Master of Arts in Nursing Prof.

Cresencia Manlangit 1

Introduction
Change. Its inevitable. Though many people fight like mad to avoid change, they cant. If you look fifty years back at anything, it has changed many times people, fashion, cars, the street in front of your home. Like death, taxes, and time, you cant escape change. Whats really important is how you manage change. Managed well, it can be healthy for you and your company, leading to improved profit margins, happier and more productive employees, and a stable and growing company. Managed poorly, it can lead to poor morale, loss in production, and ultimately the possibility of bankruptcy or selling out. No wonder so many people are afraid of change! The first thing you need to determine is what in your company will be changing. Are you downsizing? Outsourcing? Changing your IT system? Reorganizing the company? Selling it to another company outright? Or are you expanding the company? Expansion and profit can be just as stressful as downsizing and bankruptcy. Once you know all the major types of change your company will be undergoing, you should brainstorm all the different items youll need to address: accounting changes, human resources changes, laying off or hiring employees, changing locations, spreading yourself and your employees thinner. Once you have a good grasp on what you expect to see changing in your company (and that is expect because your list is never, ever quite

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accurate! It changes.) youre ready to start introducing your upper-level management staff to the details of whats going on. They already know that change is coming, whether you tried to keep it secret or not. When you change anything about your company, you will need a team of advocates. You know the compelling reasons you need to change; now you need to teach your management team how to handle these transitions and ensure that all problems are addressed smoothly. Change is hard. Sometimes its easier to hear the news from someone you dont work with every day. And because you are certain to be emotionally vested in your company, you may not be able to clearly explain what you expect from the coming changes. Next, listen to your management team, and listen carefully. They will see problems with, ramifications of, and improvements on your change management plan that would never occur to you. At the end of your introduction to change management session, have an intense and relaxed brainstorming meeting. Put papers up all around your conference room, and encourage people to list issues. Encourage creative thinking. Talk about how each department will influence the next one. Think about the companys shareholders, if you have public stock. And think about the reactions of your employees. Some will embrace change. Others will dig in and do everything they can to keep things the same. You may have union issues or other special organizational problems. The most important thing you can do with this session is get a handle on how things may need to be addressed.
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Once youve outlined the change youre expecting, you should organize a team to implement your companys changes. Your smooth transition will only be as smooth as your transitional team can make it. The obvious source for most of your transition team is your human resources department, but dont limit yourself. You may have staff who have shown themselves to be more capable managers during times of change, and you should have a voice from each department on the team. Dont forget your non-management staff, either; they will be able to give you insights into morale and everyday efficiency that will prove invaluable during the stresses involved in introducing change to your company.

Change management

is

structured

approach

to

shifting/transitioning individuals, teams, and organizations from a current state to a desired future state. It is an organizational process aimed at empowering employees to accept and embrace changes in their current business environment. In project management, change management refers to a project management process where changes to a project are formally introduced and approved.

Examples of Organizational Change 1. Missionary changes 2. Strategic changes

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3. Operational changes (including Structural changes) 4. Technological changes 5. Changing the attitudes and behaviors of personnel

As a multidisciplinary practice that has evolved as a result of scholarly research, Organizational Change Management should begin with a

systematic diagnosis of the current situation in order to determine both the need for change and the capability to change. The objectives, content, and process of change should all be specified as part of a Change Management plan.

Change Management processes may include creative marketing to enable communication between change audiences, but also deep social

understanding about leaderships styles and group dynamics. As a visible track on transformation projects, Organizational Change Management aligns groups expectations, communicates, integrates teams and manages people training. It makes use of performance metrics, such as financial results, operational efficiency, leadership commitment, communication

effectiveness, and the perceived need for change to design appropriate strategies, in order to avoid change failures or solve troubled change projects.

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Successful change management is more likely to occur if the following are included: 1. Benefits management and realization to define measurable

stakeholder aims, create a business case for their achievement (which should be continuously updated), and monitor assumptions, risks, dependencies, costs, return on investment, dis-benefits and cultural issues affecting the progress of the associated work. 2. Effective Communications that informs various stakeholders of the reasons for the change (why?), the benefits of successful

implementation (what is in it for us, and you) as well as the details of the change (when? where? who is involved? how much will it cost? etc). 3. Devise an effective education, training and/or skills upgrading scheme for the organization. 4. Counter resistance from the employees of companies and align them to overall strategic direction of the organization. 5. Provide personal counseling (if required) to alleviate any change related fears. 6. Monitoring of the implementation and fine-tuning as required.

The Nature of Change Change any alteration occurring in the work environment that affects the ways in which employees must act.
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May be planned or unplanned, catastrophic or evolutionary, positive or negative, strong or weak, slow or rapid, stimulated internally or externally Regardless of source, nature, origin, pace, or strength, the whole

organization tends to be affected by change in any part of it Change is a human as well as a technical problem Can be compared to an air-filled balloon

Equilibrium in social structure a state of relative balance between opposing forces. Established when people develop a relatively stable set of relations with their environment (learn how to deal with one another, how to perform their jobs, what to expect next) Equilibrium exists; employees are adjusted. When change comes along, adjustments are required as the

organization seeks a new equilibrium Inability of employees to adjust causes disequilibrium; the organization is in state of unbalance

Managers Roles Proactive to introduce continual organizational changes to bring about a better fit between the firm and its environment (anticipate events, initiate changes, take control of organizations destiny)
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Reactive to restore and maintain group equilibrium (respond to events, adapt to changes, tempering consequences of change) Responses to Change Work change does not produce direct adjustment It operates through each employees attitudes to produce a response that is conditioned by feelings toward the change.
Hawthorne studies, conducted by F.J. Roethlisberger proved the

theory that better lighting would lead to greater productivity. However, when lighting was decreased, there was no proportional decrease in productivity up to a certain level; employee attitudes proved as the intervening variable. The way that people feel about a change is one factor that determines how they will respond to it

Unified Social Response to Change

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Hawthorne Effect observation affects behavior. When people

are observed, or believe that someone cares about them, they act differently.
Group response to change We are all in this together.

Whatever happens to one of us affects us all. based on the social needs of man.
Homeostasis the self-correcting mechanism or characteristic

of organizations by which energies are called up to restore balance whenever change threatens.

Cost and benefits All changes have some costs. Economic costs (monetary terms) Social costs (adjustments in organizational relationships) Psychological or Psychic costs (emotional & physical stress) Before changes are implemented, an analysis of the benefits

(economic, social and psychic benefits) must be done to ensure that all benefits outweigh all costs. People will react in different and widely varying ways to change.

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20-50-30 rule: 20% receptive, 50% neutral; 30% close-minded and resistant Challenge for managers: to transform 80% (neutral & resisters) into supporters of the change Consists of any employee behaviors designed to discredit, delay, or prevent the implementation of a work change. Reasons for resistance threats to their needs for security, social interaction, status, competence, or self-esteem Other causes of resistance: Org. cultures that overvalue criticism of new ideas Employees who mouth support in public but undercut changes behind the scenes Indecisive ,managers who suffer from analysis paralysis Emphasis on flashy proposals instead of follow-through Bunker mentality where employees ignore changes because the organizational crisis is not significant. All types of employees tend to resist change because of the psychic costs that accompany it. The tendency for resistance is offset by the desire to for new experiences and for the rewards that come with change.

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Master of Arts in Nursing Prof. Cresencia Manlangit 10 Chain reaction effect the situation wherein a change that directly

affects one or a few persons may lead to a direct or indirect reaction from many people because of their mutual interest.

Reasons for Resistance Employees resist change because of 3 reasons:

Nature of change itself Employees are uncomfortable with the

change because it violates their moral belief system.

Method used People may resent having been ill-informed, reject an

insensitive and authoritarian approach.

Perceptions of inequity Someone else appears to gain the benefits

of the change.

Types of Resistance Three different types of resistance:

Logical resistance based on disagreement with facts, rational

reasoning, logic, and science. (time required to adjust, extra effort to relearn, skills downgrading, economic costs, questioned technical feasibility of change)
Psychological resistance based on emotions, sentiments, and

attitudes

(fear

of

the

unknown,

low

tolerance

for

change,

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dislike/mistrust of management, lack of trust in others, need for security/ status quo)
Sociological resistance challenges to group interests, norms, and

social values (political coalitions, opposing group values, parochial, narrow look, vested interests, desire to retain existing friendships)

Possible Benefits of Resistance Resistance is not all bad. Can bring a broad range of benefits. (implement better policies and systems of checks and balances) Can help identify specific problem areas where management can take corrective action Gives management information about the intensity of employee emotions on an issue Provides emotional release for pent-up employee feelings Encourage employees to think and talk more about the change so they understand it better

Transformational Leadership and Change Transformational leaders managers who initiate bold strategic changes to position the organization for its future.
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Master of Arts in Nursing Prof. Cresencia Manlangit 12 Create Vision crystallized long-range image or idea of what can and

should be accomplished which stretches people beyond their current capabilities and thinking and excites them to new levels of

commitment and enthusiasm.

Communicate

Charisma leaders have 2 tasks: to persuade

employees that the vision is urgent and to motivate them to achieve it. Charismatic leaders are dynamic risk takers who show their depth of expertise and use provocative symbols and language to inspire employees to take early and sustained action.
Stimulating Learning Transformational leaders recognize that the

legacy they leave behind is not simply the change itself but an organization that will continue to change. The critical task is to

develop peoples capacity to learn from the experience of change. This process is called double-loop learning. Such double loop learners develop the ability to anticipate problems, prevent many situations from arising, challenge their own limiting assumptions and views.

PRINCIPLES OF CHANGE MANAGEMENT Principle ONE Different people react differently to change The following diagram represents a spectrum of change: Stability - - - - - - - - - - - - - - - - Change
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Different people have different preferences for where they like to be on this spectrum. Some people like to be at the STABILITYend of the spectrum they like things to be the way they have always been. Other people like to be at the CHANGE end of the spectrum - they are always looking for something different and new. Problems arise when the individual's preferences differ from the situation they find themselves in. That is, if:

a stability-oriented person finds that circumstances are changing quite rapidly, or

a change-oriented person finds that everything is the same and there is nothing new

In these situations, the individuals involved can experience:

strong disatisfaction stress negative attitudes towards individuals with preferences at the other end of the spectrum (eg: distrust, dislike)

resistance (to change, or to the status quo) intense emotions loss of rational judgement

People tend to resist, therefore, approaches on other parts of the spectrum than where they themselves prefer to be.

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Principle TWO Everyone has fundamental needs that have to be met A famous psychologist called Will Schutz identified three basic needs that people have in interpersonal relations. These basic needs are also of fundamental importance in people's reaction to change:

The need for control The need for inclusion The need for openness

Whilst the need for these can vary between people, in any change process there is always some degree of need for control over one's

environment/destiny, some degree of need to be included in the process of forming the change that is taking place, and some degree of need for managers/leaders to be open with their information. If a change programme fails to meet the control, inclusion and openness needs of the individuals affected by it then that programme is likely to encounter a range of negative reactions, ranging from ambivalence through resistance to outright opposition.

Principle THREE Change often involves a loss, and people go through the "loss curve" The relevance of the "loss curve" to a change management programme depends on the nature and extent of the loss. If someone is promoted to a
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more senior position, the 'loss' of the former position is rarely an issue because it has been replaced by something better. But if someone is made redundant with little prospect of getting a new job, there are many losses (income, security, working relationships) that can have a devastating effect. There are many variations of the "loss curve". One is known as "Sarah" - that is, the individual experiences (in this order):

S-hock A-nger R-ejection A-cceptance H-ealing

The common factors amongst all "loss curves" are: 1. that there can be an initial period where the change does not sink in. For example, feelings may be kept high by the individual convincing themselves that the change is not going to happen. 2. that when the loss is realised, the individual hits a deep low. The depth of this 'low' is deepened if the loss is sudden/unexpected. 3. that the period of adjustment to the new situation can be very uncomfortable and take a long time. In the case of bereavement, the period of adjustment can be as long as two years.

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Principle FOUR Expectations need to be managed realistically The relationship between expectations and reality is very important. You can see this in customer relations - if a supplier fails to meet expectations then the customer is unhappy; if the supplier exceeds expectations then the customer is happy. To some extent the same principle applies to staff and change. If their expectations are not met, they are unhappy. If their expectations are exceeded, they are happy. Sometimes, enforced change (eg: redundancies) inevitably involve the failure to meet expectations: there had been an expectation of job security, which has now been taken away. What leaders/managers have to do, however, is make sure they don't pour petrol on the fire by making promises that can not or will not be kept. Expectations have to be set at a realistic level, and then exceeded (eg: in terms of the degree of outplacement support that will be provided).

Principle FIVE Fears have to be dealt with In times of significant change rational thought goes out of the window. This means that people often fear the worst - in fact, they fear far more than the

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worst, because their subconscious minds suddenly become illogical and see irrational consequences. Eg:

Our company is reducing staff, which means... They will make people redundant, and... I'll be the first to be kicked out, and... I'll have no hope of getting another job, and... I won't be able to pay the mortgage, so... I'll lose the house, so... My family won't have anywhere to live, and... My wife won't be able to cope, so... She'll leave me, and... I'll be so disgraced the children won't speak to me ever again.

Such fears need to be addressed, eg by helping people to recogniZe that most people who are made redundant find a better job with better pay and have a huge lump sum in their pocket! Or, where appropriate, by explaining how the reductions in staff numbers are going to be achieved (by natural wastage or voluntary redundancy).

CHANGE THEORIES IN NURSING Lewin's Change Theory Kurt Lewin's change theory is widely used in nursing and involves three stages: the unfreezing stage, moving stage, and refreezing stage.
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Lewin's theory depends on the presence of driving and resistant forces. The driving forces are the change agents who push employees in the direction of change. The resistant forces are employees or nurses who do not want the proposed change. For this theory to be successful, the driving force must dominate the resistant force. Rogers' Change Theory Everette Rogers modified Lewin's change theory and created a fivestage theory of his own. The five stages are awareness, interest, evaluation, implementation and adoption. This theory is applied to long-term change projects. It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially. Spradley's Change Theory This is an eight-step process for planned change based on Lewin's theory of change. It makes provision for constant evaluation of the change process to ensure its success. The steps are: recognize the symptoms, diagnose the problem, analyze alternative solutions, select the change, plan the change, implement the change, evaluate the change and stabilize the change. Other Theories Reddin's, Lippitt's and Havelock's theories are based on Lewin's theory and can be used to implement planned change. The first two have seven stages, while the third has six.
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Real Life Application An article titled "Managing change in the nursing handover from traditional to bedside handover---a case study from Mauritius" details the use of Lewin's and Spradley's theories to implement a change in the process of handover reports between nurses. The driving force in this case was dissatisfaction with the traditional handover method, while the resistant forces were a fear of accountability, lack of confidence and fear that this change would lead to more work. Evaluation of the implemented change showed that the new process was successfully implemented.

Conclusion

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Driving conclusion as a result of change management is not an easy task. There are a lot of things to take into consideration that will lead to the eventual creation of conclusions that transpired during the change process. There are 3 Ps to take into account. These are the people, policies and processes. These key ingredients determine how change management can directly impact the organization. (a) People It is indeed given that this is the most important aspect of the change process. It is because people working on a certain project are considered the front liners, making decisions and plans to ensure success on every phase of the change process. Though it is hard at times to unlearn old behaviors and techniques, it is still a must to embrace changes happening in the organization to focus more on what can be contributed rather than resisting team efforts on what needs to be done. (b) Policies If we are talking about changes in an organization, this means that there are certain policies that need to be revisited to determine if these still apply to the new goals and objectives of the company. Though policies are governed by company rules and regulations, there are still some exceptions that should be taken into consideration to decide if these hinder the change process from successfully implemented. (c) Processes As mentioned, old habits are hard to break and so are old processes. But
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then again, with the introduction of advance tools and equipment, new processes can easily be carried out. Though there are some previous processes that should be kept, change is still inevitable as finding simpler means of doing work is still a top priority.

In nursing, managing change in a hospital set up is a daunting task as it involves a change in the attitude and behavior of staff in a complex environment in order to gain their collaboration. The concept of no pain no gain was very evident throughout the process. Lewin's 3 stage model was useful in implementing the change in a planned and structured way. Resistance was overcome by creating a climate which encouraged open communication. The support of the ward manager and key stakeholders were significant. Evaluation has shown that the new system of handover is working well but monitoring will be ongoing with evaluation of a larger sample of patients. This change has been an enriching experience for the staff, and has generated enthusiasm and given them confidence to question some of the practices on the ward. This new approach to handover can therefore be implemented in other areas of practice and evaluated to ensure that they are meeting patients' satisfaction. Further studies can be undertaken to explore how the multidisciplinary team could further consolidate this process.

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Bibliography

Internet sources :
en.wikipedia.org/wiki/Change_management

http://www.teamtechnology.co.uk/changemanagement.html http://www.ehow.com/about_5544426_change-theories-nursing.html

Lecture : Human Resources Management by Prof. Maria Paz Castro, OLFU Graduate School, 2009

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