Initiating and Managing Change PDF

Initiating and Managing Change Chapter 4  Introduction Change is inevitable, if not always welcome. Organizational change is essential for adaptation; creative change is mandatory for growth. Change is a continually unfolding process rather than an either/or...

Initiating and Managing Change Chapter 4  Introduction Change is inevitable, if not always welcome. Organizational change is essential for adaptation; creative change is mandatory for growth. Change is a continually unfolding process rather than an either/or event. The process begins when the present state is disrupted, moves through a transition period, and ultimately comes to a desired state.  Introduction Leading change was never needed more than in today’s rapidly evolving system of healthcare. Those who initiate and manage change often encounter resistance. Even when planned, change can be threatening and a source of conflict because it is the process of making something different from what it was. There is a sense of loss of the familiar, the status quo. Although nurses should understand and anticipate these reactions to change, they need to develop and exude a different approach. They can view change as a challenge and encourage their colleagues to participate.  Key Messages from The Future of Nursing: Leading Change, Advancing Health Nurses should practice to the full extent of their education and training. Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression. Nurses should be full partners with physicians and other healthcare professionals in redesigning healthcare. Effective workforce planning and policymaking require better data collection and an improved information infrastructure.  Key Messages from The Future of Nursing: Leading Change, Advancing Health The IOM makes eight 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% by 2020. Ensure nurses engage in lifelong learning. Prepare and enable nurses to lead change to advance health. Build an infrastructure for the collection and analysis of interprofessional healthcare workforce data  The Nurse as Change Agent A change agent is one who works to bring about a change. 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, all of which are in short supply in the high-stress environment of healthcare. Changes will continue at a rapid pace with or without nursing’s expert guidance. Nonetheless, nurses, like organizations, cannot afford merely to survive changes. 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 shaping the future. Opportunities exist now for nurses, especially those in management positions, to change the system about which they so often complain.  Change Theories Because change occurs within the context of human behavior, understanding how change does (or does not) occur is helpful in learning how to initiate or manage change. Lewin (1951) proposes a force-field model, much like a football field (see Figure 5-1). He sees behavior as a dynamic balance of forces working in opposing directions within a field. Driving forces facilitate change because they push participants in the desired direction. Restraining forces impede change because they push participants in the opposite direction. To plan change, one must analyze these forces and shift the balance in the direction of change through a three-step process: unfreezing, moving, and refreezing. Change occurs by adding a new force, changing the direction of a force, or changing the magnitude of any one force. Basically, strategies for change are aimed at increasing driving forces, decreasing restraining forces, or both.  Example of Restraining , Driving Forces  The Change Process Seven Steps in the Change Process: 1. Identify the problem or opportunity. 2. Collect necessary data and information. 3. Select and analyze data. 4. Develop a plan for change, including time frame and resources. 5. Identify supporters and opposers. 6. Implement interventions to achieve desired change. 7. Evaluate effectiveness of the change and, if successful, stabilize the change.  The Change Process Step 1: Identify the Problem or Opportunity Because change is often planned to close a discrepancy between the actual and desired state of affairs, the first step is to identify the problem. Discrepancies may arise because of problems in reaching performance goals or because new goals have been created. Opportunities demand change as much as (or more than) problems do, but they are often overlooked. Be it a problem or an opportunity, it must be identified clearly.  The Change Process Step 2: Collect Necessary Data and Information Once the problem or opportunity has been clearly defined, the change agent collects data external and internal to the system. This step is crucial to the eventual success of the planned change. All driving and restraining forces are identified so the driving forces can be emphasized and the restraining forces reduced. The costs and benefits of the proposed change are obvious focal points as is the need to assess resources—especially those the manager can control. A manager who has the respect and support of an excellent nursing staff has access to a powerful resource in today’s climate.  The Change Process Step 3: Select and Analyze Data The kinds, amounts, and sources of data collected are important, but they are useless unless they are analyzed. The change agent should focus more energy on analyzing and summarizing the data than on just collecting it. The point is to flush out resistance, identify potential solutions and strategies, begin to identify areas of consensus, and build a case for whichever option is selected.  The Change Process Step 4: Develop a Plan for Change, Including Time Frame and Resource Planning the who, how, and when of the change is a key step. What will be the target system for the change? Members from this system should be active participants in the planning stage. The more involved they are at this point, the less resistance there will be later. Present attitudes, habits, and ways of thinking have to soften so members of the target system will be ready for new ways of thinking and behaving. Managers need to plan the resources required to make the change and establish feedback mechanisms to evaluate its progress and success.  The Change Process Step 5: Identify Supporters and Opposers Who will gain from this change? Who will lose? Who has more power and why? Can those power bases be altered? How? Who in control may be benefiting now? Selecting and placing personnel or terminating key people often is used to alter the forces for or against change. When key supporters of the planned change are given the authority and accountability to make the change, their enthusiasm and legitimacy can be effective in leading others to support the change. Managers need to plan the resources required to make the change and establish feedback mechanisms to evaluate its progress and success.  The Change Process Step 6: Implement Interventions to Achieve Desired Change The plans are put into motion (Lewin’s moving stage). Interventions are designed to gain the necessary compliance. The change agent creates a supportive climate, acts as an energizer, obtains and provides feedback, and overcomes resistance.  The Change Process Step 7: Evaluate Effectiveness of the Change and, if Successful, Stabilize the Change The change agent determines whether presumed benefits were achieved from a financial as well as a qualitative perspective, explaining the extent of success or failure. Unintended consequences, positive or negative, may have occurred. The change agent terminates the relationship by delegating responsibilities to target system members. The energizer role is still needed to reinforce new behaviors through positive feedback.  Change Strategies Change Strategies -> Regardless of the setting or proposed change, the change process should be followed. Specific strategies can be used, however, depending on the amount of resistance anticipated and the degree of power the change agent possesses.  1-Power–Coercive Strategies Power–Coercive Strategies are based on the application of power by legitimate authority, economic sanctions, or political clout. Changes are made through law, policy, or financial appropriations. Those in control enforce changes by restricting budgets or creating policies. Power–coercive strategies are useful when a consensus is unlikely despite efforts to stimulate participation by those involved. When much resistance is anticipated, time is short, and the change is critical for organizational survival, power– coercive strategies may be necessary 2-Empirical–Rational Model Strategies In the empirical–rational model of change strategies, the power ingredient is knowledge. The assumption is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. It is also assumed that the change agent who has knowledge has the expert power to persuade people to accept a rationally justified change that will benefit them. The flow of influence moves from those who know to those who do not know. New ideas are invented and communicated or diffused to all participants. The change agent can direct the change. There is little need for staff participation in the early steps of the change process, although input is useful for the evaluation and stabilization stages. The benefits of change for the staff and research documenting improved patient outcomes are the major driving forces.  3-Normative–Reeducative Strategies normative–reductive strategies of change rest on the assumption that people act in accordance with social norms and values. Information and rational arguments are insufficient strategies to change people's patterns of actions; the change agent must focus on noncognitive determinants of behavior as well. People’s roles and relationships, perceptual orientations, attitudes, and feelings will influence their acceptance of change. In this mode, the power ingredient is skill in interpersonal relationships, not authority or knowledge. The change agent uses collaboration, not coercion or nonreciprocal influence. Members of the target system are involved throughout the change process. Value conflicts from all parts of the system are brought into the open and worked through so change can progress. Normative–reeducative strategies are well suited to the creative problem solving needed in nursing and healthcare today. This approach can be effective in reducing 68 Chapter 5 resistance and stimulating personal and organizational creativity.  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, and belief that change is unnecessary or that it will not improve the situation. Employees may resist change because they dislike or disapprove of the person responsible for implementing the change or because they may distrust the change process. The change agent should anticipate and look for resistance to change.  Resistance to Change To Manage resistance, use the following guidelines: 1. Talk to those who oppose the change. Get to the root of their reasons for opposition. 2. Clarify information, and provide accurate feedback Good Luck ! By : Mohammad Zayet