What are the concepts of change?
One constant in the natural world is change.
Organizations today are confronted with change both internally and externally.
Effective leadership has the ability to manage the change while helping the organization moving toward identified goals.
What is a change agent?
A CHANGE AGENT is someone who copes with change and assisting others in coping with and adapting to change becomes a major professional nursing role.
Yoder-Wise, p 332 “Change agents are individuals with formal or informal legitimate power whose purpose is to initiate, champion, and direct or guide change.”
Compare and contrast change and transition
Change is a brief self-limiting event
Transition is the passage or process of change from one state to another involving an alteration in identity.
Describe characteristics of change
- Type:
Planned: deliberate, collaborative, goal directed
Unplanned: accidental, events arise, e.g. sudden decline in patient status - Source:
Internal: to the organization (change within the organization)
External to the organization e.g. government cutbacks - Intensity: subtle to radical
a. Status quo: no apparent change
b. Expansion and contraction: structure and purpose stays the same but the operation changes e.g. changed staffing patterns (taking away or adding to)
c: Transition: changes in existing framework e.g. changing shower rooms into patient rooms (changing structural appearance/physical)
d: Transformational: structure and function change e.g. path unit becoming a renal/neuro unit (taking a pre-existing unit and making it something else) - Pattern
A. Predictable – allows planning time e.g. electronic charting system
B. Sudden – difficult to respond to e.g. no morphine available - Pace: rate at which the change occurs
What is the purpose of a change process?
- solve a problem
- improve efficiency
- reduce unnecessary workload
Steps in Change Process
- Planning
- Organizing
- Implementing
- Evaluating
- Seeking feedback
- Communication
Rational-empirical Change Strategy
-assumes that we are rational people who use knowledge to embrace change
uses knowledge as a power base
-aimed at educating people about available options and assumes that the individual will change their behavior as the new behavior is more desirable
Communication of the information is important
Little resistance is anticipated
- Doesn’t account for the emotions involved
Normative-re-educative Strategy
- Focuses on the relationship needs of the group (interpersonal relationships)
- Uses collaboration, more democratic, flexible adaptation
- Stimulates organizational creativity
- Looks at others values, needs, etc.
- Assumes that the socio-cultural norms are fundamental to a person’s behavior
- Assumes that people act in accordance with values, norms and attitudes of the group (focuses on group)
- Some resistance may be expected (small to mid-level)
- Change agent does not necessarily require legitimate power but gains power with interpersonal skills
- Takes a great deal of time
- if you want to have a lasting change, this is the theory to use*
Lewin’s Change Process
Driving Forces: positive, indicate the likelihood of moving toward a goal (push you toward the change) e.g. family expectation, friends, challenge self
Restraining Forces: obstacles that decrease the likelihood of reaching a goal (push you away from the change) hinders the ability of making a change/impedes change e.g. financial costs
Status Quo: means that the driving forces are about the same as the restraining forces.
Lewin said that when a change occurs, you first have to unfreeze, move forward, then refreeze
Power-coercive Strategy
“Do it – or get out!” (Kelly, p. 297) e.g. proper footwear
Based on the use of power by a legitimate authority to gain compliance with change
Resistance is managed but can be very high.
1. Define issue and opponent
2. Organize a following
3. Build a power base
4. Begin action plan
5. Keep pressure on
6. Use stronger tactics to overcome resistance
“dicks often break bridges, keep up!”
Factors Affecting Change
- Change itself – type and scope of change
- Target system: what are the past experiences, anxiety, feelings of loss of control
- Environment: amount of trust, culture, values
- Potential responses to Change
How much resistance to expect – why?
How to Lower Resistance
-active listening
-legitimize feelings
Remain rationale
Maintain an atmosphere of trust and support
Emphasize positive consequences
Strategies to facilitate change
- commitment: personal interest
- communication: over-communicate about purpose of elements of change process, gather support
- participation: promote ownership of the process and the decisions made
- facilitation: reassure, decrease fear and anxiety
Effective Change Agent
Effective change agent is respected, trusted by others, responsible and skilled
The change process will dictate the role of the change agent Rationale – well informed Normative – energize others Power-coercive – relies on authority Reframe – highly energetic
Other strategies to facilitate change
Negotiation – give and take
Co-optation and manipulation: enlist people to your side by involving them in your process
Coercion – use of power to force others to make the change
How could a nurse be a good change agent?
- Uses a decision making process
- Thinks critically
- Works in the system
