Chapter 17

Leading Change

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Objectives

Analyze the nature and types of change in the healthcare system.

Evaluate theories and conceptual frameworks for understanding and navigating change.

Examine the use of select functions, principles, and strategies for initiating and managing change.

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Objectives (Cont.)

Formulate desirable qualities of both staff nurses and nurse leaders who are effective change agents.

Explore methods for sustaining change.

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Responsibilities of Leaders and Managers

Utilize change theory. Ensure safe and effective care during change. Serve as change manager and agent. Support staff during times of difficult

transitions.

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Responsibilities of Leaders and Managers (Cont.)

Recognize one’s own reaction to change. Assess and facilitate change at the system,

unit, team, and individual level.

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Nature of Change

Is a natural social process of altering things. Involves individuals, groups, organizations,

and society. Is constant and unavoidable.

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Characteristics of Change (Cont.)

Occurs at different speeds at both a personal and organizational level

Varies from high complexity to low complexity

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Types of Change

Planned Change – First-Order Change Unplanned – Second-Order Change

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Three Stages of Change

Unfreezing Experiencing the change Refreezing

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Linear (Planned) Change

Force field analysis Barriers Facilitators

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Two Types of Change

Linear (planned) change Nonlinear (complex) change

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Change Champions

Drive and enthusiasm Lifelong learners Good communicators Referent power

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Characteristics of Change Agents

Committed to the best way of doing things Courageous Take initiative and think outside the box Motivated Caring Humble Sense of humor

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Nonlinear (Complex) Change

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Learning Organization Disciplines

Systems thinking Personal mastery Mental models Shared vision Team learning

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Responses to Change

Human side Systems and technologic side

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Varied Reactions to Change

Type Description

Innovator Thrives on change

Early Adopter

Readily accepts change and serves as advisor about change to others

Early Majority

Prefers doing things the way they have always been done but will eventually accept new ideas

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Varied Reactions to Change (Cont.)

Type Description

Late Majority

Is openly negative and agrees to change only after most others have accepted it

Laggard Prefers traditions and openly resists change efforts

Rejector Opposes change, sabotages and develops strategies to interfere with change success

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Change Management Functions

Planning (includes assessment) Organizing Implementing

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Change Management Functions (Cont.)

Evaluating Seeking feedback

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Strategies

Approaches designed to achieve a particular purpose based on anticipation and consideration of myriad human, technologic, and system responses.

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Strategies (Cont.)

Listen Establish connection with staff Build trust Dialogue Empower

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Strategies (Cont.)

Facilitate Cooptate Coerce Manage information Manage relationships

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Self-Assessment: Are You Receptive to Change?

I enjoy learning about new ideas and approaches.

Once I learn about a new idea or approach, I begin to try it right away.

I like to discuss different ways of accomplishing a goal or end result.

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Self-Assessment: Are You Receptive to Change? (Cont.)

I talk over my ideas for change with my peers.

I volunteer to be at meetings when changes are being discussed.

I discuss my ideas for change with my family.

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Tips in Leading Change

Lead Relationships Serve as a coach and a guide Develop awareness of interdependencies Foster trust Promote openness

Lead Processes Serve as a facilitator Solve process problems Lead with the team

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Tips in Leading Change (Cont.)

Lead Culture Endorse the behavior you want Promote accountability Reward best practices Empower staff Keep the patient at the center

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Discussion

From the perspective of a manager applying a change process, consider the manager’s and the clinical educator’s responsibility to orient two nurses to staff a new infusion center for a small community hospital, and identify the appropriate functions.

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Make Change Happen!

Recognize when change is needed. Be proactive. Know how you react to change. Expect people to respond to change

differently. Be prepared for change.

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