Planned Change Paula Ponder MSN, RN, CEN

Objectives 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 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. 4

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 8

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 Economic gain improve situation Challenge Future impact Growth, recognition, achievement, and / or improved relationships Restraining Forces 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). 13

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). 14

Six Elements in the Process of Planned Change Building a relationship Diagnosing the problem Acquiring relevant resources Choosing the solution Gaining acceptance Stabilization and self-renewal Data from Havelock (1973). 15

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 long-term 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 Self-confident Conscientious Ambitious Motivation to learn Perseverance Initiative Tenacity Determination 23

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 24

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). 25

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). 26

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 28

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 31

During Change 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 32

During Change Leadership skills Vested interests Opposing group values How coalitions form Strongly held views Existing relationship dynamics disruptions 33

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 34

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 35

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). 36

Nine Common Mistakes Failing to abandon the expendable Fearing the future Picking the wrong battles Psychologically unplugging from the job Avoiding new assignments Data from Davidhizar (1996). 37

Leadership and Management Implications Organizational transformation Reimbursement for care Information system used for care documentation and assessment Nursing shortage National health care reform 38

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 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). 41

Change Drivers for Nursing Cultural diversity Aging U.S. population New services and technologies Health care costs Public policy of posting information about quality Data from Wakefield (2003). 42

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). 43

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 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?