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Initiating and Managing Change

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Maria Narvaez

on 22 July 2013

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Transcript of Initiating and Managing Change

Initiating and Managing Change
The Nurses' Role
The change agent, one who works to bring about change

Why Change?
Organizational change is essential for adaptation
Creative change is mandatory for growth and development
Change is not a singular event
1. Starts in the present
2.Has a transition period
This process of status quo is often unsettling and may elicit a grief response
3. Settles into a desired state
4. Process repeats itself
With change, new environments and opportunities present themselves
Proposals
Nurses should practice to the full extent of their education and training
Nurses should achieve higher levels of education and training though and improved education system that promotes seamless academic progression
Nurses should be full partners with physicians and other health care professionals in redesigning healthcare in the U.S.
Effective workforce planning and policy-making require better data collection and an improved information infrastructure
-IOM, 2010
Recommendations
Remove scope-of-practice barriers
Expand opportunities for nurses to lead and diffuse collaborative improvement efforts
Implement nurse residency programs
Increase the proportion of nurses with baccalaureate degrees to 80 percent by 2020
Ensure nurses engage in lifelong learning
- IOM, 2010
Prepare and enable nurses to lead change to advance health
Build an infrastructure for the collection and analysis of inter-professional healthcare workforce data
Double the number of nurses with doctorate by 2020
Lewin
Unfreezing
Refreezing
Freezing
Change happens by increasing the driving forces or decreasing the restraining forces or combination of both
Lippitt and Colleagues
What a change agent must do vs. evolution change itself
1. Diagnose the problem
2. Assess the motivation and capacity for change
3. Assess the resources and motivation of the change agent
4. Choose progressive change objects
5. The role of the change agents should be selected and clearly understood by all parties
6. Maintain the change
7. Gradually terminate from the helping relationship
(Kritsonis & Hills, 2005, p. 3)
Havelock
Active agent who uses a participative approach
1. Building a relationship
2. Diagnosing the problem
3. Acquiring resources
4. Choosing solution
5. Gaining acceptance
6. Stabilization and self-renewal
Rogers
How a decision-making unit passes from first knowledge of innovation into confirmation of decision
Initiating and Managing Change
1. Knowledge
2. Persuasion
3. Decision
4. Implementation
5. Confirmation
Prochaska & DiClemente
Change strategies can be used depending on the amount of resistance anticipated and degree of power the change agent possesses.

Power-Coercive Strategy
Empirical-Rational Model
Normative-Reeducative Strategy
Power-Coercive Strategies
Based on the application of power by a legitimate authority, economic sanction or political clout.

These changes are made through law, policy or financial appropriations.

Basically, those in control enforce changes by restricting budgets or creating policies.
People do what they are told and are compliant.

This strategy is useful when a consensus is unlikely despite efforts to stimulate participation by those involved

Can anyone think of an example of Power-Coercive strategy by the federal government?

Patient Protection and Affordable Care Act, PPACA
Empirical-Rational Model
Key power ingredient is KNOWLEDGE
People are rational and will follow their rational self interests

This strategy works best when there is little resistance and change is reasonable
Introducing new technology that is easy to use, improves nursing time and quality of care after an in-service education
Normative-Reeducative Strategies
Key power ingredient is skill in
interpersonal relationships
The change agent does not use coercion since people are social beings and will adhere to cultural norms and values, the change should include developing commitments to new ones

This approach to change will be effective in reducing resistance and stimulating personal and organizational creativity

Changing from a traditional nursing system into self-governance or initiating a home follow-up service
Resistance to Change
Resistance to change is to be expected for a number of reasons
Lack of trust
Vested interest in the status quo
Fear of failure
Loss of status or income
Misunderstanding
Belief that change is not necessary or that it will not improve the situation.

Another reason that employees may resist change is because they dislike or disapprove of the person responsible for the change or they may distrust the change process altogether.

Resistance
Response varies from ready acceptance to full-blown resistance
Innovators, love changes and thrive on it

Less radical, early adopters are still receptive to change

Early majority, prefer status quo but eventually changes

Late majority are resistive but accepting change after most did

Laggards, dislike change and are openly antagonistic

Rejecters, actively oppose and may sabotage change
Change Strategies
Resistive Behaviors
We tried that before
It would not work
No one else does it like that
We have always done it this way
We cannot afford it
We do not have time
It will cause too much commotion
You will never get it past the board
Let us wait awhile
Every new boss wants to do something different
Let's start a task force to look at it, put it on the agenda
Resistance
Resistance prevents the unexpected and forces the agent to clarify information, keep interests high, and establish why change is necessary.

It may even motivate the group to do better with what it is doing now, so that change does not have to happen.

But persistent resistance is not always beneficial; it can wear down supporters and redirect energy from implementing the change.

Dealing with resisters can cause morale to suffer even more.

Management of Resistance
Talk to those who oppose change.

Clarify information and provide accurate feedback.

Be open to revisions.

Present the negative consequences of resistance.

Emphasize positive consequences of the change.

Keep, resisters involved.

Maintain a climate of trust, support, and confidence.

Divert attention by creating a different disturbance, they tend to unify internally.
Change is not easy
Being a change agent is not easy. Although the end result of change may benefit nurses and patients alike; initially, it requires time, effort and energy
How to aid change?
Changes will continue at a rapid pace with or without nursing expert guidance.

If they are to exist as a distinct profession that has expertise in helping individuals respond to actual or potential health problems, they must be proactive in changing the future.

Summary
Initiating Change
Contrary to popular opinion, change often is not initiated by top-level management but rather emerges as new initiatives or problems are identified

Organizational readiness is the key to initiating change
Change Characteristics
Successful change agents demonstrate certain characteristics that can be cultivated and mastered with practice
The ability to combine ideas from unconnected 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, but enough persistence to resist nonproductive tampering with the planned change.

Confidence and the tendency not to be easily discouraged

Realistic thinking

Trustworthiness: a track record of integrity and success with other changes

The ability to articulate a vision through insights and versatile thinking

The ability to handle resistance

Implementing Change
In addition to initiating change, nurses and nurse managers may also be involved in the planning stage, charged with sharing information with coworkers, or they may be asked to help manage the transition to the planned change.

Planning Change
Managing Transitions to Change
Nurses may be responsible for planning change by voting on issues or ways in which they could bring about change.

periods of time between the current situation and the time when change is implemented.
The right time for a change agent to act!

Letting go of long- term, comfortable activities is difficult.
1. Add new work to the old
2. Made individual decisions about what to add and what to let go
3. Toss out everything done before
Handling Constant Change
Change has always occurred; what’s different today is both the pace of change and that an initial change causes a chain reaction of more and more change.

Change, rather than an occasional event, has become the norm.

Nurses will always find themselves in constant change!!

Follows the same path as the nursing process:
assessment, planning, implementation and evaluation
Assessment
The Change Process
Identify the Problem or Opportunity
Collect Data
Issues must be perceived in the same manner by key individuals to lessen confusion
1. Where are we now?
2. What is unique about us?
3. What differentiates us from our competitors?
4. What prevents us from moving into desired direction?
5. What kind of change is required?
1. Technological
2. Structural
3. People
1. Identify the problem or opportunity
2. Collect necessary data and information
3. Select and analyze data
4. Develop a plan for change (Time frame, Resources)
5. Identify supporters or opposing side
6. Building a coalition of supporters
7. Help people prepare for change
8. Prepare to handle resistance
9. Provide feedback mechanism to keep everyone informed
10. Evaluate effectiveness of change, if successful, stabilize
Steps in the Change Process
Driving and restraining forces are to be identified
Assess the political pulse of the decision
Who will gain from this change?
Who has more power an why?
Checks and Balances
The cost and benefits of proposed change
Analyze Data
The change agent should focus more energy on analyzing and summarizing the data than on just collecting it.
Flush out resistance
Identify potential solutions and strategies
Identify area of consensus
Build a case for whichever option is selected
Planning
This is the time to make people uncomfortable with the status quo
Implementation
Some methods are directed towards changing individuals in an organization or directed towards changing a group
Individual
Group
1. Informing
Does not address motivation
2. Training
Information + skill training
3. Selecting & placing personnel

The power of an organizational group to influence its members depends on its authority to act on an issue and the significance of the issue itself.
Evaluation
Evaluate Effectiveness
Determine if assumed benefits are acquired
Financially
Qualitative
Unintended consequences?
Stabilize change
The target system is refrozen
Interested Vice-president
Entrenched director of nurses
Nurse manager lacks change agent skills
Long-term employees resisting changes
Force-Field Analysis
1. Establish and maintain open communications with employees an customers
2. Adjust long-term strategies and plans to remain relevant
3. Focus on data-driven decisions and result-based practices
4. Celebrate evolutionary success
Taylor, 2013
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