Effective Leadership and
Management in Nursing
EIGHTH EDITION
CHAPTER
5
Initiating and
Managing Change

Learning Outcomes
1.
Explain why nurses have the opportunity to be change agents.
2.
Describe how different theorists explain change.
3.
Discuss how the change process is similar to the nursing process.
4.
Differentiate among change strategies.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Learning Outcomes
5.
Discuss how to handle resistance to change.
6.
Describe the nurse's role in change.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Change
• Change:
– Is essential for adaptation and growth
– Is the process of making something different from what it was
– Is a continually unfolding process rather than an either/or event
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Change
• Change:
– Can be threatening
– May cause a grief reaction even when planned
– Produces new opportunities
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Institute of Medicine Report
(2010)
• Future of nursing
• Proposed radical changes, including:
– "Nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States."
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Change Agents
• Change agents:
– Work to bring about change
– Are role models for others
– Stimulate the need for change and help shape its success
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Nurse as Change Agent
• Nurses facilitate change
• Must be proactive in shaping the future
• Opportunities exist now for nurses, especially in management positions
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Lewin
• Driving forces versus restraining forces
• Three-step process
– Freezing
– Moving
– Refreezing
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Lippitt
• Expanded Lewin's theory to a sevenstep process
• Focuses on what change agent must do
• Emphasizes importance of participation of key members for success
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Havelock
• Modified Lewin's theory to six-step process
• Describes active change agent
• Emphasizes participative approach
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Rogers
• Describes five-step innovation–decision process
• Emphasizes the reversible nature of change
• Stresses importance of key people and policy makers to successful change
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

The Change Process
• Same path as nursing process
– Assessment
– Planning
– Implementation
– Evaluation
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Table 5-2 Steps in the Change Process
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Assessment
• Identify the problem or the opportunity
• Ask the right questions
– Where are we now?
– What is unique about us?
– What can we do that is different?
– What is the driving stimulus in our organization?
– What prevents us from moving?
– What kind of change is required?
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Assessment
• Collect data
– Identify all driving and restraining forces
– Assess political climate
– Assess costs and benefits
• Analyze data
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Planning
• Determine who, how, and when
• Include organization/system members
• Plan resources required to make the change and establish feedback mechanisms
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Implementation
• Plans are put into action.
– Akin to Lewin's moving stage
• Methods to change individuals
• Methods to change groups
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Evaluation
• Evaluate effectiveness
• Stabilize the change
– Energizer role is still needed to reinforce
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Power-Coercive Strategies
• Based on the application of power by legitimate authority, economic sanctions, or political clout
• Useful when a consensus is unlikely despite efforts to stimulate participation
– Patient Protection and Affordable Care
Act (PPACA)
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Empirical–Rational Model
• Revolves around knowledge
• Assumption is that people are rational and will follow their rational selfinterest
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Normative–Reeducative Strategies
• Assumption that people act in accordance with social norms and values
• Power = Skill in interpersonal relationships
• Effective in reducing resistance, stimulating creativity
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Resistance to Change
• If no resistance, change may not be significant enough
• Forces changes agent to:
– Clarify
– Keep interest high
– Establish reason for change
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Reasons for Resistance to Change
• Lack of trust
• Vested interest in status quo
• Fear of failure
• Loss of stature or income
• Misunderstanding
• Belief that change is unnecessary or that it will not improve the situation
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Six Responses to Change
• Innovators love change
• Early adopters still receptive to change
• Early majority prefer the status quo
• Late majority resistant, then accept
• Laggards openly antagonistic
• Rejecters actively oppose, may sabotage
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Managing Resistance to Change
• Talk to those who oppose the change.
• Clarify information.
• Be open to revisions.
• Present negative consequences of resistance.
• Emphasize positive consequences.
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Managing Resistance to Change
• Keep resisters involved
• Maintain climate of trust, support, confidence
• Divert attention
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Nurse’s Role in Change
• Change not always initiated from top management level
• Staff nurses can initiate change
– Mandotory skill for nurses
• Cultivate and master characters of successful change agents
• Engage strategies for accessing power
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan

Nurses Role in Change
• Assist in other ways
– Planning
– Information sharing
– Managing the transition
• Change has become the norm
Effective Leadership and Management in Nursing, Eighth Edition
Eleanor J. Sullivan