The Nurses Role in Facilitating Change SMU ELMSN The Nurses Role in Facilitating Change 17 November Part 1 NURS 560 FA 2014 Dr. Mileva Saulo Lewis Professor Emerita Dr. Mileva S. Lewis, All rights reserved Change N 560 Lewis 2014

Dr. Mileva S. Lewis, All rights reserved SMU ELMSN BROADWAY MUSICAL How Many …… Dr. Mileva S. Lewis, All rights reserved Change N 560 Lewis 2014

Outcomes: Upon completion of this class, learners will be able to: Use theoretical frameworks to participate in a change process Compare and contrast different types of changes Use tools to assess a unit/organization’s readiness for change Discuss the factors that facilitate/inhibit the implementation of change Use Type® to implement change Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved

Review: Change or be Obsolete Japan – Pre-World WW II Deming, Theory Z & Quality Circles Auto Industry in America Ford Foundation Project, 1974 Auto Industry – then and now Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Change Happens Change Personal Professional Organizational Societal Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Hold onto Your Hats Dr. Mileva S. Lewis, All rights reserved

Change Agents Understand Systems SMU ELMSN Change Agents Understand Systems Open systems – flows and constraints 1972 - Bertlanfy researching international postal system – WW II Inputs Throughputs Outputs Social Systems – Seeing the world through interactions - Social groups Perceptions that shape social interactions Purpose and goals of the system Process Systems - Seeing the world from information flow Living systems – Seeing the world through the interactions of self-creating entities Senge,P. (1991). The fifth discipline: The art & practice of the learning organization. New York: Doubleday Currency. Dr. Mileva S. Lewis, All rights reserved Change N 560 Lewis 2014

Dr. Mileva S. Lewis, All rights reserved Views of Change from an Organizational Perspective The “Calm Waters” Simile Consider the Mediterranean Sea Captain made trip hundreds of times Crew responds well to small storm Occasional breaks in the status quo Unable to adapt and change during major storm Robbins, S.P. & Judge, T.A. (2008).Essentials of Organizational Behavior. (9th ed.). Upper Saddle River, NJ: Pearson Prentice Hall, p. 267 Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Views of Change from an Organizational Perspective The “White Water Rapids” Simile 40 foot raft Many grade 5 rapids New crew; river is dark and unprecedented obstacles Go to shore for new crew Robbins, S.P. & Judge, T.A. (2008).Essentials of Organizational Behavior. (9th ed.). Upper Saddle River, NJ: Pearson Prentice Hall, p. 267 Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Your Attitude Matters “Change is inevitable, but growth is optional.” Murphy, S. (1999). Mindshift for managers: Change is inevitable, growth is optional. Home Health Care Management, 21(4), 33-38. Dr. Mileva S. Lewis, All rights reserved

With whom can you identify? Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Making Theory Fun http://www.youtube.com/watch?v=91YxXk3fmw8 Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Types of Change Planned change Unplanned change or change by drift Socialization or indoctrination change Reactive or systems change Intrapersonal change Developmental or maturational change Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Planned Change Planned change, in contrast to accidental change or change by drift, is change that results from a well-thought-out and deliberate effort to make something happen. Dr. Mileva S. Lewis, All rights reserved

3 Good Reasons for Change To solve some problem. To make work more procedures more efficient. To reduce unnecessary workload. Dr. Mileva S. Lewis, All rights reserved

Accept & Plan for Resistance: Depends on 4 Things Their flexibility to change Their evaluation of the immediate situation The anticipated consequences of the change Benefit/Burden Their perceptions of what they have to lose and gain Dr. Mileva S. Lewis, All rights reserved

Overcoming Resistance Education & Communication Participation Building support and Commitment Selecting people who accept change Coercion (cautions). Robbins, S.P. & Judge, T.A. (2008).Essentials of Organizational Behavior. (9th ed.). Upper Saddle River, NJ: Pearson Prentice Hall, p. 269-70. Dr. Mileva S. Lewis, All rights reserved

Regardless of the Type of Change It brings feelings of: Achievement Loss Pride Stress. Marquis & Huston, 2015 Dr. Mileva S. Lewis, All rights reserved

Ten Emotional Phases of the Change Process Equilibrium Denial Anger Bargaining Chaos Depression Resignation Openness Readiness Reemergence (Adapted from Perlman & Takacs, 1990). Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Leading Frameworks Kurt Lewin (1951) Stages of Change Force Field Analysis Assessment of Readiness Evertt Rodgers (1962; 2003) Diffusion Theory John Kotter (1996; 2014) Create Urgency The Iceberg is melting Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Lewin’s Rules Implement for good reason. Gradual. Planned, and not sporadic or sudden. Those affected should be involved in planning for the change. Dr. Mileva S. Lewis, All rights reserved

Earliest Change Theorist Force Field Analysis Kurt Lewin (1951) The force field analysis is a method to: Investigate the balance of power Identify the key players involved in decision-making Identify who is for and who is against change Identify ways to influence those against change   http://education-portal.com/academy/lesson/kurt-lewins-force-field-analysis-change-model.html#lesson Dr. Mileva S. Lewis, All rights reserved

Stages of Change-Lewin Stage One-Unfreeze Gather data Accurate diagnosis Is change necessary Make others aware Stage Two-Movement Develop plan Set goals, objectives ID Support & resistance Stage Two, cont. Stakeholders Target dates Strategies for success Implement Available, support Evaluate, modify Stage Three-Refreeze Establish the new norm New-Slush Porter-O’Grady, ACNL Conference, 2013 Dr. Mileva S. Lewis, All rights reserved

Force Field Analysis Readiness Assign Value to + and - Dr. Mileva S. Lewis, All rights reserved

Driving and Restraining Forces Goal, e.g. Return to School Forces driving to reach the goal Forces restraining from reaching the goal Opportunity for advancement Status, social gratification Enhanced self-esteem Family supportive of efforts Low energy level Limited financial resources Unreliable transportation Time with family already limited Marquis & Huston, 2015, p. 166 Dr. Mileva S. Lewis, All rights reserved

When the pain of where you are is greater than the pain to change…. Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved The Frog in the Kettle Barna, G. (1990). The frog in the kettle. Ventura , CA: Regal Books Put in a kettle with cold water Turn the heat up slowly Put the frog in boiling water Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Human Side of Change Innovators Early adopters Early majority Late majority Laggards Rejectors Rodgers, E. (2008). Diffusion Innovations. (2nd ed.). New York: Free Press, Simon & Schuster Dr. Mileva S. Lewis, All rights reserved

Contemporary Approaches John P. Cotter Establish a sense of urgency The Guiding Team: Create the guiding coalition Vision and strategies Communicate the change vision Empower broad-based action Generate short-term wins Never letting up Consolidate gains to produce more change Make it stick: Anchor change in the organization's culture. Kotter, J. (2008). A sense of urgency. Boston: Harvard Business Press. http://education-portal.com/academy/lesson/kotters-8-step-change-model-of-management.html#lesson Dr. Mileva S. Lewis, All rights reserved

Behave with Urgency Every Day Purge and Delegate Check your “diary” Purge low priorities Delegate, delegate Don’t allow delegation up Move with speed Use freed up time – high priority items Meetings – who will and quickly do what & When Speak with Passion Behave urgently Talk with feelings Make the feeling infective Match words and deeds Don’t just talk about the external world; constantly look at it Exploit new opportunities Let them all see it Do all of the above and more As visibly as possible To as many is possible. Let them see your sense of urgency Cotter, 2008, pp. 116-17 Dr. Mileva S. Lewis, All rights reserved

Positive Deviance Report by Cynthia Leung Lindberg, C., & Clancy, T.R. (2001). Positive deviance: An elegant solution to a complex problem. Journal of Nursing Administration, 40(4), 150-153. Dr. Mileva S. Lewis, All rights reserved

Stakeholder Theory & Appreciative Inquiry Other Change Models SMU ELMSN Stakeholder Theory & Appreciative Inquiry Other Change Models Dr. Mileva S. Lewis, All rights reserved Change N 560 Lewis 2014

Dr. Mileva S. Lewis, All rights reserved Stakeholder Theory When information and decision making are shared, subordinates feel that they have played a valuable role in the change. Dr. Mileva S. Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved Stakeholder Theory Whenever possible, all those who may be affected by a change should be involved in planning for that change. Dr. Mileva S. Lewis, All rights reserved

Older Assessment for Change Model S.W.O.T. SMU ELMSN Older Assessment for Change Model S.W.O.T. Strengths Weaknesses Opportunities Threats Emphasis on “we are broken and need to be fixed” Difficult to overcome the negative impact of threats and weaknesses Dr. Mileva S. Lewis, All rights reserved Change N 560 Lewis 2014

Learner Report – Change, EI, and AI Steph Lee Vitelllo-Cicciu, J.M. (2003). Innovative leadership through emotional intelligence. Nursing Management, 34(10), 28-32 Dr. Mileva S. Lewis, All rights reserved

AI Model Application at the point of care Dr. Mileva S. Lewis, All rights reserved

Using MBTI Types to Effect Change Report from Jennifer Lee Saulo, M. (1997). Quality problem solving, decision making, type theory, and case managers, Part II. Nursing Case Management, 2(3), 109-114. Dr. Mileva S. Lewis, All rights reserved

Take Home Messages

Dr. Mileva S. Lewis, All rights reserved