1. 5
Initiating and Managing Change

2. Learning Outcomes
Explain why nurses have the opportunity to be change agents.
Describe how different theorists explain change.
Discuss how the change process is similar to the nursing process.
Differentiate among change strategies.

3. Learning Outcomes Discuss how to handle resistance to change.
Describe the nurse's role in change.

4. Change Change: Is essential for adaptation and growth
Is the process of making something different from what it was
Is a continually unfolding process rather than an either/or event

5. Change Change: Can be threatening
May cause a grief reaction even when planned
Produces new opportunities

6. Institute of Medicine Report (2010)
Future of nursing
Proposed radical changes, including:
"Nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States."

7. Change Agents Change agents: Work to bring about change
Are role models for others
Stimulate the need for change and help shape its success

8. Nurse as Change Agent Nurses facilitate change
Must be proactive in shaping the future
Opportunities exist now for nurses, especially in management positions

9. Lewin Driving forces versus restraining forces Three-step process
Freezing
Moving
Refreezing

10. Lippitt Expanded Lewin's theory to a seven-step process
Focuses on what change agent must do
Emphasizes importance of participation of key members for success

11. Havelock Modified Lewin's theory to six-step process
Describes active change agent
Emphasizes participative approach

12. Rogers Describes five-step innovation–decision process
Emphasizes the reversible nature of change
Stresses importance of key people and policy makers to successful change

13. The Change Process Same path as nursing process Assessment Planning
Implementation
Evaluation

14. Table 5-2 Steps in the Change Process

15. Assessment Identify the problem or the opportunity
Ask the right questions
Where are we now?
What is unique about us?
What can we do that is different?
What is the driving stimulus in our organization?
What prevents us from moving?
What kind of change is required?

16. Assessment Collect data Analyze data
Identify all driving and restraining forces
Assess political climate
Assess costs and benefits
Analyze data

17. Planning Determine who, how, and when
Include organization/system members
Plan resources required to make the change and establish feedback mechanisms

18. Implementation Plans are put into action.
Akin to Lewin's moving stage
Methods to change individuals
Methods to change groups

19. Evaluation Evaluate effectiveness Stabilize the change
Energizer role is still needed to reinforce

20. Power-Coercive Strategies
Based on the application of power by legitimate authority, economic sanctions, or political clout
Useful when a consensus is unlikely despite efforts to stimulate participation
Patient Protection and Affordable Care Act (PPACA)

21. Empirical–Rational Model
Revolves around knowledge
Assumption is that people are rational and will follow their rational self-interest

22. Normative–Reeducative Strategies
Assumption that people act in accordance with social norms and values
Power = Skill in interpersonal relationships
Effective in reducing resistance, stimulating creativity

23. Resistance to Change
If no resistance, change may not be significant enough
Forces changes agent to:
Clarify
Keep interest high
Establish reason for change

24. Reasons for Resistance to Change
Lack of trust
Vested interest in status quo
Fear of failure
Loss of stature or income
Misunderstanding
Belief that change is unnecessary or that it will not improve the situation

25. Six Responses to Change
Innovators love change
Early adopters still receptive to change
Early majority prefer the status quo
Late majority resistant, then accept
Laggards openly antagonistic
Rejecters actively oppose, may sabotage

26. Managing Resistance to Change
Talk to those who oppose the change.
Clarify information.
Be open to revisions.
Present negative consequences of resistance.
Emphasize positive consequences.

27. Managing Resistance to Change
Keep resisters involved
Maintain climate of trust, support, confidence
Divert attention

28. Nurse’s Role in Change
Change not always initiated from top management level
Staff nurses can initiate change
Mandotory skill for nurses
Cultivate and master characters of successful change agents
Engage strategies for accessing power

29. Nurses Role in Change Assist in other ways Change has become the norm
Planning
Information sharing
Managing the transition
Change has become the norm