The Nurses Role in Facilitating Change

The Nurses Role in Facilitating Change
Change Theories Faculty The Nurses Role in Facilitating Change NURS 560 FA 2015 Dr. Mileva Saulo Lewis Professor Emerita Dr. Mileva S. Lewis, All rights reserved Mileva S Lewis, All rights reserved

Change Theories Faculty
BROADWAY MUSICAL Dr. Mileva S. Lewis, All rights reserved Mileva S Lewis, All rights reserved

Dr. Mileva S. Lewis, All rights reserved
Agenda Part Two – Individual level Individual change – health behavioral change Transtheoretical Model (Prochaska/DiClemente Part Three – Change Models - Organizations Lewin- Force Field Analysis Kotter – Urgency Kanter – Innovative diffusion Rodgers - Diffusion Innovation Cooperider & Srivastva - Appreciative Inquiry Dr. Mileva S. Lewis, All rights reserved

Outcomes: Upon completion of this class, learners will be able to:
Apply motivational theory to the change process Describe the benefits of using theoretical frameworks to enhance the change process Compare and contrast different types of change and the nurse leaders role Use tools to assess a unit/organization’s readiness for change Discuss the factors that facilitate/inhibit the implementation of change and implications for nurse leaders 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 Health Care Dr. Mileva S. Lewis, All rights reserved

Introduction Improving the processes of patient care to improve outcomes is fundamental to patient care and requires skills in change management. Change is ever present. Change is seldom linear and controllable; it is a dynamic process that is unpredictable.

Dynamics of Change and Innovation
Alteration of the current state Considered normative in a complex system Something to be managed, controlled, and minimized in a linear system Innovation A unique type of change that restructures the deep social and economic value of an organization

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. (2012).Essentials of Organizational Behavior. (10th ed.). Upper Saddle River, NJ: Pearson Prentice Hall, p. 267 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. (2012).Essentials of Organizational Behavior. (10th ed.). Upper Saddle River, NJ: Pearson Prentice Hall, p. 267 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

Theories and Nurse Leaders
Human Phenomena Science – make sense of the how and why of events Explain Control Describe Cohen, S.A. (1980). The big R: how to do research in education. Mill Valley, CA: Mastery Learning Systems Dr. Mileva S. Lewis, All rights reserved

Patient Experiences with Change
What have you seen? What have health care providers done to facilitate change? What have you done to facilitate change? Dr. Mileva S. Lewis, All rights reserved

Transtheoretical Model: Stages of Change
Precontemption: No intention to change behavior uninformed or underinformed about the consequences of behavior tend to avoid reading, talking, thinking about their behavior 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), Dr. Mileva S. Lewis, All rights reserved

Contemplation: intending to change in the next 6 months increased awareness of pros and cons of bhv. Not ready for traditional action oriented programs Preparation: intending to take action in the immediate future- 1 month Dr. Mileva S. Lewis, All rights reserved

Preparation: good for action oriented groups Action: made specific modifications in their lifestyle within the last 6 months usually seen as changed behavior in other theories Dr. Mileva S. Lewis, All rights reserved

Maintenance: working to prevent relapse less temptation Termination have zero temptation 100% self efficacy not given too much emphasis-not practical for all behaviors Dr. Mileva S. Lewis, All rights reserved

Source Prochaska, J.O. & Vellcer, W.F. (1997). The transtheoretical model of health behavior change. American Journal of Public Health, 12(1), Prochaska, J.O. & DiClemente, C.C. (1984). The transtheoretical approach : Crossing traditional boundaries of change. Homewood, IL: Dorsey Press. Dr. Mileva S. Lewis, All rights reserved

With whom can you identify?
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

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
The 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. (2012).Essentials of Organizational Behavior. (10th ed.). Upper Saddle River, NJ: Pearson Prentice Hall, p Dr. Mileva S. Lewis, All rights reserved

Managing Resistance to Change
Resistance to change takes many forms Verbal reactions Nonverbal reactions Indirect avoidance Perceived threats to safety, security, or position Porter-O’Grady & Malloch, 2015

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

Leading Frameworks Kurt Lewin (1951) Stages of Change Force Field Analysis Assessment of Readiness Evertt Rodgers (1962; 2003) Diffusion Theory Kanter (1983) Innovative diffusion John Kotter (1996; 2014) Create Urgency The Iceberg is melting 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 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 -

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

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. 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 Kotter, 2008, pp Dr. Mileva S. Lewis, All rights reserved

Stakeholder Theory Stakeholders are those with an interest in or a stake in the outcome Those in favor Those who would be in opposition Keep your friends close and your enemies closer (Source unknown) Dr. Mileva S. Lewis, All rights reserved

Innovative Diffusion - APS Vay Hoa Hoang & Michael Haemin Jung: Musclow, S. (2005). A community hospital acute pain service. Canadian Nurse, 101(9), Small Group Discussion Motivation What model? Who are the stakeholders? Role of the APN? Dr. Mileva S. Lewis, All rights reserved

Making Change and Innovation Happen Assessment Team Reflection Integration of Ideas into a Plan Caveat: Technology, Change, and the Human Element Technology should not drive work but support work Porter-O’Grady & Malloch, 2015

Who, Why, When, and How of Change Who Should Change ? Process always begins with individuals Awareness of personal change abilities Individuals need to understand their personal comfort and competence with change Then coach others in developing understanding and competence in change and innovation Porter-O’Grady & Malloch, 2015

Dynamics of Change and Innovatio
Why Change? Change for Quality Outcomes Change for Evidence Reasons not to change? Lack of compelling evidence No specific significant risk to patients and employees Isolated issues closely linked with individual performance Something likely to be a fad rather than a solution Porter-O’Grady & Malloch, 2015 Dr. Mileva S. Lewis, All rights reserved

What to Change? Identification of the specific processes and policies that need to be changes, replaced, or created When to Change? Best determined with the input of the specific unit and the system needs and resources Porter-O’Grady & Malloch, 2015

How to Change Personal Knowledge Change and Innovation Knowledge Collaboration Embracing Vulnerability and Managing Risk Guidelines for rational risk taking Advancing the organization Developing Skills Mandatory reporting Whistle-blowing Porter O’Grady & Malloch, 2015 Dr. Mileva S. Lewis, All rights reserved

Caveat: Measuring the Impact of Change and Innovation (What Problem Are You Fixing?) Expend resources appropriately with the expectation of success of the desired plan. Benchmarking Comparison with other organizations is often difficult for a variety of reasons. Porter-O’Grady & Malloch, 2015

Course Correction Less than successful attempts at change yield information. Course correction or remediation may be needed. Document this information. Avoid punishment of individuals for outcomes that probably involved many factors. Porter-O’Grady & Malloch, 2015

Older Assessment for Change Model S.W.O.T.
Change Theories Faculty 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 Mileva S Lewis, All rights reserved

AI in Healthcare Olivia Hernandez & Osmary Hermandez & Mariam Kamyab & Colin Khosabian: Richer, M.C, Rithie, J., & Marchionni, C. (2010). Appreciative inquiry in health care. British Journal of Healthcare Management, 16(4), Dr. Mileva S. Lewis, All rights reserved

AI Model Application at the point of care

15 October 2015 Leadership Papers Due- Hardcopy – 11:50 – place in box on front table Individual Supplemental Readings: Karina Kim, Sarah Frances Lasker: Gordon, E., & Hamric, A. (2006). The courage to stand up: the cultural politics of nurses' access to ethics consultation. Journal Of Clinical Ethics, 17(3), Angelita Lat, Cinthia Vanessa Lazo, & Eva Lee. Konishi, E., Yahiro, M., Nakajima, N., & Ono, M. (2009). The Japanese Value of Harmony and Nursing Ethics. Nursing Ethics, 16(5), Jessica Sang Lee, Krystal Lee, & Stephanie Thuy Lewis: Wros, P., Doutrich, D., & Ruiz, M.E. (2009). Giving voice: Incorporating the wisdom of Hispanic RNs into practice. Journal of Cultural Diversity, 16(4), Dr. Mileva S. Lewis, All rights reserved

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