Lippit’s Change Theory

Candace CreeseWilmington University

Lippitt’s, Watson and Wesley-1958

• The Seven phases of change elaborated on Lewin's Three Step Change Theory

• The seven step theory is to focus on the role as a change agent throughout the evolution of change

• The key to change is having the right person to be the voice of change and the support for the change; empowering the process.

Lewin’s Three Step Change Theory

The process of changing the behaviors of an individuals resistance to a change in any situation.– Unfreeze- shifting the “push-pull” relationship of

opposing forces to status quo.–Movement- the status quo is the equilibrium and

this step is to increase the level of equilibrium.– Refreezing- after the implementation of change,

this step is necessary to make the change “stick”

Seven Phases of Change These phases shift the change process to include the role of a change

agent through the evolution of the change.• Phase 1:Diagnose the problem• Phase 2:Assess the motivation and capacity for change• Phase 3:Assess the resources and motivation of the change

agent(commitment the change, power, and stamina)• Phase 4:Define progressive stages of change• Phase 5:Ensure the role and responsibility of the change agent is

clear and understood (communicator, facilitator, and subject matter expert.

• Phase 6:Maintain the change through communication, feedback, and group coordination

• Phase 7:Gradually remove the change agent from the relationship, as the change becomes part of an organizational culture.

ResearchPsychiatric nurses were asked to self-reflection on orientation

of action toward change– Results yielded an outcome that nurses were either

enthusiastic, hesitant, or withdrawn about changing practices to patient-centered care on the admission unit of a psychiatric hospital.

Chief executive officers of hospitals were surveyed on the process of change at their facilities to reduce cost and maintain quality care within the organization.– With the economic crisis we are in today, many hospitals are

facing the same concern. Although the research yielded some limitations with the research, it showed the need for the change process to relieve the financial burden on hospitals to maintain high quality care on a budget.

Research

It has been used to enhance scope of practice in nurses at a time when there is a workforce shortage in the healthcare profession. The need to ensure organizational readiness for change to broaden practice roles.– Public health nurses seem to take on larger roles

and responsibilities because of the heavy work load to meet the needs of ill population, workforce demands and expectations.

Nursing Practice• Nursing leadership and management is the effective

“change agent” needed for the evolvement of change in the nursing profession. Lippitt’s phases can be used in nursing practice especially with the advancement in technology, the nature of healthcare organizations, and professional standards. The style, policies, procedures, relationships with subordinates and behaviors of a nurse manager have to be evaluated to suit the new breed of nurses. Although we experience change everyday, nurses have a difficult time embracing “planned” change. Nursing leadership must be a person who is influential to support and encourage success is the process of change.

Nurse Leadership and Management• Phase 1:Envolving all parties involved in the change that will occur (scheduling,

charting, standards for practice, etc.)• Phase 2:Discussing the pro’s and con’s and the process of the change, conducting

small group activities to assess the motivation of the participants. (this can predetermine the possible confrontation or conflict involved and allow the change agent to modify the approach of the change.

• Phase 3: the manager must have the desire to improve the situation and the approach to the process. (open mindedness and personal acceptance of the change)

• Phase 4:detailed planning, timetables and deadlines must be addressed, and designating responsibilities to implement the change that will occur.

• Phase 5:handeling personal conflicts and confrontation, from employees, about the change.

• Phase 6: Providing communication and feedback• Phase 7: this phase is when the change is implemented and the procedures and

policies are written to assure compliance with the change, and a termination date for the change agent is determined. The change agent will remain available for advice and reinforcement of the change but will turn over the responsibility of the change to the employees or participants.

My Practice• As nurses we often experience continual change especially as the

profession of nursing advances. The change to computerized charting was met with resistance by many nurses, as we strived to validate how the process would falter; to justify keeping things the way they are. The change was a smooth success and as I reflect back, I can recall the phases.

P1: Every employee was notified of the change and how it would affect them.P2: Each unit had a meeting to discuss how they felt about the changeP3: It was evident that the change agent (for me was my manager and educator)

was dedicated to the change being successful.P4: Responsibilities were designated to staff to be “super users”, well educated

about the system to support the staff in the change.P5: My manager addressed all concerns of the nurses on the unit and advocated

for the system to be personalized to our unit to enhance functionality for the population of patients we care for.

P6: Continually surveying the staff to see what we do/do not like about the system and adjusting screens and tabs to make the charting easier.

P7: For the first six weeks we had tech support and the builders of the program on hand , on every unit. Now they are reachable by telephone if help is needed.