Initiating and managing change
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This document discusses change and the nurse's role in facilitating change. It describes how change is an ongoing process that can be threatening but also creates opportunities. Nurses are well positioned to act as change agents and facilitate change through various models and strategies. These include assessing the need for change, planning and implementing the change process, and evaluating outcomes, which mirrors the nursing process. The document also addresses managing resistance to change and emphasizes the nurse's important role in initiating and leading change.
Initiating and managing change
- 1. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Initiating and Managing Change
- 2. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Learning OutcomesLearning Outcomes 1. Explain why nurses have the opportunity to be change agents. 2. Describe how different theorists explain change. 3. Discuss how the change process is similar to the nursing process. 4. Differentiate among change strategies.
- 3. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Learning OutcomesLearning Outcomes 5. Discuss how to handle resistance to change. 6. Describe the nurse's role in change.
- 4. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan ChangeChange • 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. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan ChangeChange • Change: – Can be threatening – May cause a grief reaction even when planned – Produces new opportunities
- 6. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Institute of Medicine ReportInstitute of Medicine Report (2010)(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. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Change AgentsChange Agents • Change agents: – Work to bring about change – Are role models for others – Stimulate the need for change and help shape its success
- 8. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Nurse as Change AgentNurse as Change Agent • Nurses facilitate change • Must be proactive in shaping the future • Opportunities exist now for nurses, especially in management positions
- 9. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan LewinLewin • Driving forces versus restraining forces • Three-step process – Freezing – Moving – Refreezing
- 10. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan LippittLippitt • 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. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Comparison of Change ModelsComparison of Change Models LEWIN LiPPIT Unfreezing Diagnose Problem Moving Assess Motivation Refreezing Assess Change Agent’s Motivation and Resources Select Progressive Change Objects Choose change Agent Role Maintain Change Terminate Helping Relationship
- 12. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan The Change ProcessThe Change Process • Same path as nursing process – Assessment – Planning – Implementation – Evaluation
- 13. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Table 5-2 Steps in the Change Process
- 14. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan AssessmentAssessment • Identify the problem or the opportunity • Ask the right questions – Where are we now? – 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?
- 15. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan AssessmentAssessment • Collect data – Identify all driving and restraining forces – Assess political climate Who will gain? Who will lose? – Assess costs and benefits • Analyze data
- 16. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan PlanningPlanning • Determine who, how, and when • Include organization/system members • Plan resources required to make the change and establish feedback mechanisms
- 17. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan ImplementationImplementation • Plans are put into action. – Akin to Lewin's moving stage • Methods to change individuals – Information giving – Training – Gaining support of key people • Methods to change groups – The power of the group
- 18. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan EvaluationEvaluation • Evaluate effectiveness • Stabilize the change – Energizer role is still needed to reinforce
- 19. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Power-Coercive StrategiesPower-Coercive Strategies • Based on the application of power by legitimate authority, economic sanctions, or political clout • Through laws and policies. • Useful when a consensus is unlikely despite efforts to stimulate participation • Accept it, or leave it
- 20. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan EmpiricalEmpirical–Rational ModelRational Model • Revolves around knowledge • Assumption is that people are rational and will follow their rational self- interest if it clear to them. • Change agent uses expert power
- 21. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan NormativeNormative–Reeducative StrategiesReeducative Strategies • Assumption that people act in accordance with social norms and values • Power = Skill in interpersonal relationships • Effective in reducing resistance, stimulating creativity
- 22. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Resistance to ChangeResistance to Change • If no resistance, change may not be significant enough • Forces changes agent to: – Clarify – Keep interest high – Establish reason for change
- 23. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Reasons for Resistance to ChangeReasons 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
- 24. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Look for these statementsLook for these statements • “we tried that before”. • “It won’t work”. • “No one else does it like that”. • “We can’t afford it”. • We don’t have the time”. • “It well make the angry”. • “Every new boss wants to do something different”.
- 25. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Managing Resistance to ChangeManaging Resistance to Change • Talk to those who oppose the change. • Clarify information. • Be open to revisions. • Present negative consequences of resistance. • Emphasize positive consequences.
- 26. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Managing Resistance to ChangeManaging Resistance to Change • Keep resisters involved in face-to-face contact with supporters. • Maintain climate of trust, support, confidence
- 27. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Nurse’s Role in ChangeNurse’s Role in Change • Change not always initiated from top management level – Mid-level managers are more effective • Staff nurses can initiate change – Mandotory skill for nurses • Cultivate and master characters of successful change agents • Engage strategies for accessing power
- 28. Effective Leadership and Management in Nursing, Eighth Edition Eleanor J. Sullivan Nurses Role in ChangeNurses Role in Change • Assist in other ways – Planning – Information sharing – Managing the transition • Change has become the norm