Unit “ 10 “ CONTROLLING

Controlling Final step in the management process: actions taken to ensure that actual outcomes are consistent with those Planned and anticipated. Involves setting standard, measuring performance, reporting the results, and taking actions. (this lead to corrective action).

Management of Change Change: Change is the process of making something different from what it was Change Agent: the one who works to bring about change Change: - The essence of life, it is as long as life goes on Necessary for growth. It often produces anxiety and fear. The process of making something different from what it was.

There is a sense of loss the familiar status. Nurses are seeing change in the field of patient care, new medications, new equipment and new methods treatment Change can make crises or improvement it depends on how the change is managed

Change strategies: * Appropriate strategy depends upon the power of the change agent and resistance expected Change agent should be able to facilitate and implement change effectively by: a. Focus on the appropriate change target b. The willingness and ability to change

Change strategies:…cont. 1- Rational - empirical strategies: Based on the assumption that people are rational. Used when there is little anticipated resistance to change or change is reasonable. 2- Normative - re - educative strategies: Participative strategy: participate in identifying the problem, choosing solution and implementing the change. -Based on the assumption that people act according to their commitment to socio cultural norms Does not require the change agent to have a legitimate power base.

Change strategies:…cont. Change agent gains power by skills in interpersonal relationships. Change agent must be accepted, sensitive to person’s perceptions and values and open trust relationship. 3- Power – coercive strategy: Based on the application of power: (economic sanctionsعقوبات or political cloutنفوذ سياسي) Based on the assumption that: People with less power comply to the plans, directions and leadership.

Individuals will only change when rewarded or forced to change. Resistance is handled by authority: the person must accept it or leave. Used when high resistance is expected The individual will change to avoid threat, peer pressure, or loss of job. Used when immediate change is necessary (The quicker strategy) *Should be combined with other strategies to have a permanent change .

Lewin's theory: Change Theories: Lewin provides a social - psychological view of change process. He sees behavior as forces working in opposite directions within a field The process of change here is affected by two types of forces : Driving forces: facilitate change. Restraining forces: keep system from change

Stages needed before the planned change becomes a part of the system: Lewin's theory:…cont. Change agent begin by analyzing the entire system in order to identify two forces Stages needed before the planned change becomes a part of the system: Unfreezing stage (Decision of change) Moving stage (Implementation). Refreezing stage (Stabilization)

Problem identification Decide if change is needed. Lewin's theory:…cont. 1- Unfreezing Stage : Gather data: Problem identification Decide if change is needed. Motivate participants to change. Build a trust .

According to Lewin: create change occurs through three mechanisms A. Lack of confirmation: - (Expectations have not been met). B. Guilt and anxiety: - Tension level system (goal is not met) C. psychological safety: - Providing sufficient security to minimize the risk. -People will feel comfortable and attempt the change.

2- Moving Stage (Implementation) Leader put the planned change into effect. Move the target system to a new level of equilibrium Activities in which the leader will be engaged during the changing phase: Get participants to agree that current status is not good Develop a plan including persons will be affected. Sets goals and objectives Identify areas of support and resistance. Set target dates. Introduce any new related information.

Encourage the new behavior. Providing support to avoid resistance to change. Ventilate the guilt/anxiety & other feelings Provide feedback on progress to reinforce the change process Keep communications open. Act as Energizer to keep interest high Overcome resistance.

3- Refreezing Stage: The change is stabilized and becomes a part of the target system Leader continue to act as Energizer, & delegates responsibility for change behavior to others in the target system

An Example of change: "The change to new computerized record system" by using lewin's theory of change The new system has several advantages over the old one: It requires less writing Eliminate repetition Quicker access to stored information Provides total picture of the client’s progress Different kinds of health care. Strongly supported by the administrators and executives

However: None of the staff have ever used it before . They also have not expressed any need to change the old system A side from staff members seem concerned about providing high quality care . The change identified the following: I. Driving Forces: Advantages of the new system Administrative support for the system Staff concern about quality care. Staff ability to learn the new system

II. Restraining forces: Lack of staff participation in the selection of the system. Little or no staff knowledge of the new system. Potential threat to staff feeling of security (routine). Potential threat to various disciplines because of equal access to information in the new system.

These opposing forces diagrammed in the following figure : No knowledge of system threat to various disciplines Lack of staff participation Threat to staff security Restraining forces Status quo Driving forces Administrative support Advantages of the new system ability to learn system quality of care

1- Unfreezing stage: The change agent took the following actions: A. Disconfirmation: (Actions ) Meet with every staff member in small groups to discuss inadequacies and problems found in the old system. B. Inducing guilt and anxiety: ( Actions ) Demonstrate ways in which the old system interferes with quality care Tell staff members how strongly administrators support the new system .

C. Providing psychological safety:( Actions) Assure staff members that they will learn the new system. Staff will be involved in planning the implementation Phase. Point out similarities between old and new systems . Express approval of staff concern for the quality of the care given and confidence in their ability to learn the system

2- Moving Stage (Changing) a) Introduce new information: Teach the staff how to use the new system. b) Encourage the new behavior: Begin with practice using examples from ready situations Have the staff begin using the new system according to the plan. c) Continue the supportive climate: Allow a adequate time for learning and practice before implementation. d) Provide opportunities for ventilation: Ask staff how they feel about the new system and listen and respond to what they say about it

e) Provide feed back and clarification of Goals: Check computerized records and evaluate progress Ask staff how well new system is working f) Present your self as Trustworthy : Open and direct communication Make sure that all staff were include in implementation as promised g) Overcome resistance: h) Act as Energizer: Take every opportunity to promote the new system. Demonstrate interest in staff progress.

3- Refreezing Stage (change agent actions) 1) Continue acting as Energizer: Keep the new system visible through news letters, meetings and so forth. Continue to show interest in staff progress and feeling about the new system 2) Continue guiding new behavior: Continue to check computerized records to see how well the new system is working Help staff correct mistakes and provide needed information 3) Delegate increased responsibility to others: - the outcome of the new system is turned over to the staff member and their supervisors

Barriers of Change (Resistance) 1- Threatened self- Interest. 2- Inaccurate perception: example, staff resist use of computer basing on the perception that computerization will reduce their freedom in choosing working hours and days off. 3- Objective disagreement: feel the change will benefit the organization. 4- Psychological reaction: - Feel that their freedom has been threatened or eliminated. 5- Low tolerance for change : (low self confidence) Change agent must understand why people resist change and be able to deal with resistance.

Techniques for dealing with resistance: Participation: (persons affected by change) Manipulation: (view change as less costly or more beneficial). Education: (for individuals about the change) External agents: (outside the organization) Incentives: حوافز (the benefits) Supportive behavior: (training new skill, counseling services) Gradual introduction: (change gradually)

Functions &characteristics of change agent: Developing specific, measurable objectives Listing techniques needed to accomplish of activities . Developing a timetable for completion of activities. Assessing resources. Preparing a budget.

Functions &characteristics of change agent…cont. 6. Selecting suitable persons needed for change plan. 7. Designing a method evaluating the outcome of activities 8. Anticipating resistance to change. 9. Developing strategies to manage resistance 10. Designing a plan to stabilize (refreeze) the change.