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Course: Oncology Nursing

Topic: Change Management

The Nurses International Community

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COPYRIGHT

NI Privacy Policy and Terms of Use.

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Module Goals

Learners will be able to:

Describe several change theories.
Explain the change process.
Describe what is meant by learning organizations
Identify strategies to bring about change.

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What are the Key Ideas?

Change is unavoidable ∴ uncertainty.
Theory helps us understand and prepare for change.
Transitions (reactions to change) affect people as much as the actual change.
Nurses can be change agents.

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Resistance to Change

Desire not to lose something of value.
A misunderstanding of change and its implications.
A belief that change does not make sense for the organization.
A low tolerance for change.

Kotter & Schlesinger, 2008

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Methods of Dealing with Resistance

Education and communication
Participation and involvement
Facilitation and support
Negotiation and agreement
Manipulation and coercion
Explicit and implicit coercion

Kotter & Schlesinger, 2008

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Lewin’s Force Field Analysis Theory

University of Cambridge, n.d.

Forces may be people, technology, structure or values.

Driving forces or “facilitators” help the change process.
Restraining forces or “barriers” hinder the process.
Change agents reduce barriers and support facilitators.

Change Event

Driving Forces

Restraining Forces

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Lewin’s Force Field Analysis Theory

Unfreezing = readiness (may be natural or planned, internal or external, gradual or crisis) Awareness of need for change
Experiencing the change leads to bringing something new or different into work or behaviour
Refreezing occurs when the new practice is integrated in new behaviours (accepted and applied).

University of Cambridge, n.d.

Unfreezing

Experiencing

the change

Refreezing

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Prochaska and DiClemente’s Stages of Change Theory

Deals with intentional behaviour change
Views change as a process rather than an event
The change process is characterised by a series of stages of change
In attempting to change a behaviour a person typically cycles through these stages of change

Prochaska et al., 1992

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Maintenance

Relapse

Contemplation

Action

Preparation

Termination

Precontemplation

Prochaska and DiClemente’s Wheel of Change

Prochaska, J.O., DiClemente, C.C. & Norcross, J.C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102-1114.

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Chaos Theory

Chaos theory says that open systems are affected by too many factors to calculate.

Small changes lead to significant consequences later.
The past is not necessarily a good predictor of what will happen in future. Periods of stability and of transformation.

Karaman & Oztekin, 2019

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What would the Nurse do?

What are the characteristics of a change agent? (Select all that apply)

They use a Systems thinking approach
They are comfortable managing ambiguity
They see the big picture
They are aware of the personal impact of change on others
They avoid situations where change may occur

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Learning Organizations

The basic rationale for learning organizations is that in situations of rapid change only those that are flexible, adaptive and productive will succeed.
For this to happen, organizations need to ‘discover how to tap people’s commitment and capacity to learn at all levels’.

Smith, 2001

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Five “disciplines” of Learning Organizations

Smith, 2001

Systems thinking: wide-angle, long-term view.
Personal mastery: continual learning.
Mental models: understanding our thinking through dialogue.
Building shared vision: getting commitment.
Team learning: thinking together.

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Change Management

The process of guiding organizational change to fruition, from the earliest stages of conception and preparation, through implementation and, finally, to resolution.
Organizational change can be either adaptive or transformational
Adaptive changes:

Are small, gradual, iterative changes that an organization undertakes to evolve its products, processes, workflows, and strategies over time.

Transformational changes:

Are larger in scale and scope and often signify a dramatic and, occasionally sudden, departure from the status quo.

Miller, 2020

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Change Management Activities

Planning
Organizing
Implementing
Evaluation
Communication

Commonwealth of Australia, 2015

Miller 2020

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What Must You Plan For?

Atkinson et al. 2013

Kotter 2007

Drivers (impetus) for the change you wish
Approach to change
Communications
Reward and recognition
Training needs of your staff
Measurement & reporting your progress
Organizational realignment
Support for staff
Anchoring the change

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What Are the Drivers For Change?

Customer expectations
Safety and complaints
New technology
Competition
Legislation
Financial pressure

Kotter & Schlesinger (2008)

Reese (2020); Wolters Kluwer (2018)

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Strategies for Change

Education
Support
Facilitation
Communication
Participation
Negotiation
Manipulation
Learning
Relationships
Information

Kotter & Schlesinger (2008)

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Critical Thinking Question:

Which of the following is a drive for change?

The government enacts legislation that all patient records are electronic
Staffing schedule is accomplished by the group
The hospital has a room for prayer and religious services
The staff remember coworkers birthdays on the work calendar

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Communication Strategy for Change Management

A communication strategy helps:

Guide communication activities through the change process
Ensures active engagement of all stakeholders

Communication strategy articulates/answers the ‘what’, ‘who’, ‘why’
There is never too much communication: Communicate, listen, communicate, listen, communicate, listen
Possible major changes must be communicated early and often

Initially, communicate possible outcomes of the change

Reduces uncertainty in people affected

Commonwealth of Australia (2015)

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Communication Strategy for Change Management

Help reduce uncertainty by communicating:

Timeframes associated with the change
Alternative scenarios
Highlighting what may happen and what options are being considered

Conduct internal communication with employees either before or at same time with external communication with stakeholders

Damaging to reputation of leaders and level of trust if staff hear about the change from external sources before being advised by management

Commonwealth of Australia (2015)

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Provide Rewards and Recognition

Reward leaders (enthusiasts or early adopters)
Acknowledge new behaviours
Recognize early wins
Motivate staff through the peaks and valleys of change
Share success stories

Kotter (2007)

University of Minnesota (2017)

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Critical Thinking Practice:

Reflect on why listening is essential for affecting change.

Include five reasons in your response.

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Managing Your Team Through Change

Communicate

Key messages – maximum four
Beware of “mixed messages” (Saying one thing but meaning something else)

Identify and eliminate obstacles

Understand objections
Understand performance expectations
Don’t let comments slide
Take action

Demonstrate your commitment

Be visible and unwavering

Deschamps (2008)

University of Minnesota (2017)

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Critical Success Factors

Establishing sense of urgency
Executive support
Creating vision
Communication of vision
Empowering to act on the vision
Systematic planning and creating short term wins
Consolidate improvements and produce more change (Long term anchors )
Institutionalize new approaches

Kotter (2007)

University of Minnesota (2017)

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Diffusion of Innovations Theory (Rogers)

Innovators: Brave people, leading change, very important for communication
Early Adopters: Respectable people, opinion leaders, try out new ideas, but in a careful way
Early Majority: Thoughtful people, careful but accepting change more quickly than the average
Late Majority: Skeptical people, will use new ideas or products only when the majority is using it.
Laggards: People who prefer the "old ways", critical towards new ideas
Trying quickly to convince the mass of a new controversial idea is useless. Start by convincing innovators and early adopters.

LaMorte (2019)

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Responses to Change

“It isn’t the changes that do you in, it’s the transitions. They aren’t the same thing. Change is situational: the move to a new site, … the reorganization of the roles of the team …. Transition, on the other hand is a psychological process that people go through as they come to terms with the details of the new situation that the change brings about.”

William Bridges (2003), Managing Transitions: making the most of change.

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Based on William Bridges (2003), Managing Transitions: making the most of change

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Reference:

Atkinson, J., Patel, C., Wilson, A., Mittman, B., Dominello, A., & Brown, B. (2013, September). Drivers of large-scale change in complex health systems: A rapid review. https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0004/202396/LgeSysTransf-exec.pdf

Commonwealth of Australia (2015). Module 10 Change Management and Communication. Accessed from: https://www.dese.gov.au/jobactive/resources/module-10-change-management-and-communication

Deschamps, J. (2008). Steering innovation top down. Innovation Leaders: How Senior Executives Stimulate, Steer, and Sustain Innovation. Jossey-Bass.

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Reference:

Karaman, A., Demir, M. S., & Oztekin, S. D. (2019). Chaos Theory and Nursing. International Journal of Caring Sciences, 12(2), 1223.

http://www.internationaljournalofcaringsciences.org/docs/72_karaman_special_12_2_2.pdf

Kotter, J.P. (2007). Leading Change: Why transformation efforts fail. Harvard Business Review. Accessed from:

https://irp-cdn.multiscreensite.com/6e5efd05/files/uploaded/Leading%20Change.pdf

Kotter, J.P., & Schlesinger, L.A. (2008). Choosing Strategies for Change. Harvard Business Review. Accessed from: https://hbr.org/2008/07/choosing-strategies-for-change?registration=success

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Reference:

LaMorte, W. W. (2019). Diffusion of Innovation Theory. Boston University School of Public Health. Accessed from: https://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories4.html

Miller, K. (2020). 5 Critical steps in change management process.Harvard Business School Online. Retrieved from:https://online.hbs.edu/blog/post/change-management-process

Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to addictive behaviors. American Psychologist, 47(9), 1102–1114. https://doi.org/10.1037/0003-066X.47.9.1102

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Reference:

Reese, E.C. (2020, January 1). 2020 vision: What to expect in healthcare finance over the next decade. Healthcare Financial Management Association. https://www.hfma.org/topics/hfm/2020/january/healthcare-2020s-views-on-healthcares-changing-landscape-from-thought-leaders.html

Smith, M. K. (2001) ‘Peter Senge and the learning organization’, The encyclopedia of pedagogy and informal education. [https://infed.org/mobi/peter-senge-and-the-learning-organization/. Retrieved from : https://infed.org/mobi/peter-senge-and-the-learning-organization/

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Reference:

University of Cambridge (n.d.). Force Field Analysis. Institute for Manufacturing, Department of Engineering. Accessed from: https://www.ifm.eng.cam.ac.uk/research/dstools/force-field-analysis/

University of Minnesota. (2017). Organizational Behavior. https://open.lib.umn.edu/organizationalbehavior/chapter/14-3-organizational-change/

William Bridges Associates. (n.d.). Bridges Transition Model. Accessed from: https://wmbridges.com/about/what-is-transition/

.

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