriate leadership style in line with projects goals.

Nurse leaders can be involved in smaller unit based projects or larger system wide projects.

Project size varies-choose appropriate change management model.
Change Agents
Mary Ann McGinley, Chief Nursing Officer
The Role of Nurse Leaders in Change Management
Leadership Styles:
autocratc
democratic
laissez-faire

Think about a recent change at work.
How was it presented to you?
How did it make you feel?
How did you deal with the change?
What factors were important to you?
Reflection
Change Theory. Retrieved July 21, 2014 from http://currentnursing.com/nursing_theory/change_theory.html

Gage, W, (2013). Using service improvement methodology to change practice. Nursing Standard. 27,23,51-57.

Joint Commission, (2012). Hospital Accreditation Standards. Retrieved July21, 2014 from http://books.google.com/books?id=YCI7LE0KEccC&pg=RA64-PR4&lpg=RA64-PR4&dq=leadership+standard+LD.03.05.01&source=bl&ots=0cRBFAeiQQ&sig=Su-_YS0CH3nc48kgM8beCC3wIoE&hl=en&sa=X&ei=vW7NU7xtj4rIBNuHgkA&ved=0CFcQ6AEwCA#v=onepage&q=leadership%20standard%20LD.03.05.01&f=false

Kaminski, J, (2000). Leadership and Change Management: Navigating the Turbulent Frontier. nursing-informatics.com.

Kerridge, J, (2012). Leading Change:2-Planning. Nursing Times: 108:5, 23-25.

Kerridge, J, (2012). Leading Change: 3-Implementation. Nursing Times; 108:6,23-25.

Kotter, J, (2011), Change Management vs. Change Leadership -- What's the Difference? Retrieved July 22, 2014 from http://www.forbes.com/sites/johnkotter/2011/07/12/change-management-vs-change-leadership-whats-the-difference/

Leadership Styles Questionnaire. Retrieved July 20, 2014 from http://www.sagepub.com/northouseintro2e/study/resources/questionnaires/89527_03q.pdf

Mitchell, G, (2013). Selecting the best theory to implement planned change. Nursing Management, 20:1, 32-37.

Sutherland, K, (2013), Applying Lewin's Change Management Theory to the Implementation of Bar-Coded Medication Administration. Canadian Journal of Nursing Informatics, 8:1,2.

Telephone interview, July 22, 2013, Lynn Quinn, Director of Medical Oncology, Bryn Mawr Hospital.

Email interview, July 22, 2013, Marti Lyman, Director of Patient Navigation, Bryn Mawr Hospital.

Email interview, July21, 2013, Laura Tansey, Director of Quality and Regulatory Compliance, Bryn Mawr Hospital.

References
JCAHO
LD.03.05.01
Leaders implement changes in existing processes to improve the performance of the hospital.

Rationale
Change is inevitable, and agile hospitals are able to manage change and execute new plans.
The ability of leaders to manage change is necessary for performance improvement, for successful innovation, and to meet environmental challenges
. The hospital integrates change into all relevant processes so that it's effectiveness can be sustained, assessed, and measured.

EP3:
Leaders provide the resources for performance improvement and change management, including sufficient staff, access to information, and training.

EP7:
Leaders evaluate the effectiveness of processes for the management of change and performance improvement.
Leadership Standards
John Kottter, CEO Kotter International
Change Management
"refers to a set of basic tools or structures intended to keep any change effort under control. The goal is often to minimize the distractions and impacts of the change"
Director of Medical Oncology
Unfreezing phase of Lewin's theory-ex. computer program training session identified "frustration" as a stumbling block, some caught on quickly while others needed more time which led to promoting teamwork.

Director of Patient Navigation
"Change is constant and most people struggle with it." Recognizing the early adopters and designating them as "champions" is key.

Director of Quality and Regulatory Compliance
Sustaining change is the hardest to maintain, be persistent, open-minded, challenge yourself, don't be afraid to reach outside your comfort zone.
Shared Experiences
Lack of Understanding
fundamental objections, personal beliefs
rational explanation and logical argument, provide detailed facts, use visual aids, in-person Q&A sessions
avoid antagonism

Fear
dangerous and threatening-prepare for fight or flight
loss of control, risk of unemployment, low performance expectations
discuss fears, listen, non judgemental, explore options, empathize, reassurance, find common ground

Lack of Trust
based on previous experiences, personal antagonism, workplace culture
quash rumors and assumptions, build bridges, repair relationships, do not be too defensive or apologetic, actively listen and respond honestly, identify common ground and work to build a foundation of trust
perseverance, recognize and isolate it before it becomes damaging to the project or you become disillusioned.
Maurer's levels of resistance
Focus on reducing resisting forces instead of increasing driving forces

Do not force change
Lewin's Force Field Analysis
Lewin's Change Model
Unfreezing
including front line staff in decision making process promotes empowerment autonomy and ownership, better understanding of the project and decreases resistance

Moving
actively involve nursing staff
constant communication

Refreezing
provide ongoing support of nurses on the front line
Spot resistance early

Identify source and factors involved
There are forces driving change and forces restraining it.

Where there is equilibrium or a status quo between the two sets of forces, there will be no change.

For change to occur, the driving force must exceed the restraining force.
Innovators (5%)
allies, keen to adopt new ideas
may be radical and counterproductive

Early adopters (10%)
key innovators, well connected and respected within the organization, open to change
ID and engage to help with implementation ASAP

Early majority (35%)
crucial, people of influence and authority who lead others through power based on skill, competence or social accessibility
gaining support of this group, support of late majority will follow

Late majority (35%)
prefers the status quo
engage them early, address their resistance to change

Laggards (15%)
may never become interested in change
keep them in the loop, do not alienate them, they may eventually accept change
Roger's Diffusion of Innovation Theory
Stephen Klasko, President and CEO of TJUH, Inc
1:3 improvements will fail after implementation

commitment to ongoing training and support from senior management

"win their hearts and minds" of the stakeholders engage them in the development and implementation to promote ownership

personal stake-advantages for all involved

continually motivate and reward members

smooth the transition period

celebrate the achievement-let others know about the projects success
Sustaining Change
2/3 of organizational change projects fail

unstructured approach to implementation

neglect for the human dimension of change

to deliver care based on best practice there is a continual need for change

nurses often feel that change is imposed on them
Everett Rogers, 1971
Rick Maurer, 2009
Bryn Mawr Hospital, MLHS
Full transcript