To access optimum power, use the following strategies:
1. Analyze the organizational chart. Know the formal lines of authority. Identify informal lines as well.
2. Identify key persons who will be affected by the change. Pay attention to those immedi- ately above and below the point of change.
CHAPTER 5 • INITIATING AND MANAGING CHANGE 65
3. Find out as much as possible about these key people. What are their “tickle points”? What interests them, gets them excited, turns them off? What is on their personal and organiza- tional agendas? Who typically aligns with whom on important decisions?
4. Begin to build a coalition of support before you start the change process. Identify the key people who will be affected by the change. Talk informally with them to flush out possible objections to your idea and potential opponents. What will the costs and benefits be to them—especially in political terms? Can your idea be modified in ways that retain your objectives but appeals to more key people?
5. Follow the organizational chain of command in communicating with administrators. Don’t bypass anyone to avoid having an excellent proposal undermined.
This information helps you develop the most sellable idea or at least pinpoint probable resistance. It is a broad beginning to the data-collection step of the change process and has to be fine-tuned once the idea is better defined. The astute manager keeps alert at all times to monitor power struggles.
Although a cardinal rule of change is, “Don’t try to change too much too fast,” the savvy manager develops a sense of exquisite timing by pacing the change process according to the political pulse. For example, the manager unfreezes the system during a period of coalition building and high interest, while resistance is low or at least unorganized.
You may decide to stall the project beyond a pilot stage if resistance solidifies or gains a powerful ally. In this case, do whatever you can to reduce resistance. If resistance continues, two options should be considered:
● The change is not workable and should be modified to meet the strongest objections (compromise).
● The change is fine-tuned sufficiently, but change must proceed now and resistance must be overcome.
Implementing Change In addition to initiating change, nurses and nurse managers are called on to assist with change in other ways. They may be involved in the planning stage, charged with sharing information with coworkers, or they may be asked to help manage the transition to planned change.
Planning Change One Magnet-recognized hospital engaged all its nurses in planning for the desired future of clinical nursing in its organization (Capuano et al., 2007). It held a series of group events to so- licit ideas and opinions. Every nurse—executive, manager, or staff nurse—had an equal vote to approve or veto a proposed change. This process illustrates the normative–reeducative process of change.
Managing Transitions to Change Transitions are those periods of time between the current situation and the time when change is implemented (Bridges, 2009). They are the times ripe for a change agent to act. Just as initiating change is not easy, neither is transitioning to changed circumstances.
Letting go of long-term, comfortable activities is difficult. The tendency is to:
● Add new work to the old ● Make individual decisions about what to add and what to let go ● Toss out everything done before (Bridges, 2009)
Accepting loss and honoring the past with respect is essential. Passion for the work is based on results, not activities, regardless of their necessity or effectiveness.
A large national for-profit health care system purchased a new hospital clinical informa- tion system. Because all paper charting would be eliminated, nurses would be directly
66 PART 1 • UNDERSTANDING NURSING MANAGEMENT AND ORGANIZATIONS
affected. Their participation could spell success or failure for the new system. To help the transition occur smoothly, nurses from each department met together for a demonstration of the new clinical information system and provided feedback to the IT department about nursing process and integrating patient care with the new system. Then a few nurses on each unit were selected to be trained as experts in the new technology, and they in turn trained other staff members, communicating with the IT department when concerns arose.
A nurse manager in a home health care agency used change management strategies to over- come resistance, as shown in Case Study 5-1.
Handling Constant Change Change has always occurred; what’s different today is both the pace of change and that an initial change causes a chain reaction of more and more change (Bridges, 2009). Change, rather than an occasional event, has become the norm.
Regardless of their position in an organization, nurses find themselves constantly dealing with change. Whether they thrive in such an atmosphere is a function of both their own personal resources and the environment in which change occurs.
ENCOURAGING CHANGE Peter Beasley is the nurse manager of pediatric home care for a private home health care agency. Last year, the agency completed a pilot of wireless devices for use in documenting home visits. As nurses complete the documentation, charges for supplies and medical equip- ment are generated. The agency director informed the nurse managers that all nurses will be required to use the wireless devices within the next three months.
Charlene Ramirez has been a pediatric nurse for 18 years, working for the home health care agency for the past 5 years. Charlene has been active in updating the pediatric documentation and training staff when new paper-based documentation was implemented in the past. Although she was part of the pilot, Charlene is very opposed to using the new wireless devices. She complains that she can barely see the text. At a recent staff meeting, Charlene stated she would rather quit than learn to use the new wireless devices.
Peter empathizes with Charlene’s reluctance to use the new technology. He also recognizes how much Char- lene contributes in expertise and leadership to the de- partment. However, he knows that the new performance standards require all employees to use the wireless de- vices. After three mandatory training sessions, Charlene repeatedly tells coworkers “We’ve tried things like this before, it never works. We’ll be back on paper within six months, so why waste my time learning this stuff?” The program trainer reports that Charlene was disruptive dur- ing the class and failed her competency exam.
Peter meets privately with Charlene to discuss her resistance to the new technology. Charlene again states that she fails to see the need for wireless devices in delivering quality patient care. Peter reviews the new performance standards with Charlene, emphasizing the technology requirements. He asks Charlene if she has difficulty understanding the application or just in using the device. Charlene admits she cannot read the text on the screen and therefore cannot determine what exact- ly she is documenting. Peter informs Charlene that the agency’s health benefits include vision exams and par- tial payment for corrective lenses. He suggests that she talk with an optometrist to see if special glasses would help her see the screen. Peter also makes a note to speak with the technology specialist to see if there are aids to help staff view data on the device.