8/13/2019 Chapter 5 107

1/4

CHAPTER 5: INITIATING and IMPLEMENTING CHANGE

Leading change is an art .. Brnh! "##$

Changeis needed %&re in the ra'id() e*&(*ing s)ste% &+ hea(th care. ,rgani-ati&na(

change is essentia( +&r ada'tati&n. Creati*e change is %andat&r) +&r gr&th. Change is

ine*ita/(e and necessar) +&r gr&th . Change is the 'r&cess &+ %a0ing s&%ething di++erent +r&%

hat it as. Change is a c&ntina(() n+&(ding 'ractice rather than an e*ent. Th&se h& initiate

and %anage change &+ten enc&nter resistance.

Change agentis &ne h& &r0s t& /ring a/&t a change. It is n&t eas)1 it re2ires ti%e!

e++&rt and energ). A change agent can /e a r&(e %&de( +&r &thers t&ting the '&siti*e &tc&%es

&+ change. H&e*er! %anagers sh&(d n&t initiate change +&r the sa0e &+ change &r t& sh&

that the) are %anaging.

CHANGE THEORIES

3. LEWIN (1951) +&rce +ie(d %&de(1 he sees /eha*i&r as a d)na%ic /a(ance &+ +&rces&r0ing in &''&site directi&ns ithin a +ie(d

4 Driving Fore!1 +aci(itate change /ecase the) 'sh 'artici'ants in the desired

directi&n

4 Re!training Fore!1 i%'ede changes /ecase the) 'sh 'artici'ants in &''&site

directi&n

4 "#!te$ %roe!!& Unfreezing, Moving, Freezing.

". LI%%IT an' oeage! (195*) +&csed %&re &n hat the change agent %st d& than

&n the e*&(ti&n &+ change itse(+. The) e%'hasi-ed 'artici'ati&n &+ 0e) %e%/ers &+ thetarget s)ste% thr&gh&t the change 'r&cess. C&%%nicati&n s0i((s! ra''&rt /i(ding!

'r&/(e% s&(*ing strategies nder(ie their 'hases

4 %ha!e!1 Diagnose Problem, Assess motivation, Assess change agents

motivations and resources, Select progressive change obects, !hoose

change agent role, Maintain change, "erminate helping relationships.

. HA+ELOC, (19-") descri/es an acti*e change agent as &ne h& ses a 'artici'ati*e

a''r&ach

4 .4!te$ %roe!!& #uilding a relationship, Diagnosing the problem, A$uiring

resources, !hoosing the solution, %aining acceptance, Stabilization and self&

rene'al

$. ROGERS (19*") E%'hasi-es the re*ersi/(e natre &+ change. 6e) 'e&'(e and '&(ic)

%a0ers %st /e interested in the inn&*ati&n and c&%%itted t& %a0ing it ha''en.

4 5#!te$ %roe!!& (no'ledge, Persuasion, Decision, )mplementation,

!onfirmation

8/13/2019 Chapter 5 107

2/4

THE CHANGE %ROCESS

ASS*SSM*+"

4 7ata c&((ecti&n and ana()sis +&r '(anned change t& 'r&ceed.

identif the problem or the opportunit

4 ,''&rtnities de%and change as %ch as 'r&/(e%s d&! the) %st /e identi+ied

c(ear().

collect data

4 The change agent c&((ects data e8terna( and interna( t& the s)ste%. A(( dri*ing and

restraining +&rces are identi+ied s& that the dri*ing +&rces can /e e%'hasi-ed and

restraining +&rces redced.

analze data

4 9(sh &t resistance! identi+) '&tentia( s&(ti&ns and strategies! /egin t& identi+)

areas &+ c&nsenss! and /i(d a case +&r hich &'ti&n is se(ected. tatistica( ana()sis

sh&(d /e %ade hene*er '&ssi/(e es'ecia(() i+ change agents need t& 'ersade

'e&'(e in '&er.

P-A++)+%

4 P(anning the h&! h& and hen &+ the change is a 0e) ste'. Lein;s n+ree-ing

i%ager) is re(e*ant here. Present attitdes! ha/its! and a)s &+ thin0ing ha*e t&

s&+ten s& %e%/ers &+ the target s)ste% i(( /e read) +&r ne a)s &+ thin0ing and

/eha*ing. This is the ti%e t& %a0e 'e&'(e nc&%+&rta/(e ith the stats 2&.

)MP-*M*+"A")+

4 P(ans are 't int& %&ti&n

Methods to change individuals

4 Pr&*iding in+&r%ati&n d&es n&t address the %&ti*ati&n t& change. Training is

c&nsidered a %eth&d t& change indi*ida(s. It c&%/ines in+&r%ati&n gi*ing ith s0i((

'ractice. e(ecting and '(acing 'ers&nne( &r ter%inating 0e) 'e&'(e &+ten is sed t&

a(ter the +&rces +&r &r against change

Methods to change groups

4 The greatest in+(ence is achie*ed hen gr&' %e%/ers discss isses that are

'ercei*ed as i%'&rtant and %a0e re(e*ant! /inding decisi&ns /ased &n th&se

discssi&ns.

*/A-UA")+

8/13/2019 Chapter 5 107

3/4

*valuate effectiveness

4 The change agent deter%ines hether 'res%ed /ene+its ere achie*ed.

Stabilize the change

4 The target s)ste% is re+r&-en.

CHANGE STRATEGIES

3. %OWER#COERCI+E STRATEGIES are /ased &n the a''(icati&n &+ '&er /)

(egiti%ate ath&rit)! ec&n&%ic sancti&ns! &r '&(itica( c(&t. Changes are %ade

thr&gh thr&gh (a! '&(ic)! &r +inancia( a''r&'riati&ns.

". E/%IRICAL#RATIONAL /ODEL the '&er ingredient is 0n&(edge. Pe&'(e arerati&na( and i(( +&((& their rati&na( se(+ interest i+ that se(+ interest is %ade c(ear t&

the%.

. NOR/ATI+E4REED0CATI+E STRATEGIES Pe&'(e act &n acc&rdance ith

s&cia( n&r%s and *a(es. Pe&'(e;s r&(es and re(ati&nshi's! 'erce'ta( &rientati&ns!

attitdes! and +ee(ings i( in+(ence their acce'tance t& change.

RESISTANCE to CHANGE

Resistance is e8'ected /ecase &+1 (ac0&+ trst! *ested interest in the stats 2&! +ear &+ +ai(re!

(&ss &+ stats &r inc&%e! %isnderstanding! and /e(ie+ that change is nnecessar) &r that it

&(d n&t i%'r&*e the sitati&n.

4 )nnovators0 (&*e change and thri*e &n it

4 *arl adopters1 rece'ti*e t& change

4 *arl maorit1 're+ers the stats 2&! /t e*enta(() acce'ts change

4 -ate maorit1 resisti*e! acce'ting change a(ter %&st &ther ha*e

4 -aggards1 dis(i0e change and are &'en() antag&nistic

4 1eecters1 acti*e() &''&se and %a) sa/&tage change

Resistance 're*ents the nacce'ted. It +&rces the change agent t& c(ari+) in+&r%ati&n! 0ee'

interest (e*e( high! and esta/(ish h) change is necessar). H&e*er! it can ear d&n

s''&rters and redirect s)ste% energ) +r&% i%'(e%enting the change t& dea(ing ith resisters.

THE N0RSES ROLE 2 INITIATING CHANGE

8/13/2019 Chapter 5 107

4/4

#A 'artnershi' /eteen sta++ and ad%inistrati&n id %&re e++ecti*e in 'r&dcing change

than the traditi&na( t&'4d&n a''r&ach. Ma0ing change is n&t eas) /t it is a %andat&r) s0i(( +&r

%anagers. Energ) is needed t& change a s)ste%. In+&r%ati&na( '&er! e8'ertise! and '&ssi/()

'&siti&na( '&er can /e sed t& 'ersade &thers.

I/%LE/ENTING CHANGE

Planning change

4 E*er)&ne had an e2a( *&te t& a''r&*e a 'r&'&sed change

Managing "ransition to change

4 Tran!ition& th&se 'eri&ds &+ ti%e /eteen the crrent sitati&n and the ti%e hen

change is i%'(e%ented. Acce'ting (&ss and h&n&ring the 'ast ith res'ect is

essentia(.

2A+D-)+% !+S"A+" !2A+%*

&Change has /ec&%e a n&r%. Initia( change cases a chain reacti&n &+ %&re and %&re

change. I+ )& d&n;t (i0e the crrent sitati&n! )& %a) (&&0 +&rard t& change.

I+ )& d&n;t (i0e it t&da)!