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Change Theory and the nurse as a change agent in continuous

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Brandon Emry

on 18 November 2013

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Transcript of Change Theory and the nurse as a change agent in continuous

Change Theory and the nurse as a change agent in continuous quality improvement.
by: Abbey Bunnell, bunnak01@students.ipfw.edu
Brandon Emry, emryb01@students.ipfw.edu
Marcus James, marcusjames9@gmail.com

Change and emotional intelligence
Emotionally intelligent social skills are critical when presenting change to staff.
Change Theory in Quality Improvement
Planned change is a purposeful, calculated, and a collaborative effort to implement overall improvements in a facility or unit
Change
Change is “premeditated interventions intended to modify the functioning of an organization”
Emotional Intelligence:
What is it, and how does it relate to change?
According to Sadri (2012), EI is defined as "the capacity to reason about emotions, and of emotions to enhance thinking. It includes the abilities to accurately perceive emotions, to access and generate emotions so as to assist thought, to understand emotions and emotional knowledge, and to reflectively regulate emotions to promote emotional and intellectual growth" (p. 536).
EQ Social Skill
Social Competence, Two sub dimensions:
-Empathy

-Social Skills.
Change is included under social skills
Social Skills are defined as the proficiency in managing relationships and building networks
As well as an ability to find common ground and build rapport.
(Goleman, 1998)
Hallmark of social skills
Effectiveness in leading change.

Persuasiveness

Expertise in building and leading teams
(Goleman, 1998)
Change Catalyst
Sub dimension of social skills
Simply, this is one person's ability to initiate or manage change within one's self and others.
(Goleman, 1998)
Creating an environment of open communication is essential when change is introduced
(Foltin and Keller, 2012 p. 22-23)
Social skills and the ability to motivate others are necessary to guide staff members through negativity to a place where they're not only receptive to change, but actually become actively engaged in the process.
Real life example
In 2008, the Cardiac and Vascular unit at NYU Langone Medical Center experienced a 30% increase in patient volume.
The unit also transitioned from general cardiac care to specializing in pre- and post cardiac catheterization and electrophysiology patients.
Real life example
Foltin and Keller(2012), stated that the key to the success of implementing changes was emotionally intelligent leadership.
This was achieved through engaging the in conversation about the changes, and maintaining a safe and open means of communication.
As well as empowering the staff from the beginning to lead the change effort by giving them the tools and autonomy needed to make the change.
Real life example
Foltin and Keller (2012), also state that the change process isn't complete until it becomes the new norm.
Leaders must perpetuate the forward momentum, by utilizing emotionally intelligent social skill and motivation.
The only thing that is constant in healthcare today is change. The value of these skills should not be overlooked.
(Mitchell, 2013, p. 32).
Quality improvement is defined as the process used to identify and resolve performance deficiencies. The QI process involves all employees and focuses on assessment and outcomes and determines ways to improve the delivery of quality care.
(Sommer, Johnson, Roberts, Redding, & Churchill, 2013, p. 18).
Change Theory in Quality Improvement
In healthcare, professionals deliver care based on the latest evidence of best practice, which suggests there is a continual need to update or change current practice
Although implementing change can be challenging, there are several theories that leaders can utilize to make the change process easier for everyone involved
(Mitchell, 2013, p. 32)
Why Implement Change?
In healthcare, several factors can initiate change including...
-Rising costs of treatments
-Staff shortages
-Professional obligations (changes in codes of conduct, hospital policy)
-Advances in science and technology
-Aging population
-Staff and patient safety concerns
-Potential to improve patient satisfaction

(Mitchell, 2013, p. 32).
Change Theory:
Kurt Lewin
Identified three stages in which change agents (nurse leaders/managers) must proceed before change can become part of a system
Unfreezing- when change is needed

Moving- when change is initiated

Refreezing- when equilibrium is established

(Mitchell, 2013, p. 32).
(Mitchell, 2013, p 32).
Change Theory:
Ronald Lippitt
Change Theory
People need to understand why the change is happening

Enable individuals to buy into supporting the change psychologically.

Research shows that leaders and managers tend to focus up to 90% of their efforts on selling proposed solutions to problems

Effective change requires a clear selling of the problem first, to encourage staff to understand that change is needed and for what reasons, and not just desired.
(Mclean, 2011, p. 79).
Change Theory
Individuals during the beginning phase need the four P’s:

Purpose, Picture, Plan , and Part to play


(Mclean, 2011, pg. 81).
Change Theory

At this point, the change has been successfully integrated in the system and strategies are developed to prevent a return to previous practices.


Lippitt's stage of "maintaining the change" is crucial because successful change can often regress to former, outdated practices

Important that nurse leaders and managers select appropriate change theory that will best fit their unit and employees

(Mitchell, 2013, p. 36).
Change Theory
Attempts to implement change face many potential barriers
Managers who use an appropriate framework are more likely to experience a successful change
(Mitchell, 2013, p. 36).
(Battilana & Casciaro, 2012, p.381)
(Stonehouse, 2013)
(Shafer & Aziz, 2013)
According to Stonehouse (2013) change is “an ever-present reality” (p. 443)
Change causes:

·Workload to increase

·Stress levels to increase
Change can be viewed as “an exercise in social influence”
In order for successful implementation of planned improvements the culture of a unit or workplace and the attitudes of the employees must be able to be changed.
Nurse as a Change Agent
Qualities needed in a change agent:

·“Skilled and experience in the use of change tools and who is confident with the process required”.

·Committed

·Driven

·“Has the time to bring change to successful completion”.

·Able to overcome resistance

·Encourage other members of their organization to “adopt new practices”.

·Trusted

·Needs support from management

·Must have “social influence” and have the “ability to initiate divergent changes and persuade other organization members to adopt them”.
(Stonehouse, 2013, p. 443-444)
(Battilana & Casciaro, 2012, p. 381-383).
(Oreg & Sverdlik, 2011)
Resistance to Change
Resistance to change is a natural reaction that should be expected from staff. Managers and change agents must be “supportive, acting in a positive manner towards any resistance”.

Sources of resistance:

·Technical concerns – concerns over the usefulness of the change

·Psychosocial needs – anxiety, safety and security

·Position and Power – desire to maintain position and power within an organization


(Stonehouse, 2013, p. 444).
(Whitehead, Weiss, & Tappen, 2010)
Supporting the Change Agent
In order to show employees that the management and organization are behind the change, the change agent must have “open support, so that all the staff can see that the change agent is acting on your [management/organization] behalf and with your blessing”.
(Stonehouse, 2013, p.444).
Supporting the Staff
In order to help employees embrace the change the managers and change agent must be:

·“Sensitive to the needs of your staff who are being affected”.

·Give staff time to get used to new roles and responsibility, allowing them to adapt to new ways of performing their jobs related to the implemented change

·Provide extra training and support to staff to ensure understanding of new developments

·Ensure existing staff roles are not affected negatively by change

·Address concerns and worries with staff over “working hours, a change in their working environment, a change in the team of people that they immediately work with, or the application of new techniques and ways of working”.

·Address ambivalence surrounding change and change agent and provide ambivalent employees with extra support and guidance to “alleviate the discomfort ambivalence creates” .

Cost related with supporting staff:

·Increasing staff support increases staff satisfaction and fulfillment

·A satisfied and fulfilled staff is a staff that does not face high staff turnover

·“High staff turnover on patient care units comprises quality and increases cost”.

·Staff satisfaction and retaining staff are recognized “as critical keys to solving the problems of cost, safety, and quality in health care".
(Stonehouse, 2013, p. 444)
(Oreg & Sverdilk, 2011, p. 338)
(Shafer & Aziz, 2013, p. 229)

Initiating QI Process
In order to successfully begin to attempt QI change, all impacted by the change must be included in the process. It is smart to start small with change efforts and focus on “easy successes” in order to build a culture and environment of comfort with change

By including all affected by the change “in the process and communicating fully with them in an honest and transparent way will foster trust, develop ownership and gain staff support for the change” .


Since all nurses are involved “each person brings unique strengths to the project”, “less-experienced nurses contribute new eyes and energy, while experience nurses bring a broad knowledge base and critical thinking skills to the team” and it is “important to recognize and acknowledge all contributions from front-line staff as valuable”.
(Shafer & Aziz, 2013, p. 233)
(Stonehouse, 2013, p. 444)
(Shafer & Aziz, 2013, p. 233)
References
Battilana, J., & Casciaro, T. (2012). Change agents, networks, and institutions: A contingency theory of organizational change. Academy of Management Journal, 55(2), 381-398.

Foltin, A. & Keller, R. (2012). Leading change with emotional intelligence. Nursing Management. 20-25.

Goleman, D. (1998). Working with emotional intelligence. New York: Bantam Books.

Mclean, C. (2011). Change and transition: What is the difference?. British Journal Of
School Nursing, 6(2), 78-81.

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

Oreg, S., & Sverdlik, N. (2011). Ambivalence toward imposed change: The conflict between dispositional resistance to change and the orientation toward the change agent. Journal of Applied Psychology, 96(2), 337-349.

Sadri, G. (2012). Emotional intelligence and leadership development. Public Personnel Management, 3 (41). 535-548.

Shafer, L., & Aziz, M. (2013). Shaping a unit's culture through effective nurse-led quality improvement. MEDSURG Nursing, 22(4), 229-236).

Sommer, S., Johnson, J., Roberts, K., Redding, S. R., Churchill, L. (2013). Nursing
leadership and management. (6thed.). Leawood, Kansas: Assessment
Technologies Institute, LLC.


Stonehouse, D. (2013). The change agent: the manager's role in change. British Journal of Healthcare Management, 19(9), 443-445.

Whitehead, D., Weiss, S., & Tappen, R. (2010). Essentials of nursing leadership and management. (5th ed.). Philadelphia, Pennsylvania. F.A. Davis Company.
Aim:To educate and convey the importance of change theory in nursing, the nurse's role in change,and how it relates to quality improvement
Audience: Nursing students, nursing faculty, nurse leads, nurse managers, nurse educators, and anyone who seeks to implement change
Full transcript