Planned Change in Healthcare PDF

**Planned change results from a well-thought-out and deliberate effort to make something happen.** **KNOW Planned change vs. Accidental change** - **Planned Change is the deliberate application of knowledge and skills by a leader to bring about a change.** - Must be implemented gradua...

**Planned change results from a well-thought-out and deliberate effort to make something happen.** **KNOW Planned change vs. Accidental change** - **Planned Change is the deliberate application of knowledge and skills by a leader to bring about a change.** - Must be implemented gradually. - Results from well-thought-out and deliberate effort to make something happen - **Accidental Change**: change by drift; unintentional and unpredictable - **KNOW \[KAHOOT\] A change agent is a person skilled in the theory and implementation of planned change.** - **KNOW \[KAHOOT\] Ability to communicate positively with staff, to set goals and objectives, and to identify areas of support and resistance** - **Their qualities include visionary, risk taking, flexibility, excellent communication, creativity, sensitivity, and takes steps to prevent aging in the organization and to keep current with the new realities of nursing practice** **Kurt Lewin's Change Theory Stages:** page 192 (KNOW what happens in each stage) - **KNOW \[KAHOOT\] Unfreezing**: **the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. Thus, people become discontent and aware of a need to change.** - **Gather data, diagnose the problem, decide if the change is needed** - **Be solution focused not problem focused** - **Movement**: the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces - Develop a plan, set goals & objectives, include everyone that will be affected, set target dates, develop strategies, & implement the change - Change should be initiated gradually; like if a charge nurse wants to start something new - **Refreezing**: the change agent assists in stabilizing the system change so that it becomes integrated into the status quo - Change agent should be available to support those affected by change until the change is stabilized - If this is incomplete, change will not be effective. Needs to be at least 3 to 6 months to be fully effective **Lewin's Driving and Restraining Forces** - The forces that push the system toward change are driving forces, whereas the forces that pull the system away from change are restraining forces - Ex of **driving** forces: status, increased pay, family support - Ex of **restraining** forces: low energy, limited resources, lack of transportation - **Forces for driving to reach the goal:** Opportunity for advancement, Status, social gratification, Enhanced self-esteem; Family supportive of efforts, Pay increase - **Lewin's Rules**: - Change should only be implemented for good reason - Change should always be gradual (shouldn\'t be rushed) - All change should be planned and not sporadic or sudden - **KNOW \[KAHOOT\] All individuals who may be affected by the change should be involved in planning for the change** - Stages of Change Model (DONT MEMORIZE) - Stage 1: Precontemplation: no current intention to change - "We\'ve always done it this way" - Stage 2: Contemplation: individual considers making a change - Stage 3: Preparation: there is intent to make a change in the near future - Stage 4: Action: individual modifies his/her behavior - Stage 5: Maintenance: change is maintained and relapse is avoided. - The change has to be maintained or it's gonna relapse to the old way **Classic Change Strategies** - **Rational--empirical strategies**: used when there is little anticipated resistance to the change or when the change is perceived as reasonable - **Normative--re-educative strategies:** use group norms and peer pressure to socialize and influence people so that change will occur - **Power--coercive strategies:** feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent **Different Adaptive Theories** - **KNOW \[KAHOOT\] Complex Adaptive Systems Change Theory:** **Suggest the relationship b/t elements and agents within any system are nonlinear and interconnected** - **These elements are the key players in changing settings or outcomes.** - **For example, although an individual may have behaved one way in the past, CAS theory suggests that future behavior may not always be the same (not always predictable)** - Past behavior may not always predict future behavior - **Chaos Theory:** Really about finding the underlying order in apparently random data - Looking at the underlying cause - **Everything is interrelated and the manager seeks to find the underlying order in apparently random data. Even tiny changes can change massive outcomes; makes it hard to predict future outcomes / long term behavior** - Like the butterfly effect **Organizational Aging Characteristics** - **KNOW Organizations progress through developmental stages. Goes through organization aging** - **KNOW \[KAHOOT\] Aged organizations have established "turf boundaries", they function in an orderly and predictable fashion, and are focused on rules and regulations. Change is limited** - As organizations age, structure increases to provide greater control and coordination - The young organization is characterized by high energy, movement, and virtually constant change and adaptation **Three good reasons for change:** 1. Change to solve a problem 2. Change to make work procedures more efficient 3. Change to reduce unnecessary workload **KNOW Strategies for attempting change/implementing change:** 1. **Change should never be viewed as a threat** 2. **The person acting as a change agent must make a thorough and accurate assessment** 3. **Supporters and nonsupporters need balance between stability and change** **Resistance to Change** - Biggest factor contributing to resistance is a lack of trust between the employee and the manager or the employee and the organization - Prevent resistance: - All those affected by change needs to be involved in planning - Manager: change first, model the new behavior, more likely to increase change - Ensure everyone knows what the change is, roles, and how it going to affect each person and the organization overall **KNOW Involvement in change/facilitating change:** - **Whenever possible, all those who may be affected by a change should be involved in planning for that change** - **When information and decision making are shared, subordinates feel that they have played a valuable role in the change** - **The leader has two responsibilities in facilitating change in nursing practice. First, leader-managers must be actively engaged in change in their own work and model this behavior to staff. Second, leaders must be able to assist staff members in making the needed change requirements in their work.** **Ch 12: Organizational Structure** Organizational structure refers to the way in which a group is formed, its lines of communication, and its means for channeling authority and making decisions. **Formal vs Informal Structure** - **Formal structure**: the emphasis is on organizational positions and formal power - Provides a framework for defining managerial authority, responsibility, and accountability - **Informal structure**: the focus is on the employees, their relationships, and the informal power that is inherent within those relationships - **Has its own leaders and communication channel (grapevine)** - Can be difficult to control or stop if communication goes sideways like gossip - **KNOW Grapevine communication: grapevine communication is at the heart of the informal organization; it is the conversations that occur in the break room, down the halls, during the carpool, and in between work that allows the relationships of informal groups to develop; it also can be done through social media** **Characteristics of Bureaucracies:** 1. There must be a clear division of labor a. Work is divided into units and given to particular people that are competent 2. A well-defined hierarchy of authority must exist 3. There must be impersonal rules b. Limit favoritism and unreasonable behavior; leaders can't do whatever they want c. Certain rules and rights that covers each individual person d. Promotions based on technical competence 4. There must be a system for dealing with work situations 5. There must be a system of rules for covering the rights and duties of each position 6. Selection for employment must be based on technical competence **Organizational Structure Terminology:** - **KNOW Organizational chart: an organization chart can help identify roles and their expectations.** - Span of control: the number of people directing reporting to manager - Flattening the organization; increase number of spans of control and reduces the number of administrative levels - Too many people = delayed decision making - **KNOW \[KAHOOT\] Unity of command**: **One man, one boss**; **employees have one manager to whom they report and to whom they are responsible** - **KNOW \[KAHOOT\]: Employees have 1 manager to report to** - **Unity of command is indicated by the vertical solid line between positions on the organizational chart.** - **Centrality**: where a position falls on an organizational chart; degree of communication of a particular management position - Determined by organizational distant - Closer to chain of command = more access to info - **Middle manager has broader view and large degree of centrality bc info is received from the top and the bottom and the sides** - **Scalar chain**: pyramid from top command to lowest ranking; decision-making hierarchy - Remember to include everyone that is affected when planning change - **Authority**: the official power to act and direct the work of others - **Responsibility**: a duty or an assignment - related to job assignment and must be accompanied by enough authority to accomplish the assigned task - **Accountability**: the moral responsibility that accompanies a position - They agree to be morally responsible for the consequences of their actions - **Stakeholders**: the entities in an organization's environment that play a role in the organization's health and performance, or that are affected by the organization - May be internal and external - Every organization should be viewed as being part of a greater community of stakeholders - **Shared governance**: Nurses at every level play a role in the decisions that affect nursing activity throughout the system - Managers are collaborators, teachers, and moderators of the service process; provides resources - emphasizes the empowerment of staff nurses - **Participatory management:** lays the foundation for shared governance - ​​implies that others are allowed to participate in decision making over which someone has control **Levels of management** - **Top level managers**: Board of Directors, Chief Executives Officers, Administrators - **Middle level managers**: Nurse Supervisors, Department Heads - **First level managers:** Team Leads, Charge Nurses, Primary Care Nurses, case managers **Advantages of the Organizational Chart (Display 12.2, p. 306)** 1. Maps lines of decision-making authority 2. Helps people understand their assignments and those of their coworkers 3. Reveals to managers and new personnel how they fit into the organization 4. Contributes to sound organizational structure 5. shows formal lines of communication **Limitations of the Organizational Chart (Display 12.2, p. 306)** 1. Does not show the informal structure of the organization 2. Does not indicate the degree of authority held by each line position 3. May show things as they are supposed to be or used to be rather than as they are - Role confusion and trust issues 4. Possibility exists of confusing authority with status **Types of organizational structures:** - Line structures, ad hoc design, matrix structure, service line, flat design - **Line structures:** bureaucratic, found in large healthcare facilities, efficient and simple - **Ad hoc**: modified bureaucratic structure and is used temporarily to complete a project - **Matrix:** focuses on product and function - **Service line**: used to address shortcomings - Figure 12.3, **KNOW Flattened organizational structure (ONE line of management and ONE line of staff)** - More authority and decision-making can occur when the structure is flattened out - Decentralizes the organization **KNOW Organizational Structure** - **Poor Organizational Structure:** the formal chain of command is flat restricting upward communication - **Good Organizational Structure**: communication follows the chain of command, the smallest amount of managers exist to keep the units functioning - there is a heavy reliance on committees to solve unit problems - **KNOW \[KAHOOT\] The line of communication authority depicted by solid lines on the organizational hierarchy show the chain of command** **Centralized vs. Decentralized Decision Making** - **\[KAHOOT\] Centralized decision making: a few managers at the top of the hierarchy make most of the decisions and the emphasis is on top-down approach** - **KAHOOT: Decisions are mandated from the top down** - **KNOW \[KAHOOT\] Decentralized decision making: decision making is diffused throughout the organization, and problems are solved by the lowest practical managerial level** - **As a rule, however, larger organizations benefit from decentralized decision making.** - **Display 12.3 - KNOW Criteria needed for assessing organizational culture** - **KNOW \[KAHOOT\] Organizational Culture: the values and behaviors that contribute to the unique social and psychological environment of an organization.** - **The total of an organization's values, language, traditions, customs, and sacred cows** - **KNOW \[KAHOOT\] These need to be assessed to determine organizational culture:** - **How safe the organization is, the social environment, the physical environment, and the power structure** - **KAHOOT: It is the ways of thinking, behaving, and believing that members of a unit have in common (book)** - **KNOW \[KAHOOT\] Organizational Climate is how employees perceive an organization, although the perception may be accurate or inaccurate** - **KNOW \[KAHOOT\]: Climate represents perceptions of individual** - **For example, an employee might perceive an organization as fair, friendly, and informal or as formal and very structured.** - Different people in the organization may have different perceptions - A nursing unit the manager must provide a motivational climate to promote good moral **Shared governance** - Nurses at every level play a role in the decisions that affect nursing activity throughout the system - Nurse-managers move out of traditional industrial model roles into collegial models, becoming moderators of the service process - Usually defined by a structure of rules or bylaws **KNOW Characteristics of Magnet Hospitals** - Well-qualified nurse executives in a decentralized environment, with organizational structures that emphasize open, participatory management - Autonomous, self-managing, self-governing climates that allow nurses to fully practice their clinical expertise, flexible staffing, adequate staffing ratios, and clinical career opportunities - A professional practice culture in all aspects of nursing care - Compliance with standards in the ANA's Scope and Standards for Nurse Administrators - Empirical outcomes - **14 forces of magnetism for magnet hospital status** - Quality of nursing leadership. Organizational structure. Management style - Personnel policies and programs. Professional models of care. Quality of care - Quality improvement. Consultation and resources. Autonomy - Community and the hospital. Nurses as teachers. Image of nursing - Interdisciplinary relationships. Professional development **Groupthink** - Occurs when there is too much conformity to group norms - often results in opinions and ideas that may lack merit - Needs to have gender and racial diversity - Important to have different interpretations of the same things - Allows different POVs **Chapter 13: Organizational, Political, and Personal Power** **KNOW Power is the authority and ability to get things accomplished** - **Gaining power often leads to the acquisition of MORE power** **Sources of Power: table 13-1** - **KNOW \[KAHOOT\] Referent power: developed through forming relationships with others** - **Power that a person has because others identify with that leader or with what that leader symbolizes** - **Referent power also occurs when one gives another person feelings of personal acceptance or approval. It may be obtained through association with the powerful.** - **Ability to influence staff to achieve organizational excellence \[ex. Manager, Physicians\]** - **Reward**: ability to grant favors - **Legitimate**: developed through one's position - **Coercive**: based on fear and punishment - **KNOW Expert: gained through knowledge, expertise, or experience** - **Charismatic**: personal - **Informational**: the need for information **KNOW Empowerment is transferring of authority, responsibility and freedom to act and inspire others with self-confidence** - Done by communicating their vision, making the most of their talents, planting seeds of leadership in others - Empowerment plants seeds of leadership, collegiality, self-respect, and professionalism Authority--power gap - The right to command does not ensure that employees will follow orders. - The more power subordinates perceive a manager to have, the smaller the gap between the right to expect certain things and the resulting fulfillment of those expectations by others. - The negative effect of a wide authority--power gap is that organizational chaos may develop - Figure 13.1: Power Gap Mobilizing the power of nursing (DONT MEMORIZE) **KNOW One of the most important ways in which we can increase the power of the nursing profession is to focus on mentoring future nurse leaders and leadership succession** **KNOW Action plan for increasing the power of the nursing profession** - **Pay attention to mentoring future nurse-leaders and leadership succession** - Place more nurses in positions that influence public policy. Stop nurses from acting like victims - Increase the level of nurses' understanding regarding all health-care policy efforts - Build coalitions within and outside of nursing. Support nursing leaders - Promote greater research to strengthen evidence-based practice **Building a personal power base, pg 346** - **KNOW \[KAHOOT\] After a year at the hospital the staff nurse joins the policy and procedure committee** - **Maintain personal energy** - **Present a powerful picture to others** - Work hard and be a team player - Learn the language and symbols of the organization. Learn how to use the organization's priorities - Increase professional skills and knowledge. Maintain a broad vision - Use experts and seek counsel. Be flexible. Develop visibility and voice in the organization - Learn to accept compliments. Maintain a sense of humor. Empower others Keeping Power - Maintain a small authority-power gap. Empowering subordinates - Use authority in such a manner that subordinates view what happens in the organization as necessary - Use political strategies to maintain power and authority when necessary **Queen Bee Syndrome, pg 352 & 345** - **The queen bee is a woman who has struggled to become successful, but once successful, refuses to help other women reach the same success. Female-dominated professions such as nursing often exemplify this syndrome** -