Chapter 8: People And The Process Of Change Flashcards
Micro level change
Change from the macro level that filters down to the micro.
Small scale change
Affects nurses, colleagues, patients.
Macro change
Medicare and Medicaid cuts, government regs,
They affect virtually every health care facility
Kurt Lewin model
Comfort zone
Change>unfreezing>refreezing
Sources of resistance: technical change
Is the proposed change a good change? There may be design flaws. Technical and practical reasons
Resistance to change: psychosocial needs
Change often creates anxiety, much of it related to what people fear they might lose. Maslows heirarchy.
Resistance to change: position and power
Position and power: Once gained within an organization, status, power, and influence are hard to give up. This applies to people everywhere and not just at the top.
Receptivity to change
§Study showed nurse managers are more receptive to change, innovative and decisive than staff members.
§Staff members were more resistant to change and preferred proven approaches.
§Nursing assistants, unit secretaries, and licensed practical nurses were also unreceptive to change, adding layers of people who formed a “solid” wall of resistance” to change.
§Recognize differences in preferences for certainty
§Speak to people’s feelings as the heart of change lies in the emotions surrounding it. Present a compelling image to affect people emotionally, increasing their receptivity to change and moving them into a state of readiness to change
§Do a story vs a report with statistics on readmissions such as an older man collapsed at home after discharge and not able to care for himself
§Drama through a visual display showing organisms growing on hospital equipment vs an infection control report with statistics
Active or passive resistance
§Active is expressed directly such as verbalizing dislikes or outright refusal to comply. §Attacking the idea §Refusal to change §Arguing against change §Organizing resistance of other people
§Passive is less direct and difficult to recognize. Includes avoidance, canceling appointments, too busy, refusing to make commitment to change, or ignoring §Avoiding discussion §Ignoring the change §Refusing to commit to the change §Agreeing but not acting
Lowering resistance to change
§Lowering resistance to change 4 strategies:
§sharing information. Information dissemination to clear misunderstandings of change can be done through one-on-one, group meetings or through written material
§Disconfirmation of currently held beliefs is providing evidence that what is currently being done is inadequate,incorrect, or inefficient. Emphasize the risk of what happens is it isn’t changed
§Psychological safety is different for each situation the goal is to reduce the threat as much as possible. Allow time for practice. Don’t threaten.
€Dictating change: §Effective in many situations
§Communicate a sense of urgency
§Change may be rapid but without a lasting commitment
§Even when staff members do not resist authority based change, overuse of dictates can lead to a passive, dependent, unmotivated, and unempowered staff
It is often resisted and people are passive towards it.
Strategies to overcome resistance
§Point out similarities
§Express approval of people’s interest in providing the best care possible
§Recognize competence and skill of the people involved
§Provide assurance (if possible)
§Suggest new opportunities
§Express value of contributions
§Ensure involvement of as many people as possible in the design or plan to implement change
§Provide opportunities for expression
§Allow time for practice
§Provide a climate of acceptance
Four phases of planned change
Design the change Plan the implementation Implement the change Integrate the change
Design the change
Design the Change
§What is the purpose,what are we trying to accomplish?
§Is the change necessary?
§Is the change technically correct?
§Will this work?
§Is there a better way?
Encourage people to express their thoughts.
Encourage discussion
Plan the implementation
§Why is there resistance?
§Is the resistance justified?
§What can be done to prevent or overcome resistance?
Is there a lot of other change going on, how has it been handled before.
Leadership is useful in planning the change: communicating the vision, motivating people, involving people in decisions, dealing with conflict, eliciting cooperation, providing coordination, fostering teamwork
Communicate the vision, motivate, involve people in the decision, deal with conflict, elicit cooperation, foster teamwork.
Implement the change
§What is the magnitude?
Major change or minor
§What is the complexity?
Difficult to do, require new knowledge and skill, time to learn it
§What is the pace?
Is it urgent, can it be done gradually or all at once?
§What is the current stress level?
Are there other changes, are they stressful, help keep stress tolerable.
Integrate the change
§Is the change integrated into everyday operations?
§Are people comfortable with it?
§Is it well accepted?
Have people found the new comport zone.
