1. Professional Nursing Practice Concepts and Perspectives
Seventh Edition
Chapter 15
Managing Change

2. Learning Objectives
15.1 Differentiate spontaneous, developmental, and planned change Explain the empirical-rational, normative-reeducative, and power-coercive approaches to change Compare the change process models of Lewin, Lippitt, Havelock, and Rogers Discuss types and characteristics of change agents Identify ways to manage change by enhancing motivating forces and decreasing resistive forces Describe steps in the change process.

3. Hallmark Features
A focus on foundational knowledge related to professional nursing
Includes nursing history, nursing theory, ethics, and legal aspects, etc.
An overview of professional nursing roles, issues, and changes in the profession
Discusses nurses as healthcare providers, learners and teachers, and leaders

4. Challenges and Opportunities
Rapidity and amount of change in recent decades in health care
New administrative structures, regulatory and accreditation mandates, technology, professional roles, ways of providing care
Opportunities to adapt to new demands in a positive way

5. Learning Objective 15.1
Differentiate spontaneous, developmental, and planned change.

6. Meanings and Types of Change
The process of making something different from what it was
Disrupts equilibrium
Involves endings, transitions, and new beginnings

7. Meanings and Types of Change
Those who do not reach acceptance of change experience
Disengagement
Disidentification
Disorientation
Disenchantment

8. Meanings and Types of Change
Resistance to change caused by
Threats to self-interest
Embarrassment
Insecurity
Habit
Complacency
Loss of power
Objective disagreement

9. Meanings and Types of Change
Reduce resistance to change with
Careful planning
Appropriate timing of communication and implementation dates
Adequate feedback
Employee confidence

10. Meanings and Types of Change
Three types of change
Spontaneous, reactive, or unplanned
Developmental activities
Consciously planned activities

11. Meanings and Types of Change
Spontaneous change
Reactive or unplanned
Not fully anticipated
Cannot be avoided
Little or no time to plan response strategies
Short-term or long-term
Responses can be either positive or negative
Successful responses require
Flexibility
Cohesiveness

12. Meanings and Types of Change
Developmental change
Physiopsychological changes that occur during an individual’s life cycle or the growth of an organization as it becomes more complex
Not consciously planned, they just happen
Plans can be made to deal with the changes
Organizations often grow and develop in unpredictable ways
Necessitate development of organizational charts, revised job descriptions, and formal staff meetings

13. Meanings and Types of Change
Planned change
Intended, purposive attempt by an individual, group, organization, or larger social system to influence the status quo of itself, another entity, or a situation
Important skills in planned change
Problem solving
Decision making
Interpersonal

14. Learning Objective 15.2
Explain the empirical-rational, normative-reeducative, and power-coercive approaches to change.

15. Approaches to Planned Change
Coercive (empirical-rational)
Based on belief that people are rational and that they will change if it is in their self-interest
Middle ground (normative-reeducative)
Based on assumption that motivation depends on the sociocultural norms and the commitment to these norms

16. Approaches to Planned Change
Most obtrusive (power-coercive)
Power lies with one or more persons of influence
Influence comes through political power, wealth, status, or ability
Positions of authority enforce the change

17. Learning Objective 15.3
Compare the change process models of Lewin, Lippitt, Havelock, and Rogers.

18. Change Strategies
Tiffany and Lutjens (1998): strategies from neutral to most coercive
Educational
Facilitative
Technostructural
Data-based
Communication
Persuasive
Coercive

19. Frameworks for Change
Theorists who follow the normative-reeducative approach
Lewin
Lippitt
Havelock
Rogers
Prochaska and DiClemente

20. Frameworks for Change Lewin
Change is a result of forces within a field or environment
Force Field Analysis Model: Two forces affect change process
Driving forces
Restraining forces
Three stages
Unfreezing
Moving
Refreezing

21. Frameworks for Change Lippitt, Watson, and Westley
Seven phases of planned change
Diagnose problem
Assess motivation
Assess change agent’s motivations and resources
Select progressive change objectives
Choose change agent role
Maintain change
Terminate helping relationship

22. Frameworks for Change Havelock Six-step process of planned change
Building a relationship
Diagnosing the problem
Acquiring resources
Choosing the solution
Gaining acceptance
Stabilization

23. Frameworks for Change Rogers Diffusion-innovation theory
Diffusion: process by which innovation is communicated
Three phases in the diffusion of innovation
Invention
Diffusion
Consequences

24. Frameworks for Change Rogers Five steps to diffusion of innovation
Knowledge
Persuasion
Decision
Implementation
Confirmation

25. Frameworks for Change Rogers Five groups of adopters of innovation
Innovators
Early adopters
Early majority
Late majority
Laggards

26. Frameworks for Change Prochaska and DiClemente
Five stages in the process of change
Precontemplation
Contemplation
Preparation
Action
Maintenance

27. Learning Objective 15.4
Discuss types and characteristics of change agents.

28. Managing Change
Forces that affect change can be
Internal
External

29. Managing Change Change agent must Identify source of problem
Assess motivations and capacity for change
Determine and examine alternatives
Determine and implement helping relationship

30. Managing Change Change agent is
A person or group that initiates, motivates, and implements the change
Leader
Critical thinker
Uses knowledge of change theory to be effective

31. Managing Change Effective change agent must be
Highly skilled
Accessible to all involved in change process
Honest and straightforward
Trustworthy
May be informally or formally designated
May be internal or external to the organization

32. Learning Objective 15.5
Identify ways to manage change by enhancing motivating forces and decreasing resistive forces.

33. Managing Change Common motivating forces
Perception that change is challenging and achievable
Economic gain
Perception that change will improve situation
Visualization of future positive impact of change
Potential for personal growth, recognition, achievement, and improved relationships

34. Managing Change Common restraining forces
Fear that something of personal value will be lost
Misunderstanding of the change and its implications
Low tolerance for change related to intellectual or emotional insecurity
Perception that change will not achieve goals
Lack of time or energy

35. Learning Objective 15.6
Describe steps in the change process.

36. Steps in the Change Process
Change is inevitable and necessary for growth; however, change
Is not always welcome
Produces anxiety
Evokes emotional reactions
Consumes resources and energy
Is associated with feelings of loss, grief, and pain

37. Steps in the Change Process
Sullivan’s ten steps in change process
Identify the problem or opportunity
Collect necessary data and information
Select and analyze data
Develop plan for change
Identify supporters and opposers

38. Steps in the Change Process
Sullivan’s ten steps in change process
Build coalition of supporters
Help people prepare for change
Prepare to handle resistance
Provide feedback mechanism
Evaluate effectiveness of the change

39. Resistance to Change Behavior intended to maintain the status quo
Change agent should anticipate resistance
Resistance is greatest when the idea is not concurrent with existing trends

40. Resistance to Change Managing resistance
Communicate with those who oppose change
Clarify information and provide feedback
Be open to revisions
Present negative consequences of resistance
Emphasize positive consequences

41. Resistance to Change Managing resistance Keep resisters involved
Maintain climate of trust, support, and confidence
Divert attention by creating different “disturbance”

42. Resistance to Change
Political strategies that may help manage resistance
Analyze the organization and lines of authority
Identify key people affected by the change
Find out likes and dislikes
Build a coalition of support before the change begins

43. Examples of Change
Nurses can make changes in four spheres of influence
Workplace
Organizations
Government
Community