Change should be implemented only for good reasons

Change should be implemented only for good reasons.

Try to remember a situation in your own life that involved unnecessary change. Why do you think that the change was unnecessary? What types of turmoil did it cause? Were there things a change agent could have done that would have increased unfreezing in this situation?

In addition, many good ideas are never realized because of poor timing or a lack of power on the part of the change agent. For example, both organizations and individuals tend to reject outsiders as change agents because they are perceived as having inadequate knowledge or expertise about the current status, and their motives often are not trusted. Therefore, there is more widespread resistance if the change agent is an outsider. The outside change agent, however, tends to be more objective in his or her assessment, whereas the inside change agent is often influenced by a personal bias regarding how the organization functions.

Likewise, some greatly needed changes are never implemented because the change agent lacks sensitivity to timing. If the organization or the people within that organization have recently undergone a great deal of change or stress (change fatigue), any other change should wait until group resistance decreases.

For effective change to occur, the change agent needs to have made a thorough and accurate assessment of the extent of and interest in change, the nature and depth of motivation, and the environment in which the change will occur. In addition, because human beings have little control over many changes in their lives, the change agent must remember that people need a balance between stability and change in the workplace. Change for change’s sake subjects employees to unnecessary stress and manipulation.[unique_solution]

Change should be implemented only for good reasons.

It becomes clear that initiating and coordinating change requires well-developed leadership and management skills. It also requires vision and expert planning skills because a vision is not the same as a plan. The failure to reassess goals proactively and to initiate these changes results in misdirected and poorly used fiscal and human resources. Leader-managers must be visionary in identifying where change is needed in the organization, and they must be flexible in adapting to change they directly initiated as well as change that has indirectly affected them. Display 8.1 delineates selected leadership roles and management functions necessary for leader-managers acting either in the change agent role or as a coordinator of the planned change team.

Leadership Roles

1. Is visionary in identifying areas of needed change in the organization and the health-care system
2. Demonstrates risk taking in assuming the role of change agent
3. Demonstrates flexibility in goal setting in a rapidly changing health-care system
4. Anticipates, recognizes, and creatively problem solves resistance to change
5. Serves as a role model to followers during planned change by viewing change as a challenge and opportunity for growth
6. Role models high-level interpersonal communication skills in providing support for followers undergoing rapid or difficult change
7. Demonstrates creativity in identifying alternatives to problems
8. Demonstrates sensitivity to timing in proposing change, leaders should ask “What would youplanned change
9. Takes steps to prevent aging in the organization and to keep current with the new realities of nursing practice
10. Supports and reinforces the individual adaptive efforts of those affected by change

Management Functions

1. Forecasts unit needs with an understanding of the organization’s and unit’s legal, political, economic, social, and legislative climate
2. Recognizes the need for planned change and identifies the options and resources available to implement that change
3. Appropriately assesses and responds to the driving and restraining forces when planning for change
4. Identifies and implements appropriate strategies to minimize or overcome resistance to change
5. Seeks subordinates’ input in planned change and provides them with adequate information during the change process to give them some feeling of control
6. Supports and reinforces the individual efforts of subordinates during the change process
7. Identifies and uses appropriate change strategies to modify the behavior of subordinates as needed
8. Periodically assesses the unit/department for signs of organizational aging and plans renewal strategies
9. Continues to be actively involved in the refreezing process until the change becomes part of the new status quo

Lewin’s Change Theory of Unfreezing, Movement, and Refreezing

Most of the current research on change builds on the classic change theories developed by Kurt Lewin in the mid-20th century. Lewin (1951) identified three phases through which the change agent must proceed before a planned change becomes part of the system: unfreezing, movement, and refreezing.

Unfreezing

Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. Thus, people become discontent and aware of a need to change. Zenger and Folkman (2015) note that one of Newton’s laws of thermodynamics is that a body at rest tends to stay at rest: “Slowing down, stopping, and staying at rest does not require effort. It happens very naturally. Many change efforts are not successful because they become one of a hundred priorities” (para. 16). To make a change effort successful, the leader must clear away the competing priorities and shine a spotlight on the need for a change to happen.

Rasel (2014) suggests the discontent needed to promote change can be the result of internal or external forces. Internal forces might include obsolescence of production and service, new market opportunities, new strategic direction, and a shift in sociocultural values. External forces might include regulators, competitors, market forces, customers, or technology (rasel, 2014).

Rockwell (2015) suggests, however, that sometimes people are afraid of discontent (unfreezing) and thus put significant energy into simply comforting those experiencing stress related to possible change. This simply prolongs the problem because motivation declines when discomfort is removed. Instead, Rockwell argues that before soothing someone’s discomfort related to change, leaders should ask “What would you like to do about that?” In doing so, the leader encourages transformational conversations instead of avoiding the real issue or problem. Indeed, Rockwell notes that successful leaders often bring up issues others avoid. Discomfort with discomfort invites a person to ignore issues that should be addressed.

Leaders create pull. Successful leaders run forward more than they run away. The difference is push versus pull (Rockwell, 2015).

Movement

The second phase of planned change is movement. In movement, the change agent identifies, plans, and implements appropriate strategies, ensuring that driving forces exceed restraining forces. Because change is such a complex process, it requires a great deal of planning and intricate timing. Recognizing, addressing, and overcoming resistance may be a lengthy process, and whenever possible, change should be implemented gradually. Any change of human behavior, or the perceptions, attitudes, and values underlying that behavior, takes time.

Indeed, addressing and responding appropriately to stress being experienced by those undergoing change is a high level leadership skill. Research by Zenger and Folkman (2015) suggested that helping others to change is not just about being nice or nagging others; instead, inspiration, goal setting, building trust, and making change a priority are what matter. These strategies and others identified by Zenger and Folkman are detailed in Examining the Evidence 8.1.

Hinshaw (2015b) emphasized that change movement, however, should not be delayed solely because of fear of the unknown or because some ambiguity exists. She notes that a 2010 study of more than 42 organizations found that “top performing leadership teams spent more time in project implementation than they did on project analysis. These organizations did not have different circumstances; all were presented with complex challenges and ever-changing times. The key difference between top performing and low performing teams was speed to action and the ‘we can make this work’ confidence to move quickly into implementation” (Hinshaw, 2015b, para. 7).

Refreezing

The last phase is refreezing. During the refreezing phase, the change agent assists in stabilizing the system change so that it becomes integrated into the status quo. If refreezing is incomplete, the change will be ineffective and the prechange behaviors will be resumed. For refreezing to occur, the change agent must be supportive and reinforce the individual adaptive efforts of those affected by the change. Because change needs at least 3 to 6 months before it will be accepted as part of the system, the change agent must be sure that he or she will remain involved until the change is completed.

Change agents must be patient and open to new opportunities during refreezing, as complex change takes time and several different attempts may be needed before desired outcomes are achieved.

It is important to remember though that refreezing does not eliminate the possibility of further improvements to the change. Indeed, measuring the impact of change should always be a part of refreezing. Display 8.2 illustrates the change agent’s responsibilities during the various stages of planned change.

Stage 1—Unfreezing

1. Gather data.
2. Accurately diagnose the problem.
3. Decide if change is needed.
4. Make others aware of the need for change; often involves deliberate tactics to raise the group’s discontent level; do not proceed to Stage 2 until the status quo has been disrupted and the need for change is perceived by the others.

Stage 2—Movement

1. Develop a plan.
2. Set goals and objectives.
3. Identify areas of support and resistance.
4. Include everyone who will be affected by the change in its planning.
5. Set target dates.
6. Develop appropriate strategies.
7. Implement the change.
8. Be available to support others and offer encouragement through the change.
9. Use strategies for overcoming resistance to change.
10. Evaluate the change.
11. Modify the change, if necessary.

Stage 3—Refreezing

Support others so that the change continues.

Lewin’s Change Theory of Driving and Restraining Forces

Lewin (1951) also theorized that people maintain a state of status quo or equilibrium by the simultaneous occurrence of both driving forces (facilitators) and restraining forces (barriers) operating within any field. Driving forces advance a system toward change; restraining forces impede change.

The forces that push the system toward change are driving forces, whereas the forces that pull the system away from change are called restraining forces.

Examples of driving forces might include a desire to please one’s boss, to eliminate a problem that is undermining productivity, to get a pay raise, or to receive recognition. Restraining forces include conformity to norms, an unwillingness to take risks, and a fear of the unknown.

Lewin’s (1951) model suggested that people like feeling safe, comfortable, and in control of their environment. For change to occur then, the balance of driving and restraining forces must be altered. The driving forces must be increased or the restraining forces decreased.

In Figure 8.1, the person wishing to return to school must reduce the restraining forces or increase the driving forces to alter the present state of equilibrium. There will be no change or action until this occurs. Therefore, creating an imbalance within the system by increasing the driving forces or decreasing the restraining forces is one of the tasks required of a change agent.

Making Change Possible

Identify a change that you would like to make in your personal life (such as losing weight, exercising daily, and stopping smoking). List the restraining forces keeping you from making this change. List the driving forces that make you want to change. Determine how you might be able to change the status quo and make the change possible.

A Contemporary Adaptation of Lewin’s Model

Burrowes and Needs (2009) shared a more contemporary adaptation of Lewin’s model in their discussion of a five-step stages of change model (SCM). In this model, the first stage is precontemplation. During this stage, the individual “has no intention to change his or her behavior in the foreseeable future” (Burrowes & Needs, 2009, p. 41). Next comes the contemplation stage, at which point the individual considers making a change but has not yet made a commitment to take action. This would be the phase in which unfreezing would occur according to Lewin.

A transition from unfreezing to movement begins in the preparation stage, as the individual intends to take action in the short-term future. The action stage then occurs (movement) in which the individual actively modifies his or her behavior. Finally, the process ends with the maintenance stage, at which point the individual works to maintain changes made during the action stage and prevent relapse. This stage would be synonymous with refreezing. Table 8.1 illustrates the steps of the SCM.

Burrowes and Needs (2009) suggest that breaking the process of change down into steps makes it easier to assess an individual’s readiness to change. For example, change agents might need to consider using motivation enhancement strategies if individuals are in the contemplation stage, whereas more action-based interventions would be appropriate for individuals who have already made a commitment to change. The actions taken by change agents in the action stage would be the same as those identified by Lewin for movement and in maintenance for refreezing.

Classic Change Strategies

In addition to being aware of the stages of change, the change agent must be highly skilled in the use of behavioral strategies to prompt change in others. Three such classic strategies for effecting change were described by Bennis, Benne, and Chinn (1969), with the most appropriate strategy for any situation depending on the power of the change agent and the amount of resistance expected from the subordinates.

One of these strategies is to give current research as evidence to support the change. This group of strategies is often referred to as rational–empirical strategies. The change agent using this set of strategies assumes that resistance to change comes from a lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change. This type of strategy is used when there is little anticipated resistance to the change or when the change is perceived as reasonable.

Using Change Strategies to Increase Sam’s Compliance

You are a staff nurse in a home health agency. One of your patients, Sam Little, is a 38-year-old man with type 1 diabetes. He has developed some loss of vision and had to have two toes amputated as consequences of his disease process. Sam’s compliance with four-times-daily blood glucose monitoring and sliding-scale insulin administration has never been particularly good, but he has been worse than usual lately. Sam refuses to use an insulin pump; however, he has been willing to follow a prescribed diabetic diet and has kept his weight to a desired level.

Sam’s wife called you at the agency yesterday and asked you to work with her in developing a plan to increase Sam’s compliance with his blood glucose monitoring and insulin administration. She said that Sam, while believing it “probably won’t help,” has agreed to meet with you to discuss such a plan. He does not want, however, “to feel pressured into doing something he doesn’t want to do.”

ASSIGNMENT:

What change strategy or combination thereof (rational–empirical, normative–reeducative, and power–coercive) do you believe has the greatest likelihood of increasing Sam’s compliance? How could you use this strategy? Who would be involved in this change effort? What efforts might you undertake to increase the unfreezing so that Sam is more willing to actively participate in such a planned change effort?

Because peer pressure is often used to effect change, another group of strategies exists, which use group process, and these are called normative–reeducative strategies. These strategies use group norms and peer pressure to socialize and influence people so that change will occur. The change agent assumes that humans are social creatures, more easily influenced by others than by facts. This strategy does not require the change agent to have a legitimate power base. Instead, the change agent gains power by skill in interpersonal relationships. He or she focuses on noncognitive determinants of behavior, such as people’s roles and relationships, perceptual orientations, attitudes, and feelings, to increase acceptance of change.

The third group of strategies, power–coercive strategies, features the application of power by legitimate authority, economic sanctions, or political clout of the change agent. These strategies include influencing the enactment of new laws and using group power for strikes or sit-ins. Using authority inherent in an individual position to effect change is another example of a power–coercive strategy. These strategies assume that people often are set in their ways and will change only when rewarded for the change or when they are forced by some other power–coercive method. Resistance is handled by authority measures; the individual must accept it or leave.

Often, the change agent uses strategies from each of these three groups. An example may be reflected in the change agent who wants someone to stop smoking. The change agent might present the person with the latest research on cancer and smoking (the rational–empirical approach); at the same time, the change agent might have friends and family encourage the person socially (normative–reeducative approach). The change agent also might refuse to ride in the smoker’s car if the person smokes while driving (power–coercive approach). By selecting from each set of strategies, the change agent increases the chance of successful change.

Resistance: The Expected Response to Change

Even though change is inevitable, it creates instability in our lives, and some conflict should always be expected. Indeed, conflict and resistance almost always accompany change because change alters the balance of a group.

The level of resistance often depends on two things: whether the change is mandated and if the change is proactive (Hinshaw, 2015a). Proactive change is generally less emotional than mandated change; yet, the lines often blur between the two because proactive change launched by one group may be perceived as mandated change by another.

The level of resistance also generally depends on the type of change proposed. Technological changes encounter less resistance than changes that are perceived as social or that are contrary to established customs or norms. For example, nursing staff may be more willing to accept a change in the type of IV pump to be used than a change regarding who is able to administer certain types of IV therapy. Nursing leaders also must recognize that subordinates’ values, educational levels, cultural and social backgrounds, and experiences with change (positive or negative) will have a tremendous impact on the degree of resistance. It is also much easier to change a person’s behavior than it is to change an entire group’s behavior. Likewise, it is easier to change knowledge levels than attitudes.

Similarly, Amos, Johns, Hines, Skov, and Kloosterman (2012) suggest that straightforward change, learning to do something a different way, and responding to something that obviously needs to be changed are often relatively easy to accomplish. However, changing something that involves a challenge to the beliefs that underpin our lives threatens the security of the individuals involved and these types of changes are much more apt to result in resistance.

In an effort to eliminate resistance to change in the workplace, managers historically used an autocratic leadership style with specific guidelines for work, an excessive number of rules, and a coercive approach to discipline. The resistance, which occurred anyway, was both covert (such as delaying tactics and passive–aggressive behavior) and overt (openly refusing to follow a direct command). The result was wasted managerial energy and time and a high level of frustration.

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

What Is Your Attitude Toward Change?

How do you typically respond to change? Do you embrace it? Seek it out? Accept it reluctantly? Avoid it at all cost? Is this behavioral pattern similar to your friends and that of your family? Has your behavior always fit this pattern, or has the pattern changed throughout your life? If so, what life events have altered how you view and respond to change?

Today, resistance is recognized as a natural and expected response to change, and leader-managers must resist the impulse to focus on blaming others when resistance to planned change occurs. Instead, they should immerse themselves in identifying and implementing strategies to minimize or manage this resistance to change. One such strategy is to encourage subordinates to speak openly so that options can be identified to overcome objections. In addition, it is the role of the leader to see the vision of what the future state will be like after the change has taken place and to share that vision with his or her followers.

Likewise, workers should be encouraged to talk about their perceptions of the forces driving the planned change so that the leader can accurately assess change support and resources. It takes a strong leader to step up and engage when a change effort meets with pushback.

Still, there are individual variations in terms of risk taking and willingness to accept change. Some individuals, even at very early ages, demonstrate more risk taking than others. Certainly temperament and personality play at least some role in this. Change agents then should be aware of life history variables as well as risk-taking propensity when assessing the likelihood of an individual or group being willing to change.

Early in a planned change then, leader-managers should assess which workers will promote or resist a specific change, by both observation and direct communication. Then, the manager can collaborate with change promoters on how best to convert those individuals more resistant to change.

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. Workers want security and predictability. That is why trust erodes when the ground rules change, as the assumed “contract” between the worker and the organization is altered. Subordinates’ confidence in the change agent’s ability to manage change depends on whether they believe that they have sufficient resources to cope with it. In addition, the leader-manager must remember that subordinates in an organization will generally focus more on how a specific change will affect their personal lives and status than on how it will affect the organization.

Planned Change as a Collaborative Process

Often, the change process begins with a few people who meet to discuss their dissatisfaction with the status quo and an inadequate effort is made to talk with anyone else in the organization. This approach virtually guarantees that the change effort will fail. People abhor “information vacuums,” and when there is no ongoing conversation about the change process, gossip usually fills the void. These rumors are generally much more negative than anything that is actually happening.

As a rule, anyone who will be affected by a change should be included in planning it. When information and decision making are shared, subordinates feel that they have played a valuable role in the change. Change agents and the elements of the system—the people or groups within it—must openly develop goals and strategies together. All must have the opportunity to define their interest in the change, their expectation of its outcome, and their ideas on strategies for achieving change. It is the wise manager, however, who empowers the early adopter frontline change agents on his or her team to sway the group (Hinshaw, 2015b).

It is not always easy, however, to attain grassroots involvement in planning efforts. Even when managers communicate that change is needed and subordinate feedback is wanted, the message often goes unheeded. Some people in the organization may need to hear a message repeatedly before they listen, understand, and believe the message. If the message is one that they do not want to hear, it may take even longer for them to come to terms with the anticipated change.

Whenever possible, all those who may be affected by a change should be involved in planning for that change.

When change agents fail to communicate with the rest of the organization, they prevent people from understanding the principles that guided the change, what has been learned from prior experience, and why compromises have been made. Likewise, subordinates affected by the change should thoroughly understand the change and the impacts that will likely result. Good, open communication throughout the process can reduce resistance. Leaders must ensure that group members share perceptions about what change is to be undertaken, who is to be involved and in what role, and how the change will directly and indirectly affect each person in the organization.

The Leader-Manager as a Role Model During Planned Change

Leader-managers must act as role models to subordinates during the change process. The leader-manager must attempt to view change positively and to impart this view to subordinates. Rather than viewing change as a threat, managers should embrace it as a challenge and the chance or opportunity to do something new and innovative. Indeed, the leader has two responsibilities in facilitating change in nursing practice. First, leader-managers must be actively engaged in change in their own work and model this behavior to staff. Second, leaders must be able to assist staff members in making the needed change requirements in their work.

It is critical that managers not view change as a threat.

Managers must also believe that they can make a difference. This feeling of control is probably the most important trait for thriving in a changing environment. Unfortunately, many leader-managers lack confidence in their ability to serve as an effective change agent. The end result, when this occurs, is a lack of engagement in the change process and a role modeling to followers that the change may not be worth the time and energy necessary to bring it to fruition.

Organizational Change Associated With Nonlinear Dynamics

Most 21st-century organizations experience fairly brief periods of stability followed by intense transformation. In fact, some later organizational theorists feel that Lewin’s (1951) refreezing to establish equilibrium should not be the focus of contemporary organizational change because change is unforeseeable and ever present. This is particularly true in health-care organizations, where long-term outcomes are almost always unpredictable.

In the past, organizations looked at change and organizational dynamics as linear, occurring both in steps and sequentially. More contemporary theorists maintain that the world is so unpredictable that such dynamics are truly nonlinear. As a result, nonlinear change theories such as complex adaptive systems (CAS) theory and chaos theory now influence the thinking of many organizational leaders.

Complexity and Complex Adaptive Systems Change Theory

Complexity science has emerged from the exploration of the subatomic world and quantum physics and suggests that the world is complex as are the individuals who operate within it. Thus, control and order are emergent rather than predetermined, and mechanistic formulas do not provide the flexibility needed to predict what actions will result in what outcomes.

CAS theory, an outgrowth of complexity 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.

CAS theory suggests that the relationship between elements and agents within any system is nonlinear and that these elements are constantly in play to change the environment or outcome.

For example, although an individual may have behaved one way in the past, CAS theory suggests that future behavior may not always be the same (not always predictable). This is because that individual’s prior experience and past learning may change his or her future choices. In addition, the rules or parameters of each situation are different, even if these differences are subtle; even small variations can dramatically alter choice of action. CAS theory also suggests that the actions of any agent within the system affect all other agents in the system; that is, that context and action are interconnected. Finally, CAS theory suggests that there are always hidden or unanticipated elements in systems that make linear thinking almost impossible.

In their classic work on CAS, Olson and Eoyang (2001) suggest that the self-organizing nature of human interactions in a complex organization leads to surprising effects. Rather than focusing on the macrolevel of the organization system, complexity theory suggests that most powerful change processes occur at the microlevel, where relationships, interactions, and simple rules shape emerging patterns. The main features of the CAS approach are shown in Display 8.3.

Change should be achieved through connections among change agents instead of from the top-down.

There should be adaptation to uncertainty during the change instead of trying to predict stages of development.

Goals, plans, and structures should be allowed to emerge instead of depending on clear, detailed plans and goals.

Value differences should be amplified and explored instead of focusing on consensus in change efforts.

Patterns in one part of the organization are often repeated in another part. Thus, change does not need to begin at the top of an organization to be successful. The goal instead is self-similarity rather than differences in how change is implemented in different parts of the organization.

Successful change fits with the current organizational environment instead of with an ideal. This is what makes it sustainable.

In applying CAS theory to planned change, it becomes clear that the multidimensionality of health-care organizations, and the individuals who work within them, results in significant challenges for the change agent. Change agents then must carefully examine and focus on the relationships between the elements and be careful not to look at any one element in isolation from the others. It also suggests that time and attention must be given to trying to understand these relationships and interactions even before unfreezing is attempted and that continual monitoring and adaptation will likely be needed for movement and refreezing to be successful.

Chaos Theory

The roots of chaos theory, considered by some to be a subset of complexity science, likely emerged from the early work of meteorologist Edward Lorenz in the 1960s to improve weather forecasting techniques (MIT News, 2008). Lorenz discovered that even tiny changes in variables often dramatically affected outcomes. Lorenz also discovered that even though these chaotic changes appeared to be random, they were not. Instead, he found that there were deterministic sequences and physical laws, which prevail in nature, even if this does not appear to be the case.

Chaos theory is really about finding the underlying order in apparently random data.

Determining this underlying order, however, is challenging, and the order itself is constantly changing. This chaos makes it difficult to predict the future. In addition, chaos theory suggests that even small changes in conditions can drastically alter a system’s long-term behavior (commonly known as the butterfly effect). Thus, changes in outcomes are not proportional to the degree of change in the initial condition. As a result of this sensitivity, the behavior of a system exhibiting chaos appears to be random, even though the system is deterministic in the sense that it is well defined and contains no random parameters.

Chaos and complexity theories have great application within the health-care arena. For example, despite putting a great time of energy and time into planning, many plans with sharply delivered strategies and targets are often not effective. This is because hidden variables are not explored and general goals and boundaries are not developed. For example, a single individual or unit can undermine a planned organizational change, particularly if the actions of that individual or unit to undermine the change are covert. The change agent might inadvertently focus on the aftermath of the subversive action without ever realizing the root cause of the problem.

Elena Capella, a nurse educator at the University of San Francisco School of Nursing and Health Professions, suggests that students should receive training about chaos theory as a part of their nursing education (Hall, 2015). She introduces chaos theory to her students to help them handle the intense needs of the emergency room, reaching a sense of calm in disaster situations. She notes there are patients in the emergency department (ED) who don’t follow protocols, there are patients who have different backgrounds and understandings, there are miscommunications, and there are problems with coordination. “In such a disorganized and chaotic setting, you need someone to step in as a reorganization force, someone who can redirect everyone’s attention and energy in an efficient manner” (Hall, 2015, para. 6).

This is the same behavior that is needed of the change agent. It is imperative then that change agents have an understanding of complexity theory and chaos theory because the use of nonlinear theories to explain organizational functioning and change is expected to increase in the 21st century.

Organizational Aging: Change as a Means of Renewal

Organizations progress through developmental stages, just as people do—birth, youth, maturity, and aging. 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. Change is limited.

It is clear that organizations must find a balance between stagnation and chaos, between birth and death. In the process of maturing, workers within the organization can become prisoners of procedures, forget their original purposes, and allow means to become the ends. Without change, the organization may stagnate and die. Organizations need to keep foremost what they are going to do, not what they have done.

For example, Gordon (2013) and Owarish (2013) shared insights regarding Kodak, founded in 1880 by George Eastman, and one of America’s most notable companies, helping establish the market for camera film and then dominating the field. But it suffered from a variety of problems over the last four decades—almost all related to being an aged organization. Kodak’s top management never fully grasped how the world around them was changing and they hung on to obsolete assumptions (such as digital prints will never replace film prints) long after they were no longer the case.

In addition, Kodak followed a pattern seen by a number of aged organizations who face technological change. First, they tried to ignore a new technology hoping it would go away by itself. Then they openly put it down by using various justifications such as it is too expensive, too slow, and too complicated. Then they tried to prolong the life of the existing technology by attempting to create synergies between the new technology and the old (such as photo CD). This further delayed any serious commitment to the new order of things.

In the end, Kodak failed to realize its limitations, ignored the data, and spent an additional 15 years in avoidance mode until it became virtually irrelevant in the market. With only one full year of profit after 2004, Kodak ended up filing for bankruptcy in 2012, after 131 years of being the pioneer in the film industry.

Philpot (2013) provides another example in her accounting of Blackberry’s market plunge from having 40% of the smartphone market in North America in 2010 to only 2% by the end of 2012. Philpot suggests this death spiral occurred as the result of accelerated obsolescence and notes that the “shelf life” of any business model is shorter now than ever before. She concludes that leaders today have to know how to “keep one foot in today and the other in tomorrow. In other words, their responsibility is to successfully execute their current business model while also re-inventing their company to compete in a market that they have not yet seen” (Philpot, 2013, para. 4).

Young or Old Organization?

Reflect on the organization in which you work or the nursing school you attend. Do you believe that this organization has more characteristics of a young or aged organization? Diagram on a continuum from birth to death where you feel that this organization would fall. What efforts has this organization taken to be dynamic and innovative? What further efforts could be made? Do you agree or disagree that most organizations change unpredictably? Can you support your conclusions with examples?

Integrating Leadership Roles and Management Functions in Planned Change

It should be clear that leadership and management skills are necessary for successful planned change to occur. The manager must understand the planning process and planning standards and be able to apply both to the work situation. The manager is also cognizant of the specific driving and restraining forces within a particular environment for change and is able to provide the tools or resources necessary to implement that change. The manager, then, is the mechanic who implements the planned change.

The leader, however, is the inventor or creator. Leaders today are forced to plan in a chaotic health-care system that is changing at a frenetic pace. Out of this chaos, leaders must identify trends and changes that may affect their organizations and units and proactively prepare for these changes. Thus, the leader must retain a big-picture focus while dealing with each part of the system. In the inventor or creator role, the leader displays such traits as flexibility, confidence, tenacity, and the ability to articulate vision through insights and versatile thinking. The leader also must constantly look for and attempt to adapt to the changing and unpredictable interactions between agents and environmental factors as outlined by the complexity science theorists.

Both leadership and management skills are necessary in planned change. The change agent fulfills a management function when identifying situations where change is necessary and appropriate and when assessing the driving and restraining forces affecting the plan for change. The leader is the role model in planned change. He or she is open and receptive to change and views change as a challenge and an opportunity for growth. Other critical elements in successful planned change are the change agent’s leadership skills—interpersonal communication, group management, and problem-solving abilities.

Perhaps, there is no greater need for the leader than to be the catalyst for professional change as well as organizational change. Many people attracted to nursing now find that their values and traditional expectations no longer fit as they once did. It is the leader’s role to help his or her followers turn around and confront the opportunities and challenges of the realities of emerging nursing practice; to create enthusiasm and passion for renewing the profession; to embrace the change of locus of control, which now belongs to the health-care consumer; and to engage a new social context for nursing practice.

Additional Learning Exercises and Applications

Implementing Planned Change in a Family Planning Clinic

You are a Hispanic registered nurse (RN) who has recently received a 2-year grant to establish a family planning clinic in an impoverished, primarily Hispanic area of a large city. The project will be evaluated at the end of the grant to determine whether continued funding is warranted. As Project Director, you have the funds to choose and hire three health-care workers. You will essentially be able to manage the clinic as you see fit.

The average age of your patients will be 14 years, and many come from single-parent homes. In addition, the population with which you will be working has high unemployment, high crime and truancy levels, and great suspicion and mistrust of authority figures. You are aware that many restraining forces exist that will challenge you, but you feel strongly committed to the cause. You believe that the high teenage pregnancy rate and maternal and infant morbidity can be reduced.

ASSIGNMENT:

1. Identify the restraining and driving forces in this situation.
2. Identify realistic short- and long-term goals for implementing such a change. What can realistically be accomplished in 2 years?
3. How might the Project Director use hiring authority to increase the driving forces in this situation?
4. Is refreezing of the planned change possible so that changes will continue if the grant is not funded again in 2 years?

Retain the Status Quo or Implement Change?

Assume that morale and productivity are low on the unit where you are the new manager. In an effort to identify the root of the problem, you have been meeting informally with staff to discuss their perceptions of unit functioning and to identify sources of unrest on the unit. You believe that one of the greatest factors leading to unrest is the limited advancement opportunity for your staff nurses. You have a fixed charge nurse on each shift. This is how the unit has been managed for as long as everyone can remember. You would like to rotate the charge nurse position but are unsure of your staff’s feelings about the change.

ASSIGNMENT:

Using the phases of change identified by Lewin (1951), identify the actions you could take in unfreezing, movement, and refreezing. What are the greatest barriers to this change? What are the strongest driving forces?

How Would You Handle This Response to Change?

You are the unit manager of a cardiovascular surgical unit. The workstation on the unit is small, dated, and disorganized. The unit clerks have complained for some time that the chart racks on the counter above their desk are difficult to reach, that staff frequently impinge on the clerks’ work space to discuss patients or to chart, that the call-light system is antiquated, and that supplies and forms need to be relocated. You ask all eight of your shift unit clerks to make a “wish list” of how they would like the workstation to be redesigned for optimum efficiency and effectiveness.

Construction is completed several months later. You are pleased that the new workstation incorporates what each unit clerk included in his or her top three priorities for change. There is a new revolving chart rack in the center of the workstation, with enhanced accessibility to both staff and unit clerks. A new state-of-the-art, call-light system has been installed. A small, quiet room has been created for nurses to chart and conference, and new cubbyholes and filing drawers now put forms within arm’s reach of the charge nurse and unit clerk.

Almost immediately, you begin to be barraged with complaints about the changes. Several of the unit clerks find the new call-light system’s computerized response system overwhelming and complain that patient lights are now going unanswered. Others complain that with the chart rack out of their immediate work area, charts can no longer be monitored and are being removed from the unit by physicians or left in the charting room by nurses. One unit clerk has filed a complaint that she was injured by a staff member who carelessly and rapidly turned the chart rack. She refuses to work again until the old chart racks are returned. The regular day-shift unit clerk complains that all the forms are filed backward for left-handed people and that after 20 years, she should have the right to put them the way that she likes it. Several of the nurses are complaining that the workstation is “now the domain of the unit clerk” and that access to the telephones and desk supplies is limited by the unit clerks. There have been some rumblings that several staff members believe that you favored the requests of some employees over others.

Today, when you make rounds at change of shift, you find the day-shift unit clerk and charge nurse involved in a heated conversation with the evening-shift unit clerk and charge nurse. Each evening, the charge nurse and unit clerk reorganize the workstation in the manner that they believe is most effective, and each morning, the charge nurse and unit clerk put things back the way they had been the prior day. Both believe that the other shift is undermining their efforts to “fix” the workstation organization and that their method of organization is the best. Both groups of workers turn to you and demand that you “make the other shift stop sabotaging our efforts to change things for the better.”

ASSIGNMENT:

Despite your intent to include subordinate input into this planned change, resistance is high and worker morale is decreasing. Is the level of resistance a normal and anticipated response to planned change? If so, would you intervene in this conflict? How? Was it possible to have reduced the likelihood of such a high degree of resistance?

The Nursing Profession and Change

ASSIGNMENT:

If professions were classified in a manner similar to organizations, do you believe that the nursing profession would be classified as (a) an aging organization, (b) in constant motion and ever renewing, or (c) a closed system that does not respond well to change?

Overcoming Resistance to a Needed Change

You are the charge nurse of a medical/surgical unit. Recently, your hospital have spent millions of dollars to implement a bedside medication verification (BMV) system to reduce medication errors and to promote a culture of patient safety. In this system, the nurse, using a handheld device, scans the drug he or she is planning to give against the patient’s medication record to make sure that the right drug, at the right dose, is being given at the right time to the right patient. The nurse then scans the patient’s name band/arm band to assure the right patient is receiving the drug and finally scans his or her own name badge to document who is administering the drug to the patient. If any of the codes do not match, a signal goes off, alerting the nurse of the discrepancy.

It has come to your attention, however, that some nurses are overriding the safety features built into the barcoding system. For example, some nurses are reluctant to wake sleeping patients to scan his or her bar code before they administer an IV push medication and instead simply scan the chart label. Some nurses have overridden the bar code warning, assuming it was some kind of technological glitch. Some nurses have administered drugs to patients despite having name bands that have become smudged or torn and no longer scan well. Still, other nurses are carrying multiple prescanned pills on one tray or charting that drugs have been given, even though they were left at the bedside. Finally, you learned that one nurse even affixed extra copies of her patient’s bar codes to her clipboard, so that they could be scanned more quickly.

ASSIGNMENT:

Despite thorough orientation and training regarding BMV, it is clear that some staff have developed “work-arounds” to the barcoding system, increasing the risk of medication errors and patient harm. Your staff suggest that although they understand bedside medication verification or BMV reduces risks to patients, that the equipment does not always work, and that performing the additional safety checks often takes them more time than how they did it in the past, ultimately delaying medications to patients who need them. The staff states they will try to be more careful in implementing the bedside medication verification procedures, but you continue to sense resistance on their part. What strategies could you employ now to foster refreezing of the new system? Would rational–empirical, power–coercive, or normative–reeducative strategies be more effective? Provide a rationale for your choice.

Citation listed below

Marquis, B. L., & Huston, C. J. (2017). Leadership roles and management functions in nursing: Theory and application (9th ed.). Philadelphia, PA: Lippincott, Williams & Wilkin