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See also organisational cultural analysis and change Securing individual and group level change See also Managing the human dimensions of change
How Can we understand the complexity, interdependence and fragmentation PESTELI/STEP* 6 Box Organisational Model (Weisbord, 1976) * External, Organisational Model (Burke-Litwin, 1992) (Environmental) 7S Organisational Model (Peters & Waterman, 1980) analysis Content context & Process Model (Pettigrew & Whipp, 1991) Soft Systems Methodology Other models both Process Mapping and Redesign external and internal analysis
Why do we need to change SWOT Analysis Self Assessment against quality frameworks eg Clinical Gov, ISO9000, EFQM, Baldridge, NSF
Who and What can change Force Field Analysis Stakeholder analysis Readiness and capability also (WIFM) Cultural analysis See also models of
organisation (above)
Organisational Development (OD) Organisational Learning Action Research Project management service improvement teams TQM, EFQM, CG Parallel Learning Structures group level change Individual Change
Force field analysis (Lewin, 1951) is a diagnostic technique which has been applied to ways of looking at the variables involved in determining whether organisational change will occur. It is based on the concept of forces, a term which refers to the perceptions of people in the organisation about a particular factor and its influence.
Driving forces are those forces affecting a situation and which are attempting to push it in particular direction. These forces tend to initiate change or keep it going. Restraining forces are forces acting to restrain or decrease the driving forces. A state of equilibrium is reached when the sum of the driving forces equals the
As long as the driving forces equal the restraining forces, the status quo is maintained. If disequilibrium is created with one of the forces gaining strength over the other, a change may occur. To facilitate a change, strategies need to be developed to reduce the restraining forces and strengthen the driving forces
Iles & Southerland, 2001, p. 43-44
Lewin formulated three fundamental assertions about force fields and change.
Increasing the driving forces results in an increase in the resisting forces; the current equilibrium does not change but is maintained under increased tension. Reducing resisting forces is preferable because it allows movement towards the desired state, without increasing tension. Group norms are an important force in resisting and shaping organisational change.
USE: Once change priorities have been agreed, using methods from the last two clusters, a force field analysis can be used to identify actions that would enhance their successful implementation.
Potency of Forces
Medium
Low
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Capability
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Enrolment
Apathy
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Disposition
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OPTIONAL Activity
Innovation research refers to a body of literature that contains many models and approaches. Some of the specific areas within it provide insights that are particularly relevant to managers. Originating in the marketing literature of the 1960s, innovation research has developed into a significant area in its own right (Rogers, 1983; Stocking, 1992). Research into the diffusion of innovations suggests that the propensity of individuals to change and implement new ideas, products or processes differs. The adoption process, from an individual perspective,
Iles & Southerland, 2001, p.56-57
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The adoption process, from an individual perspective, has been depicted as a five-stage process, starting with:
establishing an awareness of the innovation in potential adopters and proceeding through: persuasion, or arousal of interest mental evaluation of the innovation trial to implementation (Rogers, 1983; Van de Ven, 1993).
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Innovation research (Rogers, 1983) provides insights for change management in three ways. First, it identifies properties of innovations (in this case organisational changes) that are likely to meet with success. These are:
relative advantage, the degree to which it is perceived to be better than existing technology compatibility, the perceived fit of the innovation with existing structures, procedures and values complexity, the degree of difficulty involved in learning about and implementing the innovation trialability, the extent to which an innovation can be tried by potential adopters without major investment of time or resources observability, the degree to which outcomes resulting from the adoption of an innovation are visible.
Armed with this knowledge, managers can optimise and tailor their change programmes in order to maximise chances of success.
Iles & Southerland, 2001, p.56-57
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In health, Stocking (1985) provides a more specific list about the key factors in the adoption of innovations or change. It includes:
the presence of identifiable enthusiasts for innovation or change conducive power relationships (i.e. lack of conflict with national policies or professional opinion) adaptability to local conditions a general perception that the innovation meets current needs minimal requirements for extra resources.
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In health, Stocking (1985) provides a more specific list about the key factors in the adoption of innovations or change. It includes:
the presence of identifiable enthusiasts for innovation or change conducive power relationships (i.e. lack of conflict with national policies or professional opinion) adaptability to local conditions a general perception that the innovation meets current needs minimal requirements for extra resources.
More recent work in this field has been concerned to explore the social and cultural factors in promoting or hindering change (Pettigrew et al., 1992; Dawson et al., 1999).
Iles & Southerland, 2001, p.56-57
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The second insight concerns the important role that organisational context plays in the adoption of innovation and change. Three environmental features have been linked with the propensity to innovate:
rapid change and heterogeneity in an organisations operating environment effective external communication networks presence of boundary-spanning individuals (Slappendel, 1996).
These environmental/organisational features are key contributing process to organisation organisational learning (Dixon, 1999; Pedler et al, 191; Senge 1990)
Iles & Southerland, 2001, p.56-57
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The third insight that innovation research provides for change managers is that individuals have different attitudes to change per se. It categorises people in terms of their propensity to change, ranging from: innovators (venturesome) to early adopters (respectable) to early majority (deliberate) to late majority (sceptical) to laggards (traditional).
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Late Majority
Those who will follow the lead of a powerful person if they show signs of agreement and support for your ideas. The commitment is centred on political calculation. Predictable, these peoples interest will need considerable evidence the more vivid and directly observable the better before they can be mobilised away from present methods and preferences. As a group, this category may be relatively risk adverse.
Resistors (Laggards)
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loss of control too much uncertainty surprise confusion loss of face concerns about competence in a new context increased workload change fatigue the view that costs outweigh benefits past resentments real threats. (Kanter et al., 1992; Dawson, 1996)
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2 Mention it 1 No need
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No of People
Time
Early Adopters
No of People
Early Majority
Late Majority
Resitors
Innovators
Time
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68%
No of People
16%
16%
Time
Early Adopters
No of People
Early Majority
Late Majority
Resitors
Innovators
Time
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10
10
Current State
Future State
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Lewin (1951) formulated three fundamental assertions about force fields and change: 1. Increasing the driving forces results in an increase in the resisting forces; the current equilibrium does not change but is maintained under increased tension. 2. Reducing resisting forces is preferable because it allows movement towards the desired state, without increasing tension. 3. Group norms are an important force in resisting and shaping organizational
change.
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Once change priorities have been agreed, a Force Field Analysis can be used to identify actions that would enhance their successful implementation. Lewin (1951) suggests that there are three phases in the change process.
Unfreezing
Moving
Re-freezing
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Unfreezing
Moving
Re-freezing
This can be done by providing information or examples of new ways of doing things or getting the job done or by raising everyone's awareness that the goal or goals of the organisation are not being met in some way and that a change is necessary to get back on track. It is necessary to make those involved in the process feel secure and at ease with the proposed change or changes to reduce threats to the safety and security of those involved and reduce resistance to the proposed change. During unfreezing, the process of developing an awareness to a need or problem is started and change is seen as the only solution.
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The change agent needs to increase pressures toward the change and reduce threats associated with changing. According to Lewin, this is done through three mechanisms.
Disconfirmation: occurs when the change agent introduces evidence that a need is not being met. This can be done through meeting with the staff in small groups to discuss inadequacies or problems. Inducing guilt or anxiety: can be accomplished by introducing a period of uncomfortableness about the way things are and how they are not meeting an important goal or value. Creation of psychological safety: the third mechanism is important to provide sufficient security to minimise risk involved with the change. The change agent can provide time for discussion, involvement, education, supervision and approval to small advances toward the intended change.
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Moving or Changing (Planning, Overcoming Resistance, Implementation, Open Communication & Support)
This is the actual change or implementation phase of the change process. During the moving stage, the driving forces have overcome the restraining forces and the change moves ahead A new way of behaving or working is established as information and feedback is used to encourage group involvement and allow the participants to discuss and assimilate the change into their practice. The change is planned in detail and then implementation begins. Time must be allowed for support, group discussion, evaluation, and feedback to deal with resistance as it occurs. Open communication is important.
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During Refreezing, the change has been implemented and needs to be stabilised. The organisation (client system) must return to its normal level of functioning and the change consolidated into the regular operations of the organisation. The change becomes integrated into the whole organisation as part of its routine functioning. The change agent must provide guidance and support to ensure that the change will be maintained. The change agent needs to reduce participation in the functioning of the change and delegate responsibility for the continuance of the change. The integration of the change allows the change process to end and the participants (client system) to take on the responsibility for the continuance of operations. Refreezing takes place as the group has moved to a new equilibrium of the driving and restraining forces with the change functioning in place.
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Determine the need for change. Define the desired future state Describe the present state. Assess the present in terms of the future to determine the work to be done. Manage the transition.
D dissatisfaction: with the present situation V vision: an understanding of what the change(s) would look like C capacity: sufficient resources to make the change happen F first steps: an appreciation of how the change is to be implemented (Adapted from Beckhard & Harris, 1987) If any of the elements on the left-hand side of the equation are zero, there will be insufficient impetus to overcome the resistance to
change!!
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D x V x C x F > Resistance D dissatisfaction: with the present situation V vision: an understanding of what the change(s) would look like C capacity: sufficient resources to make the change happen F first steps: an appreciation of how the change is to be implemented (Adapted from Beckhard
If any of the elements on the left-hand side of the equation are zero, there will be insufficient
& Harris, 1987)
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D x V x C x F > Resistance
Creating shared Dissatisfaction with the status-quo: Rea (1993) provides some practical advice on leading change in relation to Beckhard & Harriss (1987) model. Look at your stakeholder scan:
This is achieved partly through the strength of the vision Create opportunities for learning about what other organisations in your health sector do by visiting these. Ensure that stakeholders are encouraged to access relevant contemporaneous research in order to inform best practice. Create opportunities for patient/client involvement in developing services eg through patient stories etc. Ensure evidence of poor performance from surveys and audits is disseminated to all stakeholders within the client system. Provide immediate direct evidence of the cost benefits of existing process.
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D x V x C x F > Resistance
Creating shared Visions of a better state: Rea (1993) provides some practical advice on leading change in relation to Beckhard & Harriss (1987) model. Look at your stakeholder scan:
How precisely might you create dialogue with the different interests? Which interests might prefer closer direction? Which might prefer virtually autonomous decision-making? (Remember that history is important) What factors might damage the efforts to achieve shared discussion? What would the vision need to look like; Detailed? Flexible? Highly Measured? Would your change issue be more effectively achieved by one vision or many, as formulated by various interests? What do we do about potentially contradictory visions between stakeholders?
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D x V x C x F > Resistance
Securing Individual & Group Level Change Yukl (1998) argues that and effective visioning must:
Provide a simple but exciting picture of a desirable but attainable future, which is highly discrepant from the present state. Involve and/or attend to the needs of as many stakeholders as possible. Be based on core ideologies and values of the organisation. Include a plan for implementation. Be flexible enough for regular review.
"A vision should be simple and idealistic, a picture of a desirable future, not a complex plan with quantitative objectives and detailed action steps. The vision should appeal to the values, hopes and ideals of organisation members and other stakeholders whose support is needed. The vision should emphasis distant ideological objectives rather than immediate tangible benefits. The vision should be challenging but realistic. To be meaningful and credible, it should not be a wishful fantasy, but rather an attainable future about what is important for the organisation, how it should related to the environment, and how people should be treated." (Yukl G, 1998, pp.443)
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What resources are needed to achieve the change? dont forget resources such as energy and capability How can the resources be generated or shared? How can we use existing resources in a different way? What are the consequences of not changing? First Step Key Questions. What first steps could people undertake which everyone agrees would be moving in the right direction? How can you create a safe first step safe uncertainty? (Consider, training, vision, levels of supervision, incremental steps, building on what already works ie do not through the baby out with the bath water).
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D x V x C x F > Resistance
Securing Individual & Group Level Change Creating Safe Fist Step with appropriate Support Rea (1993) provides some practical advice on leading change in relation to Beckhard & Harriss (1987) model. Look at your stakeholder scan in order to: Involve stakeholders in developing a plan for implementation: try to include as many contingencies as possible create short term wins! Determine appropriate levels of supervision during the change process for all stakeholders within the client system. Provide access to education and learning opportunities according to individual need. Recognise that individuals within the client system will internalise and commit to the change within very different time scales. Role model appropriate behaviours yourself - recognise and reward these behaviours in others. Match mature/competent individuals with those who are less so. Be accessible and encourage discussion. Celebrate each and every success
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The development of a need for change, including problem awareness and a desire for change. Establishment of a change relationship between the change agent and the client system and their mutual decision to work together on the change. Clarification or diagnosis of a client system's problem; a collaborative effort to diagnose the difficulties. Examination of alternative means of action and goals, and the establishment of goals and intentions of action. Transformation of intentions into actual change efforts, in which the active work of changing takes place and success, is measured by how well plans are transformed into achievements. Generalisation and stabilisation of the change. The process of institutionalisation occurs. Achieving a terminal relationship to prevent the client system from becoming too dependent on the change agent.
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Knowledge-Awareness or Knowledge is presented to the group, showing that the innovation is available. Persuasion-Interest arousal, excitement with the innovation its utility to the client system is explained. Decision - the decision to use and evaluate the innovation is made. Implementation - the innovation is trialled occurs. Confirmation decision to adopt or reject the innovation is made by the group.
Rogers also considers the role of the change agent as important and delineates the responsibilities of the change agent role: to develop a need for change, establish an information -exchange relationship, diagnose the problem, create an intent to change in the client, translate the intent into action, stabilise the adoption and prevent discontinuance, and achieve a terminal relationship. (White K, 1998, p.185)
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Summary of the 6 Stages: Build a relationship Diagnose a problem Acquire resources Choose a solution Gain Acceptance Stabilisation and Termination
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The change agent needs to diagnose the problem and make a systematic attempt to understand it.
The relationship between the people involved in the change must be carefully developed for success to be achieved. An assessment of the client, his or her norms, the leaders, the gatekeepers, and the larger environment should be completed. The diagnosis should include details about the symptoms, history, and causes. The change agent should help the client to articulate his or her needs as problem statements. Resources are needed for diagnosis, awareness, and evaluation before trial, for trial, evaluation after trial, installation and maintenance.
Identify and acquire relevant resources that will help in reaching the solution to the defined problem.
Choose a solution to accomplish the change after generating a range of possibilities that follow looking at the implications, testing the feasibility of the alternative solutions, and adapting the preferred one to the needs and circumstances of the client system. Move the solution toward acceptance and adoption. Finally, there is the need to stabilise the innovation so that the client system can maintain the change on its own. Thus, a gradual termination of the change agent relationship is accomplished.
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Evaluation
Confirmation
Stabilisation
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Examine the organisation's operating environment for change factors and competitive realities Identify and discuss crises, or major opportunities Assemble a group with enough power to lead the change effort Encourage the group to work better as a team Use every vehicle possible to communicate the new vision and strategies Teach new behaviours by the example of the guiding coalition Get rid of obstacles to change Change system structures that seriously undermine the vision Encourage risk taking and non-traditional ideas, activities and actions
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Plan for visible performance improvements Create those improvements Recognise and reward employees involved in the improvements
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Kotter & Schlesinger (1985) Methods for dealing with resistance to change?
Securing Individual & Group Level Change
Approach Education + Communication Commonly used in situations Where there is a lack of information or inaccurate information and analysis Advantages Once persuaded, people will often help with the implementation of the change Drawbacks Can be very timeconsuming if lots of people are involved
Participation + Involvement
Where the initiators do not have all the information they need to design the change and where others have considerable power to resist
People who participate will be committed to implementing change, and any relevant information they have will be integrated into the change plan
/CTD
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Kotter & Schlesinger (1985) Methods for dealing with resistance to change?
Securing Individual & Group Level Change
Commonly used in situations Where people are resisting because of adjustment problems Where someone or some group will clearly lose out in a change, and where that group has considerable power to resist
Advantages No other approach works as well with adjustment problems Sometimes it is a relatively easy way to avoid major resistance
Drawbacks Can be time consuming, expensive and still fail Can be too expensive in many cases if it alerts others to negotiate for compliance
Negotiation + Agreement
/CTD
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Kotter & Schlesinger (1985) Methods for dealing with resistance to change?
Securing Individual & Group Level Change
Commonly used in situations
Approach
Advantages
Drawbacks
Manipulation + Cooptation
It can be a Can lead to future relatively quick and problems if people inexpensive feel manipulated solution to resistance problems It is speedy, and can overcome any kind of resistance. Can be risky if it leaves people mad at the initiators
Where speed is essential, and the change initiators posses considerable power
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References
Ackerman L, 1997, Development, transition or transformation: the question of change in organisations, in Organisational Development Classics Ed D Van Eynde, J Hoy and D Van Eynde, San Francisco: Jossey Bass Argyris, C. 1992. On Organisational Learning. Oxford: Blackwell Argyris, C. and Schn, D. 1978. Organisational Learning: a Theory of Action Perspective. Reading, Mass: Addison-Wesley Argyris, C. and Schn, D. 1996. Organisational Learning II: Theory, Method and Practice. Reading, Mass: Addison-Wesley Beckhard, R. and Harris, R. 1987. Organisational Transitions: Managing Complex Change. Wokingham: Addison-Wesley Bennis W, Beene K & Chin R, 1985, The Planning of Change (4Ed) cited in White K M, 1998, Chapter 13 Planned Change in Rocchicciolo J T & Tilbury M S, 1998, Clinical Leadership in Nursing, W B Saunders, London Broome A, Managing Change (2Ed), 1998, Macmillan, London Bushy A & Kamphuis J, 1993, Response to innovation: Behavioural Patterns, Nursing Management, 24(3), 62-64 Costello S, 1994, Managing Change in the workplace, New York: Irwin Duck J D, 1993, Managing Change: The Art of Balancing, Harvard Business review, Nov/Dec, pp.109-118
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References
Goodman M, 1995, Creative management, Prentice-Hall, London Havelock R, 1973, The Change Agents Guide to innovation in Education, New Jersey, Educational Technology Publications in Rocchicciolo J T & Tilbury M S, 1998, Clinical Leadership in Nursing, W B Saunders, London Iles V & Sutherland K, 2001, Managing Change in the NHS: Organisational Change a review for health care managers, professionals and researchers, London: National Coordinating Centre fro NHS Service Delivery and Organisational R & D (NCC/SDO) Johnson G & Scholes K, 1993, Exploring Corporate Strategy, Text & Cases (3rd Ed), Prentice-Hall, London, pp. 37-8 Kotter J P & Schlesinger L A, 1979, Choosing Strategies for change, Harvard Business Review, March-April, pp. 106-113 Kotter J P, 1995, Why Transformation Efforts Fail, Harvard Business Review, MarchApril, pp. 59-68 Lamb M C & Cox M A, 1999, Implementing Change in the National Health Service, Journal of Management in Medicine, Vol 13, No 5, pp. 288-297 Lewin K, 1951, Field Theory in Social Sciences, Harper Row, New York in Marquis B L & Huston C J, 2000, Leadership Roles and Management Functions in Nursing, Lippincott, New York Lippitt T, Watson J, Westley B, 1958, The Dynamics of Planned Change, New York, Harcourte-Brace in Rocchicciolo J T & Tilbury M S, 1998, Clinical Leadership in Nursing, W B Saunders, London Mabey C & Mayon-White B (Eds), 1993, Managing Change, Open University Press
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Marquis B L & Huston C J, 2000, Leadership Roles and Management Functions in Nursing, Lippincott, New York Mullins L, 2000 (5th Ed), Management and Organisational Behaviour, London: Financial Time Publishing Nadler D & Tushman M , 1995, Types of organisational change: from incremental improvement to discontinuous transformation, in D Nadler, R Shaw & A Walton (Eds), Discontinuous change: leading organisational transformations (p.14-34), San Francisco: Jossey Bass National Assembly for Wales, 2001, A Plan for the NHS and its partners Paperback English Dictionary, 1986, Collins, London Peters T & Waterman R, 1982, In Search of Excellence, New York: Harper and Row Pettigrew. A. 1987. The Management of Strategic Change. Oxford: Blackwell Pettigrew, A. and Whipp, R. 1991. Managing Change for Competitive Success. Oxford: Blackwell Pettigrew, A., Ferlie, E. and McKee, L. 1992. Shaping Strategic Change. London: Sage Perlman D & Takacs G J, 1990, The ten stages of change, Nursing Management, 21(4), pp.33-38
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Proehl R A, 2001, Organisational Change in the Human Services, London: Sage Publications Rea C, 1993, Managing Clinical Directorates, Churchill- Livingstone, London Rocchicciolo J T & Tilbury M S, 1998, Clinical Leadership in Nursing, W B Saunders, London Rogers E, 1983, Diffusions of Innovations (3rd Edition), New York, Free Press in Rocchicciolo J T & Tilbury M S, 1998, Clinical Leadership in Nursing, W B Saunders, London Senior B, Organisational Change, 1997, Pearson Educational, Harlow, England Upton T & Brooks B, 1999, Managing Change in the NHS, Open University Press Weisbord, M. 1976. Organisational diagnosis: six places to look with or without a theory. Group and Organisational Studies 1: 430-47 White K M, 1998, Chapter 13 Planned Change in Rocchicciolo J T & Tilbury M S, 1998, Clinical Leadership in Nursing, W B Saunders, London Yoder-Wise P, 1999, Leading and Managing in Nursing, Mosby, St Louis, Missouri Yukl G, 1998, Leadership in Organisations (4Ed), Prentice Hall, New Jersey Ywe L & McClenahan T, 2000, Getting better with evidence, experience of putting evidence into practice, London: Kings Fund
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