nurs 490 Change Theory-Discussion Paper.

nurs 490 Change Theory-Discussion Paper.

Because change is a constant in the healthcare environment, it is important to remember key points:Tmployees will react differently to change, no matter how important or advantageous the change is purported to be.T Basic needs will influence reaction to change, such as the need to be part of the change process, the need to be able to express oneself openly and honestly, and the need to feel that one has some control over the impact of change.TChange often results in loss (e.g., downsizing, changes in established routines) and employees may react with shock, anger, and resistance, and, hopefully, ultimate acceptance.

TChange must be managed realistically, without false hopes and expectations, yet with enthusiasm for the future. nurs 490 Change Theory-Discussion Paper.TIt is important that management deal with the fears and concerns triggered by change in an honest manner (Monaghan, 2009; Team Technology, 2014).CHANGE THEORIESPBelow are samples of both classic and current change theories. This list is not meant to be all-inclusive.PLewin’s Change TheoryTA three-step model based on the premise that behavior is a dynamic balance of forces working in opposition.

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Driving forces facilitate change by pushing employees in a desired direction, and inhibiting forces hamper change because they push employees in the opposite direction.1. Step 1 is the process of altering behavior to “unfreeze,” or agitate the status quo (equilibrium state). Step 1 is necessary if resistance is to be overcome and conformity achieved.2. Step 2, “change,” involves movement of the employees to a new level of equilibrium. It helps employees to view change from a new perspective, to work together to achieve desired outcomes of change, and to facilitate consistency among management and employees.3. Step 3 is “refreezing,” or attaining equilibrium with the newly desired behaviors. Step 3 occurs after change is implemented so that new behaviors and desired outcomes can be integrated into the organization (Lewin, 1951).PLippitt’s Seven-Step Change TheoryTExpands Lewin’s theory to place additional emphasis on the role of the change agent 1.

Step 1: Diagnose the problem by examining all possible consequences, determining who will be affected by the change, identifying essential management personnel who will be responsible for fixing the problem, collecting data from those who will be affected by the change, and ensuring that those affected by the change will be committed to its success.2.

Step 2: Evaluate motivation and capability for change by identifying financial and human resources capacity and organizational structure.nurs 490 Change Theory-Discussion Paper.3.

Step 3: Assess the change agent’s motivation and resources, experience, stamina, and dedication.4.

Step 4: Select progressive change objectives by defining the change process and developing action plans and accompanying strategies.5.

Step 5: Explain the role of the change agent to all involved employees (e.g., expert, facilitator, consultant) and ensure that expectations are clear. nurs 490 Change Theory-Discussion Paper.

Step 6: Maintain change by facilitating feedback, enhancing communication, and coordinating the effects of change.7. Step 7: Gradually terminate the helping relationship of the change agent (Lippitt, Watson, & Wesley, 1958).PRoger’s Five-Stage Change Theory1. Stage 1: Impart knowledge in terms of the reason for the change, how it will occur, and who will be involved.2. Stage 2: Persuade employees to accept change by relaying essential information and note that attitudes, both favorable and unfavorable, are formed.3. Stage 3: Decide whether to ultimately adopt the change by analyzing data and implementing a pilot study or trial of the new processes triggered by the change.4. Stage 4: Implement the change on a more permanent or established basis as the organization evolves to accommodate the change.5. Stage 5: Confirm adoption of the change by the employees responsible for and affected by the change (Rogers & Shoemaker, 1971).PTransitions TheoryT“Model for analyzing the human behavioral response to predictable and unpredictable change” (Meleis, 2010, p. 754, as cited in Berry, 2013)TCharacteristics include process with beginning and end, disconnectedness, perception, and patterns of responseTCategories of transitionsPDevelopmentalPSituationalPHealth–illnessPOrganizationalTSpradley Model Eight-step model based on Lewin’s Theory:1. Recognize the symptoms2. Diagnose the problem3. Analyze the alternative solutions4. Select the change5. Plan the change6. Implement the change7. Evaluate the change8. Stabilize the changePPlanned change must be constantly monitored (Swansburg & Swansburg, 2002).Crisis Management: method used to adapt to change1. Modeled by four characteristics: Reduce tensions2. Demonstrate organizational commitment and expertise3. Control the flow and accuracy of information4. Manage resources effectivelyTOrganizations with crisis management plans are better able to attend to the needs of those affected (Rundio, Wilson, & Meloy, 2016).PWilliam Bridges’ Theory Into TransitionTChange of any sort, justified or not, succeeds or fails on the basis of whether people affected do things differently (Bridges, 2009). Three phases of physiological readjustment and reorientation to change:1. Transitions start with an ending: signal that things are changing2. The neutral zone: place between end and beginning, old ways are finished and new ways not yet embedded3. The beginning: adaptation has occurred, new direction (Mclean, 2011)

Skills to support adaptation to changePIdentify who is losing whatPAccept the reality and importance of the subjective lossPDo not be surprised at overreactionPAcknowledge the losses openly and sympatheticallyPExpect and accept signs of grievingPCompensate for the lossesPGive people information over and overPDefine what is over and what isn’tPMark the endingPTreat the past with respectPLet people take a piece of the old way with them (Bridges, 2009). Adaptation to Change (Niessen, Swarowsky, & Leiz, 2010)TIn order to be effective when work requirements change, individuals have to adapt to the direct consequences of changeTAdaptation to changes in the workplace goes beyond merely learning new knowledge and skillsTRequires the unlearning of old work procedures, the accomplishment of tasks and duties in light of the changeTAdaptation is indicated by fit, satisfaction, satisfactory performance, and tenurePAppreciative InquiryTAppreciative inquiry (AI) takes an opposite approach. Rather than define a problem, AI looks at what works in an organization. Positive questions are asked to see potentials and possibilities to move toward.TThe AI cycle has four stages:1. Discovery: Asking relevant stakeholders what is already positive in current practice: what is.2. Dream: Through the use of imagination, create a clear vision for the future: what might be.3. Design: Based on positive past achievements, identify the positive actions needed to reach the “dream”: how to get there.4. Destiny: Creating a climate for positive sustainable change: positive empowerment.TCentral to AI’s theory are five underlying principles:1. Constructionist Principle: People create their reality by how they view the world (organization)2. Poetic Principle: Organizations, like poems, are open to infinite interpretation3. Simultaneity Principle: Change occurs as we talk about it4. Anticipatory Principle: Change is what we view as our future5. Positive Principle: Positive questions lead to positive images, which lead to positive energy and relationships (Cooperrider & Whitney, 2001)MANAGEMENT OF CHANGE: BASIC CONCEPTSPChange management is the process of making changes in a deliberate, planned, and systematic manner.PChange management uses theories, models, methods and techniques, tools, and skills.PKnowledge of change management is drawn from numerous disciplines (e.g., psychology, business management, economics, engineering, organizational behavior).

The goal of change management is to implement change efficiently for the benefit of the organization.PChange has both content and process dimensions. Addressing underlying processes and effective communication of the change expectations leads to a successful change initiative.At the core of effective change are clearly defined outcomes of the proposed change, identified actions to attain the outcomes, and implementation of those actions (Monaghan, 2009; Nickols, 2007).nurs 490 Change Theory-Discussion Paper.Creating a Climate for Effective ChangePRecognize that change is never easy and will be met with enthusiasm by some and resistance by others.PIdentify those who will be enthusiastic about the change (early adopters) and those who will be resistors (laggers); involve them to build momentum and identify barriers, respectively.PCollect and analyze data so that the need for change (and its consequences) can be clearly articulated.PGive employees information honestly and allow them to ask questions and express concerns.PArticulate the reasons for change, how it will affect employees, how it will benefit the organization, and the desired outcomes of the change process.PEnsure leadership commitment so that leaders, in turn, can provide consistent information to staff members (Jones, Aquirre, & Calderone, 2004; Monaghan, 2009; Nickols, 2007).Resistance to ChangePAnticipate barriers to change, including components of organizational structure, and take action to remove them. Diffuse power groups and processes to prevent large barriers from systems and stakeholders (Porter-O’Grady & Malloch, 2003).PEmployees are resistant to change for a variety of reasons:TFear of losing one’s job, having to acquire new skills, and losing the ability to work effectively in a changed environmentTFear of losing one’s unofficial power or influenceTFailure to understand the reasons for changeTFailure to understand how the change will benefit the workplaceTFailure of management to involve affected employees in the change processTFailure of management to communicate effectively (e.g., not providing the reason for or full breadth of the change, limiting information to a few persons, limiting methods used for communication)TFailure of management to relay facts about the change process honestly and realistically (Monaghan, 2009; Nickols, 2007)Change resistors must be identified, worked with, challenged, and placed in the midst of the change process so as not to impede the change (Porter-O’Grady & Malloch, 2003).The Process of Managing ChangePAssessment phaseTIdentify problem or opportunity for changeTCollect and analyze data

Recognize driving and restraining forcesTIdentify potential for resistancePPlanning (unfreezing) phaseTKnow the target system for the changeTAssemble a teamTCreate a process and operational indicatorsTEstablish a timeline for feedback and evaluation of progressPImplementation phaseTInitiate plansTCreate a supportive environmentTProvide informationTProvide trainingTSelect key stakeholders to support the changeTValue participants’ inputTEnsure team has appropriate authority to actPRecognize and address conflictsTReward desired behaviorsPEvaluation (refreezing) phaseTMonitor operational indicatorsTEvaluate effectivenessTStabilize the change (Mick, 2011, as cited in Berry, 2013; Sullivan & Decker, 2009)TEAMS AND CHANGEPEffective teams adapt to the requirements of various tasks, the interdependence of team members, and any changes in the team’s environment (Kilpatrick, Lavoie-Tremblay, Ritchie, & Lamothe, 2014).PA team with a common purpose and clear identification of roles and responsibilities creates a cohesive working unit that has an impact not only on the delivery of quality service, but also on the psychological well-being of the team members (Huber, 2013).PThe nurse professional development practitioner must collaborate with interprofessional groups and participate in team-building activities that foster acceptance to change.REFERENCESBerry, M. (2013). Change agent/team member. In S. L. Bruce (Ed.), Core curriculum for nursing professional development (4th ed., pp. 751–777).  nurs 490 Change Theory-Discussion Paper.Chicago: Association for Nursing Professional Development.Bridges, W. (2009). Managing transitions: Making the most of change (3rd ed.). Philadelphia: Da Capo Press.Cooperrider, D. L., & Whitney, D. (2001). A positive revolution in change: Appreciative inquiry. Retrieved from http://appreciativeinquiry.case.edu/uploads/whatisai.pdfHarper, M. G., & Maloney, P. (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Chicago: Association for Nursing Professional Development.Huber, D. L. (2013). Leadership and nursing care management (5th ed.). Atlanta: Elsevier Health Science.

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Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: The National Academies Press. Retrieved from https://www.nap .edu/read/10027/chapter/1Institute of Medicine. (2011). The future of nursing: Leading change, advancing health.Washington, DC: The National Academies Press. Retrieved from https://www.nap.edu/read/12956/chapter/1Jones, J., Aquirre, D., & Calderone, M. (2004). 10 principles of change management. Strategy+Business. Retrieved from http://www.strategy-business.com/article/rr00006?pg=allKilpatrick, K., Lavoie-Tremblay, M., Ritchie, J., & Lamothe, L. (2014). Advanced practice nursing, health care teams, and perceptions of team effectiveness. Journal of Trauma Nursing, 21(6), 291–299.Lewin, K. (1951). nurs 490 Change Theory-Discussion Paper.Field theory in social science. New York: Harper & Row.Lippitt, R., Watson, J., & Westley, B. (1958). The dynamics of planned change. New York: Harcourt, Brace & World.Malloch, K., & Porter-O’Grady, T. (2006). Introduction to evidence-based practice in nursing and health care. Sudbury, MA: Jones & Bartlett.Mclean, C. (2011). Change and transition: What is the difference? British Journal of School Nursing, 6(2), 78–81. doi:10.12968/bjsn.2011.6.2.78.Monaghan, H. M. (2009). Change & change agents. In S. L. Bruce (Ed.), Core curriculum for staff development (3rd ed., pp. 111–137).Pensacola, FL: National Nursing Staff Development Organization.Nickols, F. (2007). Change management 101: A primer. Retrieved from http://www.nickols.us /change.pdfNiessen, C., Swarowsky, C., & Leiz, M. (2010). Age and adaptation to changes in the workplace. Journal of Managerial Psychology, 25(4), 356–383. http://dx.doi.org/10.1108/02683941011035287O’Shea, K. L. (2002). Staff development nursing secrets. Philadelphia: Hanley & Belfus.Porter-O’Grady, T., & Malloch, K. (2003). Quantum leadership: A textbook of new leadership. Sudbury, MA: Jones & Bartlett.Rogers, E., & Shoemaker, F. (1971). Communication of innovations: A cross-cultural approach. New York: Free Press.Rundio, A., Wilson, V., & Meloy, F. (2016). Nurse executive (3rd ed.). Silver Spring, MD: American Nurses Association.Sullivan, E. J., & Decker, P. J. (2009). Effective leadership and management in nursing (7th ed). New Jersey: Prentice Hall.Swansburg, R., & Swansburg, R. (2002). Introduction to management and leadership for nurse managers (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers.Team Technology. (2014). Change management: Five basic principles, and how to apply them. Team Technology. Retrieved from http://www.teamtechnology.co.uk/changemanagement.html

nurs 490 Change Theory-Discussion Paper.