ch 8 planned change

Lewin's restraining forces

(barriers) forces that pull the system away from change - resistance, bad timing, lack of power

Lewin's driving forces

(facilitate) - forces that push the system towards change - desire to please your boss, eliminate a problem, PAY RAISES & receiving recognition, healthcare (private health insurance program premiums are above what consumers can afford)

Organizational Aging: Change as a Means of Renewal

* as org. age, they become MORE STABLE - young org.: high energy & fluid - aged org. : established turf, control & change is limited - organizations must have balance -w/o change, organization stagnate/die

phases in the change theory

** UNFREEZING ** MOVEMENT ** REFREEZING

About the change theory

** should be implemented for GOOD REASON ***it should be GRADUAL ****it should be PLANNED - all individuals affected should be involved (change agent also)

Necessary for Practice Changes to Occur

***** Must feel a need for change (unfreezing) A helping relationship between the change agent and his patient (Movement)

what are challenges for change agents?

***Organizations tend to reject outside change agents. -Perceived as lacking information. -Motives are not trusted

Refreezing stage

***TAKES 3-6 MONTHS TO BE ACCEPTED support others so that the change continuos!! Assist in stabilizing the system so that it becomes integrated into the status quo Be supportive Reinforce Make a commitment to be available until the change is complete Refreezing does not eliminate the possibility of further improvements to the change

Strategies to minimize resistance to change

**Established trust & rapport with workers Encourage subordinates to speak openly Encourage workers to share their perceptions of the forces driving changes Then, assess the need for support & resources See & share the vision of what the future state will be after the change is implemented Experienced change agent & project champion

complex adaptive systems (CAS)

**The relationship btwn elements & agents within a system is nonlinear & are constantly in motion for change

Chaos Theory (Butterfly Effect)

- 3finding the order in what appears to be random data -Hidden variables must be explored before change is considered -This chaos makes it difficult to determine the future

examples of driving forces

- a desire to please one's boss - eliminating a problem that is undermining productivity - get a PAY RAISE - receive recognition

examples of restraining forces

- conformity to norms - unwillingness to take risks - a fear of the unknown

Integrate Leadership & Management in Planned Change

-Understand plan of action & implement. -Be aware of restraining/driving forces. -Provide tools/resources needed for change. -Be productive in a chaotic changing system. -Know the trends & changes facing your system. -Big picture focus. -Integrate vision, adapt to change & know when change is needed. -Model professional skills.

leader & manager functions in planned change

-Well developed org. skills -Vision & expert planning skills -Ongoing evaluation of org. goals -Changes implemented based on evaluation org. needs **Appropriate use fiscal & human resources*** ***Be visionary & flexible in adapting to change***

What are the forces driving change in healthcare?

-rising health care costs -declining reimbursements -workforce shortages -increasing technology -dynamic nature of knowledge -growing elderly populations

Unfreezing Stage occurs when

-the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited (Gather the information, A change needs to be made, Gonna disrupt the status quo, Have the people to understand that a change needs to be made)

Needed Change to impact 21st Century Organization Dynamics

Change is unforeseeable & ever present **HCS's long term outcomes are UNPREDICTABLE This unpredictability can not be managed with traditional linear theories (Lewin) Nonlinear theories are needed to managed change in this unpredictable society

how should change be implemented?

Change should be planned and implemented GRADUALLY! doesn't happen overnight

planned change (definition)

Deliberate application of knowledge & skills by a leader to bring about change [a well thought out effort to make something occur]

Movement stage

Identify, plans, and implements appropriate strategies Ensures that driving forces exceeds restraining forces Implement gradually and for good reason Allow time change to be fully assimilated

change theory; who was the theorist

Kurt Lewin

Resistance: Expected Response to Change

Level of resistance is based on type of change Technological changes involve LESS resistance (ex changing IV pump) **Perceived social changes that are contrary to customs or norms involve MORE resistance. Change in who is able to administer certain types of IV therapy. It is easier to change knowledge levels than attitudes Values, education, culture, exp. & social bckgrd affect level of resistance to change

change agent (definition)

Person skilled in theory and implementation of planned change.

what is important for change agents and changes?

TIMING. people have to get used to the first change before a second change

unfreezing stage

Unfreeze the forces that maintain the status quo People become discontented and aware of a need for change. People may feel anger. Convince members of the group to change when guilt, anxiety, or concern can be elicited and most importantly anger! Make a through and accurate assessment of the extent and interest of the change Implement change for good reason Coerce members of the group to change, or when guilt, anxiety, or concern can be elicited

Nonlinear Change Theory has two different theories that are

a) complex adaptive systems (CAS) b) chaos theory (butterfly effect)

Why is there resistance to change?

because change disrupts the homeostasis or balance of the group, resistance should always be expected It's a natural and expected response to change

HC organizations have continual change directed at

organizational re structuring quality improvement employee retention

more resistance with

perceived social changes (ex: change in who is able to administer certain type of IV therapy)

what are inside agents influenced by?

personal bias

change agent examples

prather is a better change agent for next semester since she is an inside agent

for movement stage, you may have

resistance. (change takes time; so do it GRADUALLY)

change agents must have

sensitivity to the needs of the organization

people like to feel safe, comfortable, and in control of their environment. for change to occur:

the balance of driving and restraining forces must be altered. - driving are increasing - restraining are decreased

in organized planned change,

the manager is often the change agent

Why do health care organizations change?

to upgrade their structure to promote greater quality to keep their workers

CAS theory example

while an individual may have behaved one way in the past, CAS theory suggests that future behavior may not always be the same. - the prior exp. may change his/her future choices - small variations in the situation can dramatically alter the choice of action ~ there are always hidden or unanticipated elements in systems that make linear thinking almost impossible

you have a better change of implementing change and being successful if

you've made change before