PLANNED CHANGE
MARQUIS CHAPTER 8
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DIRECTION OF CHANGE IN 21ST CENTURY HEALTH-CARE
ORGANIZATIONS
Organizational restructuring
Quality improvement
Employee retention
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QUALITIES OF CHANGE AGENTS
Visionary
Risk taker
Flexible
Excellent communicator
Creative
Sensitive
Current
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KURT LEWIN’S CHANGE THEORY
Unfreezing: The change agent convinces members of the group to
change or guilt, anxiety, or concern are elicited.
Movement: The change agent identifies, plans, and implements
appropriate strategies, ensuring that driving forces exceed
restraining forces.
Refreezing: The change agent assists in stabilizing the system
change so that it becomes integrated into the status quo.
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LEWIN’S DRIVING AND RESTRAINING FORCES
Driving (facilitators): forces that push the system toward change
Restraining (barriers): forces that pull the system away from change
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DRIVING AND RESTRAINING FORCES (GOAL: RETURN
TO SCHOOL)
Forces driving to reach the Forces restraining from
goal reaching the goal
• Opportunity for • Low energy level
advancement
• Limited financial resources
• Status, social gratification
• Unreliable transportation
• Enhanced self-esteem
• Time with family already
• Family supportive of efforts
limited
• Pay increase
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LEWIN (1951) IDENTIFIED SEVERAL RULES THAT SHOULD
BE FOLLOWED IN IMPLEMENTING CHANGE
Change should only be implemented for good reason.
Change should always be gradual.
All change should be planned and not sporadic or
sudden.
All individuals who may be affected by the change
should be involved in planning for the change.
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STAGES OF CHANGE MODEL (PROCHASKA AND DICLEMENTE 1970’S)
Stage 1: Precontemplation No current intention to change
Stage 2: Contemplation Individual considers making a
change.
There is intent to make a change
Stage 3: Preparation
in the near future.
Individual modifies his or her
Stage 4: Action behavior.
Change is maintained and
Stage 5: Maintenance relapse is avoided.
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TTM: STAGES OF CHANGE
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TTM: DECISIONAL BALANCE
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TTM: DECISIONAL BALANCE
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TTM: 10 PROCESSES OF CHANGE
Processes of Change: Experiential Processes of Change: Behavioral
1. Consciousness Raising [Increasing 6. Stimulus Control [Re-engineering]I
awareness]I recall information people had remove things from my home that
given me on how to stop smoking remind me of smoking
2. Dramatic Relief [Emotional arousal]I react
emotionally to warnings about smoking
7. Helping Relationship [Supporting]I have
cigarettes someone who listens when I need to talk
about my smoking
3. Environmental Reevaluation [Social
reappraisal]I consider the view that 8. Counter Conditioning [Substituting]I find
smoking can be harmful to the environment that doing other things with my hands is
4. Social Liberation [Environmental a good substitute for smoking
opportunities]I find society changing in 9. Reinforcement Management
ways that make it easier for the nonsmoker [Rewarding]I reward myself when I
5. Self Reevaluation [Self reappraisal]My don’t smoke
dependency on cigarettes makes me feel
10. Self Liberation [Committing] I make
disappointed in myself
commitments not to smoke
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CLASSIC CHANGE STRATEGIES
Rational–empirical strategies: used when there is little anticipated
resistance to the change or when the change is perceived as
reasonable
Normative–reeducative strategies: use group norms and peer
pressure to socialize and influence people so that change will
occur
Power–coercive strategies: feature the application of power by
legitimate authority, economic sanctions, or political clout of the
change agent
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QUESTION
A nurse-manager is attempting to restructure the unit to prevent
understaffing of the nurses. The nurses agree this is a needed change.
What type of change strategy would be most effective?
A. Rational–empirical strategies
B. Normative–reeducative strategies
C. Power–coercive strategies
D. None of the above
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ANSWER
A. Rational–empirical strategies
Rationale: When using rational–empirical strategies, the change agent
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.
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REMINDER
Because change disrupts the homeostasis or balance of the group,
resistance should always be expected.
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COMPLEX ADAPTIVE SYSTEMS CHANGE THEORY
CAS Theory: Identifying patterns that are emerging from
randomness
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
Olson and Eoyang (2001) suggest that the self-organizing nature
of human interactions in a complex organization leads to
surprising effects.
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CHARACTERISTICS OF COMPLEX SYSTEMS
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COMPLEX ADAPTIVE SYSTEM CHANGE THEORY
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COMPLEX ADAPTIVE SYSTEM CHANGE THEORY AS IT
RELATES TO NURSING
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CHAOS THEORY
Really about finding the underlying order in apparently random
data
Determining this underlying order, however, is challenging, and
the order itself is constantly changing.
Changes in outcomes are not proportional to the degree of change
in the initial condition.
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ORGANIZATIONAL AGING
Organizations progress through developmental stages.
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.
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QUESTION
Tell whether the following statement is true or false:
The young organization is characterized by low energy and
resistance to change.
A. True
B. False
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ANSWER
B. False
Rationale: The young organization is characterized
by high energy, movement, and virtually constant
change and adaptation.
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Planned Change Versus Accidental
Change
Regardless of the type of change, all major change
brings feelings of achievement, pride, loss, and stress.
Planned change, in contrast to accidental change or
change by drift, is change that results from a well-
thought-out and deliberate effort to make something
happen.
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Question
Which emotions are commonly associated with change?
A. Pride
B. Stress
C. Loss
D. Achievement
E. All of the above
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Answer
E. All of the above
Rationale: Change is associated with a wide range of
feelings, some positive and others negative.
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THREE GOOD REASONS FOR CHANGE
Change to solve some problem.
Change to make work procedures more efficient.
Change to reduce unnecessary workload.
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RESISTANCE—THE NATURAL AND EXPECTED RESPONSE TO
CHANGE
Individuals’ resistance typically depends on four things:
Their flexibility to change
Their evaluation of the immediate situation
The anticipated consequences of the change
Their perceptions of what they have to lose and gain
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QUESTION
Tell whether the following statement is true or false:
For change to be effective, it should be immediate and
sweeping.
A. True
B. False
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ANSWER
B. False
Rationale: Change should be gradual and carefully
planned rather than sudden.
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QUESTION
Presenting employees with the pros and cons of a new
system to be implemented is an example of which type
of strategy?
A. Rational
B. Normative
C. Power
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ANSWER
A. Rational
Rationale: A rational change agent uses empirical reasoning
as a tool for initiating change.
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Resistance 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.
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Involvement in Change
Whenever possible, all those who may be affected
by a change should be involved in planning for that
change.
When information and decision making are shared,
subordinates feel that they have played a valuable
role in the change.
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INTEGRATING LEADERSHIP AND MANAGEMENT FUNCTIONS
IN PLANNED CHANGE
Manager: mechanic who implements the planned change
Leader: inventor or creator of the planned change
Both leadership and management skills are necessary in
planned change.
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