10 Ghadeer Change.ppt

 Introduction In the nursing profession, the need for change has never been greater. Change is needed in both the practice of nursing and in the systems that nurses use to deliver care. Learning how to manage change was listed as one of the major components necessary when...

 Introduction In the nursing profession, the need for change has never been greater. Change is needed in both the practice of nursing and in the systems that nurses use to deliver care. Learning how to manage change was listed as one of the major components necessary when developing future nurse leaders. Being an effective change agent requires expert planning skills. This includes planning for changing needs. The failure to reassess goals proactively (practical) and initiate these changes results in misdirected and poorly used fiscal and human resources. 2  Definitions Change Change is the process of making something different from what it was. Change is the opportunity to alter the flow of events in your life, the lives of patients, or an organization. Change simply means alteration which occurs as a result of internal or external forces imposing on an individual or organization. External forces for change are those that originate outside the person or organization, e.g. insurance companies, state and federal government, consumers, new technologies, physicians and competitions. Internal forces come from within the organization or from within the person, e.g. strategy for success formulated by top management, the decision to purchase new technologies, or a need for change in employee behavior. 3  Definitions Change agent Change agent is one who works to bring about a change. The nurse often acts as an insider, a change agent who is a part of the system being altered. Nurses also can be outsiders or consultants for change in other systems. A change agent is the person who seeks to cause or create change. This person may originate the ideas for change or may be an individual who recognizes the value of new ideas originated by others. 4  Change Agent Skills Successful change agents demonstrate certain characteristics that can be cultivated (educated) and mastered with practice. These characteristics are: 1.The ability to combine ideas from unconnected sources. 2.The ability to energize others by keeping the interest level up and demonstrating a high personal energy level. 3.Skill in human relations; well-developed interpersonal communication, group management, and problem-solving skills. 4.Integrative thinking; the ability to retain a big picture focus while dealing with each part of the system. 5  Change Agent Skills 5. Sufficient flexibility to modify ideas when modifications will improve the change. 6. Confidence and tendency not to be easily discouraged. 7. Realistic thinking. 8. Trustworthiness (honesty); a track record of integrity and success with other changes. 9. Ability to articulate a vision through versatile (multitalented, resourceful) thinking. 10. Ability to handle resistance to change. 6  Reasons for Change Good reasons for change that are applicable to a wide variety of situations include: 1. Change in order to solve a 7. Improve work problem. environment. 2. Change to make work 8. Increase profitability. procedures more efficient. 9. Improve nurse 3. Change to reduce satisfaction. unnecessary work. 10. Improve nurses' social 4. Improve patient care. well- 5. Lower costs. being. 6. Increase economic status of 11. Achieve organizational nurses. objectives. 12. Achieve personal 7 objectives.  Reasons for Change- Continued There are several rules that should be followed in implementing change: 1. Change should only be implemented for good reason. 2. Change should always be gradual. 3. All change should be planned and not be sporadic or sudden. 4. All individuals who may be affected should be involved in planning for the change. 8  Factors Influencing Change The role of the change agent The change agent may be an employee of the organization or an outside consultant. Consultants are often used when the change requires specialized expertise and skills, freedom from day-to-day organizational responsibilities, or the objectivity of an outsider. Driving or restraining forces The external and internal forces that push toward change are called the driving forces. Forces that push against change are called restraining forces. When these forces are in equilibrium, the status quo is maintained. For change to occur, driving forces must be increased or the restraining forces must be decreased so that the balance becomes upset. The change agent must identify the driving and restraining forces in order to assess the best plan for implementing change. Reduction of restraining forces is a more effective way to encourage change than increasing driving forces. Increasing driving forces may lead to hostility and the emergence of additional restraining forces. 9  Types of Change There are two ways in which change can occurs. One is planned change and the other is change by drift or accidental change. Planned change Planned change needs someone like you to serve as the change agent. This usually is someone with experience and skill in the change process. Planned change comes from a committee or an administrative group. Planned change is a well thought out and deliberated effort to make a change. 10  Types of Change Change by drift, accidental, or unplanned change Unplanned change occurs because of an imbalance in the system. Because people have not been taught about the forthcoming change and obviously have not had an opportunity to be involved in it, change by drift is generally met with resistance and hostility (aggression and opposition). Change by drift is not desirable because of the distress it brings to people who are either asked or required to make change without knowing why or being involved in the change process. It also resembles the idea of "putting out fires" instead of planning and making decisions that prevent the fires. 11  Causes of Resistance to Change 1. Stress. 2. Threat to security. 3. Habits. 4. Lack of knowledge. 5. Cultural environment. Values and beliefs. Religion. Social inhibitions. 6. Implied (indirect) criticism. 7. Conservatism (over protection). 8. Insecurity. 9. Perceptions: loss of power, personal relationships. 12 Strategies for Overcoming Obstacles to Change Managed change. Collection and development of data. Preparation or planning. Training and education. Rewards. Using groups as change agents. Communications. The organizational environment. Anticipating potential failures. 13  Levels of Change There are four levels of change: knowledge, attitudes, individual behavior, and group behavior. 1) Change in knowledge tends to be easiest to make since they can result from reading a book or listening to a lecturer. 2) Attitude structures are emotionally charged in a positive and/or negative way. Therefore, they are more difficult to change than knowledge. 3) Moving to greater difficulty, individual behavior comes next. 4) Group behavior is the hardest to change because of the numbers of people. Trying to change customs, moves, and traditions is also difficult. 14  Change Theories Theories of change have emerged from the work of both behavioral scientists and management theorists. These theories include: Empirical-Rational theory This theory maintains that a change will be accepted by a person, group, or organization when it is seen as desirable and is aligned with the interest of those affected. It is primarily used for technological changes, e.g. the introduction of an automated medication dispensing machine on the nursing unit. If the manager explained to you that you would no longer have to count narcotics each shift, that patient charges would now be automatic, and that you could learn to use the machine in thirty minutes, you might see the changes as desirable because it would save your time. It would be in line with your self-interest: you could get finished your shift on time. In this example, the change would probably proceed easily and quickly. 15  Change Theories Power-coercive theory This theory is employed when a leader orders change and those with less power comply. Using this theory, the nurse who wishes to be a change agent would need official authority in order to mandate a change. A power-coercive strategy may be used to force a change when it is assumed that experience with the change will lead to a change in values. Normative re-educative theory This theory states that change will take place only after changes in attitudes, values, skills, and significant relationships have occurred. This model emphasized that involvement of those affected by the change is essential in achieving changes in attitudes, beliefs, and norms. In utilizing this strategy, the change agent must involve the recipients of change in working out the plans for achieving the change. Mutual trust and collaboration facilitate this process of change. In this theory, the input of ideas, information and technology must be aligned with norms and values for the change to successfully occur. This theory is the foundation for most major organizational change today. 16  Change Process and Responsibilities of Change Agent 1. Unfreezing:  Gather data.  Diagnose the problem.  Decide if change is necessary.  Make others aware of the need for change. 2. Movement:  Develop a plan.  Set goals and objectives.  Identify areas of support and resistance.  Include everyone in the planning that will be affected.  Establish target dates.  Develop appropriate strategies for alteration.  Implement the change.  Be available to support others through the process; offer encouragement as needed.  Employ tactics for overcoming resistance.  Evaluate the change.  Modify, if necessary. 17  Change Process and Responsibilities of the Change Agent 3. Refreezing: Support others so that the change remains in place. There are ten emotional phases in the change process.  Unfreezing phase is reflected in the aspects of equilibrium, denial, anger, and bargaining.  movement phase is reflected in the aspects of chaos (confusion), depression, and resignation.  Refreezing phase is reflected in the aspects of openness, readiness, and reemergence (recurrence). 18  Strategies of Change Fellowship strategy Everyone is heated equally and emphasis is placed on team building in a group, getting to know group members, and building social bonds (links) among members. This strategy is ideal for followers who have high social and esteem needs, e.g. getting people together at an informal dinner party to discuss new directions for a unit. 19  Strategies of Change Political strategy A political strategy means identifying the formal and informal power structures. Once these structures are identified, efforts are made to influence those in power. The assumption of this strategy is that something will get accomplished if the influential people in a system wish it to be carried out, e.g. directors who want to change from having nurses write separate notes to record on the progress notes might identify the key people in hospital policy-making and discuss with them individually prior to bringing the recommendation to a format gathering. 20  Strategies of Change Economic strategy Money talks! Emphasis is on controlling material resources, anything and anybody can be influenced that is, bought and sold. Inclusion in a group is often based on profession or control of marketable resources. Fundraisers often employ this strategy. Academic strategy In academia, knowledge is the primary influencer. The belief is that people are logical, rational and objective; that decisions will be based on what research suggests is the best path to follow. Emotions are not usually acknowledged in an academic strategy, even though it is known that people can never be entirely objective on anything. In suggesting ways that result in more effective outcomes of patient care, a manager might cite research studies that support the identified goal for a unit. 21  Strategies of Change Engineering strategy Engineering strategy is a sociological approach with the belief that if the surrounding change, the people in those surroundings will also change. Health care planners use this strategy when designing patient units so that beds are in close proximity to the nurse’s station. The logic is that if nurses are close to patients, they will spend more time “at the bed side” and the quality of care will increase. Military strategy Physical force and real threats are the names of this game. Position power is used in the form of threats and punishment if the leader’s wishes are not obeyed. A manager must assess the need for such a strategy- it should be the last possible approach. 22  Strategies of Change Confrontation strategy This approach induces non-violent and non- physical conflict within people. A manager forces people to hear and see what is happening in a situation. The intent is that once people are aware of what is occurring; change will follow. 23  Role of Nurse Manager in Fostering Appropriate Organizational Change Nurse managers should have dramatically improved capacities to exercise relevant, reliable, and responsive leadership. Nurse managers need to be visionary in identifying areas where organizational change is needed, additionally they will have to be flexible in adapting to changes they have directly initiated or indirectly been affected by. Critical leadership skills are required of the nurse manager to understand when and how to initiate and coordinate organization change. The nurse manager will need to learn to work with new employees to advise them of innovations that may help the organization be more effective and responsive to the environment. Nurse managers must constantly strive to limit the disruptive effects of organization change. 24  Summary Change is the opportunity to alter the flow of events in your life, the lives of patients, or an organization. A change agent is the person who seeks to cause or create change. Successful change agents demonstrate certain characteristics that can be cultivated and mastered with practice. There are various reasons for change that are applicable to a wide variety of situations. Factors influencing change are: the role of the change agent, and driving or restraining forces. 25  Summary Types of Change are planned change, and change by drift, accidental change, or unplanned change. There are four levels of change: knowledge, attitudes, individual behavior, and group behavior. Theories of change have emerged from the work of both behavioral scientists and management theorists. These theories include: Empirical-Rational theory, Power-coercive theory, and normative re-educative theory. Components of change process are: Unfreezing, movement, and refreezing. Strategies of change include: Fellowship strategy, political strategy, economic strategy, academic strategy, engineering strategy, confrontation strategy, and military strategy. 26