Planned Change in 21st Century Healthcare Organizations

1. Chapter 8 Planned Change

2. Direction of Change in Twenty-First Century Health-Care Organizations • Organizational restructuring • Quality improvement • Employee retention

3. Qualities of Change Agents • Visionary • Risk taker • Flexible • Excellent communicator • Creative • Sensitive • Current

4. Kurt Lewin’s Change Theory • Unfreezing: the change agent convinces members of the group to change or guilt, anxiety, or concern are elicited • Movement: the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces • Refreezing: the change agent assists in stabilizing the system change so that it becomes integrated into the status quo

5. Lewin’s Driving and Restraining Forces • Driving (facilitators): forces that push the system toward change • Restraining (barriers): forces that pull the system away from change

6. Driving and Restraining Forces (Goal: 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 • Pay increase • Low energy level • Limited financial resources • Unreliable transportation • Time with family already limited

7. Lewin (1951) Identified Several 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

8. Stages of Change Model (Burrowes and Needs, 2009) • Stage 1: Precontemplation • Stage 2: Contemplation • Stage 3: Preparation • Stage 4: Action • Stage 5: Maintenance • No current intention to change • Individual considers making a change • There is intent to make a change in the near future • Individual modifies his or her behavior • Change is maintained and relapse is avoided

9. Classic Change Strategies • Rational–empirical strategies: used when there is little anticipated resistance to the change or when the change is perceived as reasonable • Normative–reeducative strategies: use group norms and peer pressure to socialize and influence people so that change will occur • Power-coercive strategies: feature the application of power by legitimate authority, economic sanctions, or political clout of the change agent

10. Question A nurse-manager is attempting to restructure the unit to prevent understaffing of the nurses. The nurses agree this is a needed change. What type of change strategy would be most effective? • Rational–empirical strategies • Normative–reeducative strategies • Power–coercive strategies • None of the above

11. Answer Answer: Rationale:

12. Reminder • Because change disrupts the homeostasis or balance of the group, resistance should always be expected

13. Complex Adaptive Systems Change Theory • Suggests that the relationship between elements and agents within any system is nonlinear and that these elements are the key players in changing settings or outcomes • Olson and Eoyang (2001) suggest that the self-organizing nature of human interactions in a complex organization leads to surprising effects

14. Chaos Theory • Really about finding the underlying order in apparently random data • Determining this underlying order, however, is challenging, and the order itself is constantly changing • Changes in outcomes are not proportional to the degree of change in the initial condition

15. Organizational Aging • Organizations progress through developmental stages • As organizations age, structure increases to provide greater control and coordination • The young organization is characterized by high energy, movement, and virtually constant change and adaptation • Aged organizations have established “turf boundaries,” function in an orderly and predictable fashion, and are focused on rules and regulations

16. Question Tell whether the following statement is true or false: The young organization is characterized by low energy and resistance to change. • True • False

17. Answer Answer: Rationale:

18. Integrating Leadership and Management Functions in Planned Change • Manager: mechanic who implements the planned change • Leader: inventor or creator of the planned change Both leadership and management skills are necessary in planned change

19. Regardless of the type of change, all major change brings feelings of achievement, pride, loss, and stress 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 Planned Change versus Accidental Change

20. Question Which emotions are commonly associated with change? • Pride • Stress • Loss • Achievement • All of the above

21. Answer Answer: Rationale:

22. Three Good Reasons for Change • Change to solve some problem • Change to make work procedures more efficient • Change to reduce unnecessary workload

23. Question Tell whether the following statement is True or False: For change to be effective, it should be immediate and sweeping. • True • False

24. Answer Answer: Rationale:

25. Change should never be attempted unless the change agent can make a commitment to be available until the change is complete Attempting Change

26. Question Presenting employees with the pros and cons of a new system to be implemented is an example of which type of strategy? • Rational • Normative • Power

27. Answer Answer: Rationale:

28. Resistance—The Natural and Expected Response to Change Individuals’resistance typically depends on four things: • Their flexibility to change • Their evaluation of the immediate situation • The anticipated consequences of the change • Their perceptions of what they have to lose and gain

29. 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 Resistance to Change

30. Whenever possible, all those who may be affected by a change should be involved in planning for that change When information and decision making are shared, subordinates feel that they have played a valuable role in the change Involvement in Change