Planned Change
Paula Ponder MSN, RN, CEN
Objectives
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Discuss reasons for change
Define change agent
Discuss change agent strategies
Review the natural and expected response to
change
“The significant problems we face
cannot be solved at the same level
of thinking we were at when we
created them.”
—Albert Einstein
Change
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Change is inevitable
Organizational change can be driven by many forces
Change is seldom easy
Leadership skills
– To make sure that the change we are going thru isn’t
sabatoged
• Re-energizing and empowering a workforce.
– Who better to ask how to change things for the better
than the people actually working, doing the job
• Historically change has been viewed as coming from
the top down, but new research shows that this
kind of change doesn’t work well.
Change
• Planned change – intended, purposeful attempt or
proactive plan by an individual (change agent) or
group to create something new
– Well thought out, deliberate, initiated and coordinated,
require well developed leadership. Require visions and
expert planning skills. Vision is your future goal, the
painting of what you want it to be. An organization will
never be better than the vision that guides it, different
than a mission.
• Unplanned change or change by drift – occurs
without any control or effort
Change
• Covert – occurs without awareness, we don’t
know they’re happening
• Overt – occurs with awareness, we know
they’re happening
• Developmental or maturational – a result of
physical or psychosocial changes during the
life cycle, not only us, but also the
organization
Change
• Change agent – a person skilled in the theory and
implementation of planned change, synonymous
with the phrase “change facilitator,” usually an
outsider (because they’re not biased and the
organization won’t have as much resentment for
the outsider)
• Champion – to support, coordinate, and market the
change at all levels of the organization. May or may
not be outsiders, taken aside and taught all the stuff
about the change in advance, and sent back out to
us to explain it and gather support. Like
cheerleaders
Lewin’s Force Field Analysis
• Kurt Lewin (1951) identified three phases that the
change agent must initiate before a planned change
can occur
• A successful change involves three elements:
– Unfreezing
– Movement
– Refreezing
Data from Lewin (1947, 1951).
Still the basis for how we change things now
Lewin’s Model
• Unfreezing – Occurs when the change agent
convinces members of the group to change or when
guilt, anxiety, or concern can be elicited.
• Movement – the change agent identifies, plans, and
implements appropriate strategies, ensuring that
driving forces exceed restraining forces. Sets goals,
target dates to implement the change. Whenever
possible we are going to try to implement change
gradually!
Lewin’s Model
• Refreezing – the change agent assists in
stabilizing the system change so that is becomes
integrated into the status quo. Change agent is
out there being supportive, helping people adapt,
making sure you have the tools you need to
sustain the change, making sure you have the
reasons and that you know why, making sure
everything is stable. Usually takes about 3 – 6
months. We should never attempt a change
unless that change agent can stay there the entire
time.
Change Agents
• Change agents must be patient and open to new
opportunities during refreezing, as complex change
takes time and several different attempts may be
needed before desired outcomes are achieved.
Driving / Restraining Forces
• Driving Forces
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Economic gain
improve situation
Challenge
Future impact
Growth, recognition,
achievement, and / or
improved relationships
• Restraining Forces
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Need for security
Lack of time or energy
Failure to see the big picture
Perceived loss of freedom
Negative past experience
Seven Phases of the Change Process
• Diagnosis of the problem
• Assessment of motivation and capacity to change
• Assessment of the change agent’s motivation and
resources
• Selection of progressive change objectives
Data from Lippitt (1973).
Seven Phases of the Change Process
• Choosing an appropriate role for the change
agent
• Maintaining the change once it started
• Termination of the helping relationship with the
change agent
Data from Lippitt (1973).
Six Elements in the Process
of Planned Change
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Building a relationship
Diagnosing the problem
Acquiring relevant resources
Choosing the solution
Gaining acceptance
Stabilization and self-renewal
Data from Havelock (1973).
Complexity Science
• Complexity science argues that the world is complex, as
are the individuals who operate within it.
– Simple is following a recipe, and complicated is sending a
rocket into space, but complex is raising a child. If you think
about raising a child, there is no specific formula and you
have to adapt to each child differently, it’s a moving growing
thing, and you learn on the job. You follow general guidelines
but sometimes these are changed with experience.
• Thus, control and order are emergent rather than
predetermined, and mechanistic formulas do not
provide the flexibility needed to predict what actions
will result in what outcomes.
Complexity Science Systems
• Linear
– Result of change is predictable. Ex. Light work is carrying a
small bag uphill. It will be harder if we carry a moderate bag
up the hill, and it will be even harder carrying an even
heavier bag up the hill.
• Non-Linear
– If we change one factor, it’s not readily predictable, but still
replicable (not every time, but sometimes). It may be harder
to carry the heavier bag, but it may not be. Sometimes a
small change in A results in no change in B, or a huge change
in B, it just depends.
• Random
– Exactly what it says… Even if the same starting circumstances
are replicated, the results are different every subsequent
time.
Complex Adaptive Systems
• Change should be achieved through connections
between change agents, instead of from the top
down
• There should be adaptation during the change to
uncertainty
• Goals, plans, and structures should be allowed to
emerge instead of depending on clear, detailed
plans and goals
• Nonlinear. Should be achieved thru connections of
change agents, instead of from the top down. We
should adapt during the change for uncertainty.
Chaos Theory
• Chaos theory is really about finding the underlying
order in apparently random data.
• Chaos theory also suggests that even small changes
in conditions can drastically alter a system’s longterm behavior, commonly known as the butterfly
effect.
• In a code, everything appears to be very chaotic,
but is there not things that are happening that
should happen? We’re giving drugs, doing CPR, etc.
There is underlying order in the chaos.
• Can drastically change the behavior or the long
term effects on a system.
Rules That Should Be Followed in
Implementing Change:
• Change should only be implemented for good
reason.
• Change should always be gradual.
• All change should be planned, and not sporadic or
sudden.
• All individuals who may be affected by the change
should be involved in planning for the change.
Lewin (1951)
Change Agent Strategies
• Rational–empirical
– Assumes that people are rational and receptive to
change when given adequate facts
• Normative–re-educative
– Change will only occur when attitudes and relationships
are altered
• Power–coercive
– Result of an individuals need to please a supervisor, or
fear of losing their job.
(Bennis et al, 1969)
Innovation Theory
• Innovation refers to the process of bringing any new
or problem-solving idea into use
• Often linked with creativity
• The process of eliminating the obsolete and the no
longer productive efforts of the past
• Organizations need to promote innovation. We
need to view change as an opportunity. Innovation
is often linked to creativity.
Characteristics of
Nurse Innovators
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Self-confident
Conscientious
Ambitious
Motivation to learn
Perseverance
Initiative
Tenacity
Determination
Leaders as Change Agents
• Articulate a clear need for change.
• Get group participation by leaving the details to the
people who must implement the change
• Get reliable information to the implementers
• Motivate through rewards and benefits.
• Do not promise things that cannot be delivered
Change Management
• Executives do not direct change; they initiate
and influence the direction
• Recipients of change, translate and edit plans
for change
• The main method used by recipients to
interpret change is through informal
communication
Data from Balogun (2006).
Change Management
• Senior management must monitor and engage
the “informal” channels
• Attention must be given to open discussions
and storytelling in communication about
change
• Recipients of change will mediate outcomes,
managers need to engage activity with them
Data from Balongun (2006).
Change Management
• Using change agents to help the engagement
may be helpful (especially in large
organizations)
• Senior managers need to “live the changes”
they want to adopt
Data from Balongun (2006).
Resistance to Change
• Resistance to change should be expected as integral to
the whole change process
• Resistance may be rooted in anxiety or fear
– Fear a loss of status, power, control, $$, job, whatever. There
are misconceptions about the change (inadequate
information).
• Not all resistance is bad; it may be a warning that
something needs readjusting or clarity
– If you’re the change agent and you get resistance, you need
to look into it! Take the person causing the most resistance,
bring them in, and help me solve the problem.
• Viewing the nurse or resistor as the solution versus the
problem helps reframe the issue
Resistance to Change
• Perhaps the greatest factor contributing to the
resistance encountered with change is a lack of
trust between the employee and the manager or
the employee and the organization
Crusaders / Tradition bearers
• Crusaders – want to make things better for the
future
• Tradition bearers – preservers of what is best from
the past and present
• These are both ok people, not necessarily
resisters. Put them together and let them work
together.
Increasing the Probability
for Change
• Explain the rationale for a change so individuals
understand it
• Allow emotions to be worked out
– Needs time
• Give participants all the information they need
• Help individuals cope with change
During Change
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Time and effort it takes to adjust
Possibility of less desirable outcomes
Fear of the unknown
Tolerance for change capacity
Trust levels
Need for security
During Change
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Leadership skills
Vested interests
Opposing group values
How coalitions form
Strongly held views
Existing relationship dynamics disruptions
Actions to Avoid
• Simply announce a change without laying the
foundation
• Ignore or offend powerful people
– Huge no no
• Violate the authority and communication lines
in an organization
• Rely only on formal authority
• Overestimate your formal authority
Actions to Avoid
• Communicate ineffectively
• Put people on the defense
• Underestimate the perceived magnitude
of the change
• Ignore the people’s fears about insecurity
or change of status
• Fail to be open to criticism
Nine Common Mistakes
• Assuming management should keep them
comfortable
• Expecting someone else to reduce the stress
• Shooting for a low-stress work setting
• Trying to control the uncontrollable
Data from Davidhizar (1996).
Nine Common Mistakes
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Failing to abandon the expendable
Fearing the future
Picking the wrong battles
Psychologically unplugging from the job
Avoiding new assignments
Data from Davidhizar (1996).
Leadership and Management
Implications
• Organizational transformation
• Reimbursement for care
• Information system used for care
documentation and assessment
• Nursing shortage
• National health care reform
Leadership / Management
Behaviors
● Models the change they want to see
● Communicates the need for change
● Adapts to change
● Enables change to progress constructively
● Develops mutual goals
● Change is implied in the definition of
leadership
Attempting Change
● Change should never be attempted
unless the change agent can make a
commitment to be available until the
change is complete.
Areas of Change Influencing
Healthcare Today
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Population as customer
Wellness care and prevention
Cost management
Interdependence among professionals
Client as consumer of cost and quality
Continuity of information
Data from Issel and Anderson (1996).
Change Drivers for Nursing
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Cultural diversity
Aging U.S. population
New services and technologies
Health care costs
Public policy of posting information about
quality
Data from Wakefield (2003).
Core Principles of Change
• Participation is not a choice.
• Life always reacts to directives; it doesn’t obey
them.
• We do not see “reality.” We create our own
interpretation of what is real.
• To create living health in a living system and
connect it to more of itself.
Data from Wheatley (2007).
Good Reasons for Change
• Change to solve some problem
• Change to make work procedures
more efficient
• Change to reduce unnecessary
workload
Organizational Development
• Developmental or maturational – a result
of physical /psychosocial changes during
the life cycle
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Birth
Youth
Maturity
Aging
Change is the law of life and
those who look only to the past
or the present are certain to
miss the future.
-John F. Kennedy
Everyone thinks of changing
the world, but no one thinks
of changing himself
-Leo Tolstoy
Questions?