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PRESENTED BY:
Learning Objectives:
At the end of the report, the learners shall be able to: define what is change. identify the forces of change. differentiate the views of the change process. discuss organizational inertia and resistance to change. enumerate the techniques for managing change. be aware of the contemporary issues and know how to manage change. distinguish ways in stimulating innovation.
What is Change?
NOTHING IS PERMANENT BUT CHANGE. - HERACLITUS (C. 500 BC)
managing change and innovation did not always fit comfortably together. Thats not surprising. Managers are people who like order. They like forecasts to come out as planned. In fact, managers are often judged on how much order they produce. Innovation, on the other hand is often a disorderly process. Many times, perhaps most times, innovation does not turn out as planned. As a result, here is tension between managers and innovation. -Lewis Lehro (about the first years at Minnesota Mining and Manufacturing)
I cant understand why people are frightened of new ideas. Im frightened of old ones. - John Cage
Change fosters growth and innovation; progress cannot occur without change. The ability to create and manage meaningful change is an essential skill for nurses in the 21st century. If nurses are to be leaders of change, it is imperative that they understand the changes occurring in the health-care arena, use political clout to have a hand in the changes, and master the change process. - Rebecca A. Jones
Change
Means to be different, to cause to be different or to
alter Process of making something different from what it was Is inevitable, if not always welcome Is necessary for growth, although it produces anxiety and fear May be personal or organizational Can occur suddenly or incrementally Can be macro or micro change May be planned or unplanned
Unplanned Change
Also called reactive change, accidental change or
change by drift Usually occurs suddenly and in response to some event or set of circumstances For example: an unanticipated rise in patient census may precipitate the need for a change in patient assignments. Decisions are made and change follows as a reaction to an event.
Planned Change
Entails planning and application of strategic actions
For
example, changing staffing patterns from extensive use of unlicensed personnel to an allprofessional staff requires time and planning.
Planned Change
More likely to occur incrementally, over time Responds to anticipated events in the environment
or community
Deliberate application of knowledge and skills by a
Change Agent
One who generates ideas, introduces the innovation,
and works to bring about the desired change A person skilled in the theory and implementation of planned change One who works to bring about a change
In organizational planned change, the manager is
Change Agent
The individual or group that seeks to lead change May be from inside or outside the organization May have formal lines of authority or may be
informal leaders In either case, the change agent is responsible for moving those affected by the change through the process and implementing the change.
Change Agent
Effective change agents are masters of change.
They do three things correctly: 1. they sense the right moment to initiate the plan, 2. they find supporters for their ideas, and 3. they have vision (Bruning, 1983).
Change Agent
The successful change agent earns the respect and
trust of the target system (individuals, groups, or organizations) by communicating openly and honestly, offering assistance, and demonstrating ability.
A change agents success depends on communication
style, interpersonal skills and expert power. Ongoing communication is integral to the role of the change agent.
Forces of Change
INTERNAL OR EXTERNAL DRIVING AND RESTRAINING
status quo or equilibrium by the simultaneous occurrence of both driving forces (facilitators) and restraining forces (barriers) operating within any field.
the balance of driving and restraining forces must be altered. The driving forces must be increased or the restraining forces decreased.
INNOVATIONS
COMFORT ZONE
DISCOMFORT ZONE
theory to a seven-step process and focused more on what the change agent must do than on the evolution of change itself.
They emphasized participation of key members of
the target system throughout the change process, particularly during planning. Communication skills, rapport building and problem-solving strategies underlie their phases.
HAVELOCKs Model
Havelock (1973) described a six-step process also a modification of Lewins model. Unfreezing a. Building a relationship b. Diagnosing the problem c. Acquiring resources Moving d. Choosing the solution e. Gaining acceptance Refreezing f. Stabilization and self-renewal
Lippitt
1. Diagnose problem 2. Assess motivation 3. Assess change agents motivations and resources 4. Select progressive change objects 5. Choose change agent role 6. Maintain change 7. Terminate helping relationships
Havelock
1. Building a relationship 2. Diagnosing the problem 3. Acquiring resources 4. Choosing the solution 5. Gaining acceptance 6. Stabilization and self-renewal
Rogers
1. 2. 3. 4. 5. Knowledge Persuasion Decision Implementation Confirmation
Shared Vision
Discipline 4: Team
personal vision Building an internal picture of the world; the lens through which the world is viewed Translating personal vision into a collective vision and developing a culture of common caring Fostering shared, participative decision making Shifting from fragmentation to holism
Chaos Theory
Chaos actually has an order. Changes that seem to occur at random are, in reality,
interrelated behaviors.
Organizational Inertia
is the tendency of a mature organization to continue
Organizational Inertia
two elements - resource rigidity and routine rigidity
1. Resource rigidity - stems from an unwillingness to invest - relates to the motivation to respond 2. Routine rigidity - stems from an inability to change the patterns and logic that underlie those investments - relates to the structure of that response.
Organizational Inertia
discontinuous change is often thought to be the impetus necessary to prompt organizational change, a change in inertia, by decreasing the current inertia through changes in resources and routines.
While threat perception is a response catalyst, it has
been found to decrease inertia in some cases, a good thing, but increase inertia in other cases.
Resistance to Change
Resistance almost always accompanies change
proposed.
Resistance to Change
Nursing leaders also must recognize that
subordinates values, educational levels, cultural and social backgrounds, and experiences with change (positive and negative) will have a tremendous impact on the degree of resistance. It is easier to change a persons behavior than an entire groups behavior. It is easier to change knowledge levels than attitudes.
All major change takes time.
Resistance to Change
Pesut (2000) classifies individuals in response to their propensity to seek change:
Crusaders are change agents who see problems in
the present and want to make things better for the future.
Tradition bearers are the preservers of what is best
Sources of Resistance
Technical Concerns Psychosocial Needs Threat to persons Position and Power Perhaps the greatest factor contributing to the
resistance encountered with change is lack of trust between the employee and the manager or the employee and the organization.
Recognizing Resistance
PASSIVE Avoiding discussion Ignoring the change Refusing to commit to the change Organizing resistance of other Agreeing but not acting people
Recognizing Resistance
Statements of Resistance: We tried that before. It wont work. No one else does like that. Weve always done it this way. We cant afford it. We dont have the time. It will cause too much commotion. Youll never get it past the board.
Recognizing Resistance
Statements of Resistance: Lets wait a while. Every new boss wants to do something different. Lets start a task force to look at it; put it in the agenda.
interest level high and establish why change is necessary A stimulant as much as it is a force to be overcome Motivates the group to do better what it is doing now, so that it does not have to change
the implementation phase Wears down supporters Redirects system energy from implementing the change to dealing with resisters Morale can suffer.
Recognizing Resistance
resisters. Look for nonverbal signs of resistance, such as poor work habits and lack of interest in the change. Once resistance has been recognized, action can be taken to lower it or even eliminate it.
Lowering Resistance
Information dissemination Disconfirmation of currently held beliefs Provision of psychological safety
Command
Three classic strategies for effecting change in others were described by Bennis, Benne and Chinn (1969).
research as evidence to support change) and reason change agent assumes that resistance to change comes from lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change (justification) and in their self-interest used when there is little anticipated resistance to the change or when the change is perceived as reasonable
relationships Takes into account social and cultural implications of change Based on the assumption that group norms are used to socialize individual Requires winning over those affected by the change Success is often relationship-based
authority, economic sanctions, or political clout and control Change agent orders change and those with less power comply Useful when a consensus is unlikely despite efforts to stimulate participation by those involved, when much resistance is anticipated, time is short and the change is critical for organizational survival
short-lived if people have not embraced the need for the change through some other mechanism.
BARRIER
Desire to remain in our comfort zone. Inadequate access to information. Lack of shared vision. Lack of adequate planning. Lack of trust.
STRATEGY
Rational-empirical Rational-empirical Normative-re-educative Rational-empirical & Normative-re-educative Rational-empirical & Normative-re-educative
Resistance to change.
Normative-re-educative
Poor timing or inadequate time planned. Good timing Fear that power, relationships, or control Normative-re-educative will be lost Even when change is desirable, the amount of personal energy required for the change to occur is doomed to be great. Good timing
Contemporary Issues
Rising health care costs
- External pressure exerted by federal and state governments, insurance companies, employees, labor unions and the public to control spending and redirect health care from expensive inpatient care to more cost-effective outpatient care
Declining reimbursement
- major payors of health care are pressuring for better management of resource consumption
Contemporary Issues
Workforce shortages
Increasing technology
Information availability Growing elderly population
Contemporary Issues
Burritt (2005) suggests that these dynamic forces
have led to a progressive destabilization in some health care organizations to such an extent that they threaten viability.
The reality then is that todays health care agencies
are continually instituting change to upgrade their structure, promote greater quality, and keep their workers.
Contemporary Issues
Today,
most health care organizations find themselves undergoing continual change directed at organizational restructuring, quality improvement, and employee retention.
Institutionally based
Mobility based or
care Process oriented Procedurally driven Based on mechanical and manual intervention
multisettings Outcome driven Best practice oriented Emphasized by technology and minimally invasive intervention
Provider driven
User driven
Treatment based
Reflective of late stage
Health based
Geared for early
Stimulating Innovation
INNOVATION
The introduction of something new Result of creativity In nursing service organizations, it is the key to
survival and growth in nursing and health care A way to gain personal satisfaction, rewards and recognition while organization survives, thrives and prospers Ex. Brgy. Tanod Program/System; NBS (Piso sa Bata)
forces Provide time for individual effort Provide opportunity for professional growth Encourage interaction with others outside the group Promote constructive intragroup and intergroup competition
Learning Exercises:
Identify a change that you would like to make in your personal life (such as losing weight, exercising daily, or 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.
Learning Exercise:
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?
References:
BOOKS: Jones, Rebecca A. (2007). Nursing Leadership and Management: Theories, Processes and Practice, International Ed. Philadelphia, PA: F.A. Davis Company. pp. 167-181. Marquis, Bessie L. & Carol J. Huston. (2009). Leadership Roles and Management Functions in Nursing: Theory and Application, 6th Ed. Philadelphia, PA. Lippincott Williams & Wilkins. pp. 166-180. Sullivan, Eleanor J. & Phillip J. Decker. (1997). Effective Leadership and Management in Nursing, 4th Ed. CA, USA: Addison Wesley Longman, Inc. pp. 265-281. Tappen, Ruth M. Weiss, Sally A. & Diane K. Whitehead. (2001). Essentials of Nursing Leadership and Management, 2nd Ed. Philadelphia, PA: F. A. Davis Company. pp. 111-119.
References:
INTERNET:
Innovation. Retrieved Aug. 12, 2011 @ 6:00 PM. Available: http://innovationzen.com/blog/2006/ 11/17/the-definition-of-innovation/. Organizational Inertia. Retrieved Aug. 12, 2011 @ 6:10 PM. Available: http://createadvantage.com /glossary/organizational-inertia.