Clarify information, and provide accurate feedback.
Managers need to plan the resources required to make the change and establish feedback mechanisms to evaluate its progress and success. Establish control points with people who will provide the feedback and work with these people to set specific goals with time frames. Develop operational indicators that signal success or failure in terms of performance and satisfaction.
Three surgery center nurses designed a flow chart of how the process could be improved. They took it to their administration and were put in charge of its implementation.
Implementation The plans are put into motion (Lewin’s moving stage). Interventions are designed to gain the nec- essary compliance. The change agent creates a supportive climate, acts as an energizer, obtains and provides feedback, and overcomes resistance. Managers are the key change-process actors. Some methods are directed toward changing individuals in an organization, whereas others are directed toward changing the group.
Methods to Change Individuals The most common method used to change individuals’ perceptions, attitudes, and values is information giving. Providing information is prerequisite to change implementation, but it is inadequate unless a lack of information is the only obstacle to effecting change. Providing infor- mation does not address the motivation to change.
Training is often considered a method to change individuals. Training combines information-giving with skill practice. Training typically shows people how they are to perform in a system, not how to change it. Therefore, it is a strategy to help make the transition to a planned change rather than a mechanism to initiate change.
Selecting and placing personnel or terminating key people often is used to alter the forces for or against change. When key supporters of the planned change are given the authority and
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accountability to make the change, their enthusiasm and legitimacy can be effective in leading others to support the change. Conversely, if those opposed to the change are transferred or leave the organization, the change is more likely to succeed.
Methods to Change Groups Some implementation tactics use groups rather than individuals to attain compliance to change. The power of an organizational group to influence its members depends on its authority to act on an issue and the significance of the issue itself. The greatest influence is achieved when group members discuss issues that are perceived as important and make relevant, binding de- cisions based on those discussions. Effectiveness in implementing organizational change is most likely when groups are composed of members who occupy closely related positions in the organization.
Individual and group implementation tactics can be combined. Whatever methods are used, participants should feel their input is valued and should be rewarded for their efforts. Some people are not always persuaded before a beneficial change is implemented. Sometimes behav- ior changes first, and attitudes are modified later to fit the behavior. In this case, the change agent should be aware of participants’ conflicts and reward the desired behaviors. It may take some time for attitudes to catch up.
The surgery center nurses worked with physician offices, insurance companies, and other hospital departments to implement the new process for preoperative services.
Evaluation Evaluate Effectiveness At each control point, the operational indicators established are monitored. The change agent determines whether presumed benefits were achieved from a financial as well as a qualitative perspective, explaining the extent of success or failure. Unintended consequences and undesir- able outcomes may have occurred.
Stabilize the Change The change is extended past the pilot stage, and the target system is refrozen. The change agent terminates the helping relationship by delegating responsibilities to target system members. The energizer role is still needed to reinforce new behaviors through positive feedback.
Over the next three months, the preoperative services department was able to show a 90 percent decrease in duplicate test orders, a 50 percent decrease in patient waiting time, and an 80 percent increase in physician satisfaction with the process.
Change Strategies Regardless of the setting or proposed change, the four-step change process should be followed. However, specific strategies can be used, depending on the amount of resistance anticipated and the degree of power the change agent possesses.
Power-Coercive Strategies Power-coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political clout. Changes are made through law, policy, or financial appropriations. Those in control enforce changes by restricting budgets or creating policies. Those who are not in power may not even be aware of what is happening. Even if they are aware, they have little power to stop it. Health care reform legislation, is an example of power-coercive strategy by the federal government.
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Power-coercive strategies are useful when a consensus is unlikely despite efforts to stimulate participation by those involved. When much resistance is anticipated, time is short, and the change is critical for organizational survival, power-coercive strategies may be necessary.
Empirical–Rational Model In the empirical–rational model of change strategies, the power ingredient is knowledge. The assumption is that people are rational and will follow their rational self-interest if that self- interest is made clear to them. It is also assumed that the change agent who has knowledge has the expert power to persuade people to accept a rationally justified change that will benefit them.
The flow of influence moves from those who know to those who do not know. New ideas are invented and communicated or diffused to all participants. Once enlightened, rational people will either accept or reject the idea based on its merits and consequences. Empirical–rational strategies are often effective when little resistance to the proposed change is expected and the change is perceived as reasonable.
Well-researched, cost-effective technology can be implemented using these strategies. In- troducing a new technology that is easy to use, cuts nursing time, and improves quality of care might be accepted readily after in-service education and a trial use. Using bar codes to match medications to patients is another example.
The change agent can direct the change. There is little need for staff participation in the early steps of the change process, although input is useful for the evaluation and stabilization stages. The benefits of change for the staff and research documenting improved patient out- comes are the major driving forces.
Normative–Reeducative Strategies In contrast to the rational-empirical model, normative–reeducative strategies of change rest on the assumption that people act in accordance with social norms and values. Information and rational arguments are insufficient strategies to change people’s patterns of actions; the change agent must focus on noncognitive determinants of behavior as well. People’s roles and relationships, perceptual orientations, attitudes, and feelings will influence their acceptance of change.
In this mode, the power ingredient is not authority or knowledge, but skill in interpersonal relationships. The change agent does not use coercion or nonreciprocal influence, but col- laboration. Members of the target system are involved throughout the change process. Value conflicts from all parts of the system are brought into the open and worked through so change can progress.
Normative–reeducative strategies are well suited to the creative problem solving needed in nursing and health care today. With their firm grasp of the behavioral sciences and communica- tion skills, nurses are comfortable with this model. Changing from a traditional nursing system to self-governance or initiating a home follow-up service for hospitalized patients are examples of changes amenable to the normative–reeducative approach.
In most cases, the normative–reeducative approach to change will be effective in reduc- ing resistance and stimulating personal and organizational creativity. The obvious drawback is the time required for group participation and conflict resolution throughout the change process. When there is adequate time or when group consensus is fundamental to successful adoption of the change, the manager is well advised to adopt this framework.
Resistance to Change Resistance to change is to be expected for a number of reasons: lack of trust, vested interest in the status quo, fear of failure, loss of status or income, misunderstanding, and belief that change
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is unnecessary or that it will not improve the situation (Yukl, 2009; Hellriegel, Jackson, & Slocum, 2007). In fact, if resistance does not surface, the change may not be significant enough.
Employees may resist change because they dislike or disapprove of the person responsible for implementing the change or they may distrust the change process. Regardless, managers continually deal with change—both the change that they themselves initiate and change initiated by the larger organization.
Resistance varies from ready acceptance to full-blown resistance. Rogers (2003) identified six responses to change:
● Innovators love change and thrive on it. ● Less radical, early adopters are still receptive to change. ● The early majority prefer the status quo, but eventually accept the change. ● The late majority are resistive, accepting change after most others have. ● Laggards dislike change and are openly antagonistic. ● Rejecters actively oppose and may even sabotage change.
The change agent should anticipate and look for resistance to change. It will be lurking somewhere, perhaps where least expected. It can be recognized in such statements as:
● We tried that before. ● It won’t work. ● No one else does it like that. ● We’ve always done it this way. ● We can’t afford it. ● We don’t have the time. ● It will cause too much commotion. ● You’ll never get it past the board. ● Let’s wait awhile. ● Every new boss wants to do something different. ● Let’s start a task force to look at it; put it on the agenda.
Expect resistance and listen carefully to who says what, when, and in what circumstances. Open resisters are easier to deal with than closet resisters. Look for nonverbal signs of resis- tance, such as poor work habits and lack of interest in the change.
Resistance prevents the unexpected. It forces the change agent to clarify information, keep in- terest level high, and establish why change is necessary. It draws attention to potential problems and encourages ideas to solve them. Resistance is a stimulant as much as it is a force to be overcome. It may even motivate the group to do better what it is doing now, so that it does not have to change.
On the other hand, resistance is not always beneficial, especially if it persists beyond the planning stage and well into the implementation phase. It can wear down supporters and redirect system energy from implementing the change to dealing with resisters. Morale can suffer.