Initiating and
implementing Change
Prepared by:
TAHIRA BIBI
Assistant Nursing
Instructor
CON GTHSL Lahore
OBJECTIVES
At the end of this lecture the learners will be
able to:
Define the concept of change
Enlist the factors affecting the change
Explaining the change theories and models
Elaborate the capacity for change
Describe the strategies for change
The Concept of Change
Change is a process, not an event. It can
be planned or unplanned and can be
influenced by forces inside and outside of
the organization.
Definition of Change
Change is the process of making
something different from what it
was.
Change is an act or process
through which something
becomes different.
Change Agent
A change agent is a person from
inside or outside the organization
who helps an organization transform
itself by focusing on such matters as
organizational effectiveness,
improvement, and development.
The nurses as change agent
Nurses role in facilitating change
Change will continue at a rapid pace
with or without nursing’s expert
guidance.
Nurses must be proactive in shaping
the future
Forces for Change
External Forces Internal Forces
Competition Laws and regulations Strategy modifications
New technologies New equipment
Labor market shifts New processes
Business cycles Workforce composition
Social change Job restructuring
Compensation and benefits
Labor surpluses and shortages
Employee attitude
7
Change Can Be Perceived As
Positive or Negative
– Getting a Job After Graduating From College
– Getting Married
– Having a Child
– Child Leaving for College
– Getting a New Computer
– Losing a Job
– Divorce
– Death of a Parent
The five building blocks of
successful change
Prosci ADKAR Model
® ®
Awareness Awareness of the need for change
Desire to participate and support the
Desire change
Knowledge Knowledge on how to change
Ability to implement required skills
Ability
© 2012 Prosci and Bill Cigliano
and behaviors
Reinforcement ®
Reinforcement to sustain the change
9
Factors Affecting the Change
Process
Capacity for change
Forces that positively influence change
Forces that negatively influence change
Theories that inform change
Force Field Model
(Kurt Lewin Theory of change)
Assessing the environment
in which the change is to
occur
Kurt Lewin Force Field Model
Kurt Lewin (1951) proposed a force field
model.
He sees behaviours as a dynamic balance
of forces working in opposing direction
within a field such as an organization
Force Field Model
Driving Forces
Restraining Forces
Driving Forces
Driving forces facilitate change because they
push participants in the desired direction.
Driving forces move one toward the desired
change.
Restraining Forces
Restraining forces impede change because
they push participants in the opposite direction.
Restraining forces resist the desired change,
inhibiting its attainment.
A State of Equilibrium
People are viewed as constantly seeking a
balance between the power of the two forces,
which allows the status quo to be maintained in
a frozen state of existence.
A State of Equilibrium
When one of the forces is substantially altered,
reflecting a change in the power status of the
other, the state of equilibrium is “unfrozen,” and
there is a break in the status quo.
Kurt Lewin Force Field Model
1. Unfreezing
2. Moving
3. Refreezing
Basically strategies for change are aimed at
increasing driving forces, decreasing
restraining forces.
Lippitt Change Model
Lippitt and colleagues (1958) extended Lewin’s
theory to a seven- step process and focused more
on what the change agent must do than on the
evolution of change itself.
They emphasized participation of key members of
the target system through out the change process,
particularly during planning.
Communication skills, rapport building and problem
solving strategies underlie their phases.
Steps Of Lippitt Change Model
1. Diagnose problem
2. Assess motivation
3. Assess change agent’s motivations and
resources
4. Select progressive change objects
5. Choose change agent’s role
6. Maintain change
7. Terminate helping relationship
Havelock Change Model
Havelock (1973) also modify the
Lewin’s Model.
He describes an active change
agent as one who uses a
participative approach.
Havelock Change Model
1. Building a relationship
2. Diagnosing a problem
3. Acquiring resources
4. Choosing the solution
5. Gaining acceptance
6. Stabilization and self- renewal
Rogers Change Model
Rogers (2003) takes a broader approach
than Lewin, Lippitt, and Havelock
His six step innovation decision process
details how an individual or decision
making unit passes from knowledge of an
innovation to confirmation of the decision
to adapt or reject a new idea.
Rogers Change Model
His framework emphasizes the reversible nature of
change
Participants may initially adapt a proposal but later
discontinue it or the reverse they may initially reject it
but adapt it at a later time.
If the change agent is unsuccessful in achieving full
implementation of a proposal, it should not be assumed
the issue is dead, it can be resurrected, perhaps in an
altered form or at a more opportune time.
Steps of Rogers Change Model
1. Knowledge
2. Persuasion
3. Decision
4. Implementation
5. Confirmation
Key people and policy makers must be interested
in the innovation and committed to make it
happen
Erwin Change Model
Erwin(2005) found that
organizational change in hospitals
could only be successful and
sustained if senior administrators
were fully committed to change.
Prochaska & DiClemente Change
Model
Prochaska & DiClemente Change Model
(2005) proposed a trans theoretical model of
behaviour change.
1. Pre contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
Classifying the Change
Magnitude of the change
Degree of difficulty in making the change
Classifying the Change
First-order or continuous change
Second-order or discontinuous change
First-order or Continuous Change
Change occurs without a disruption to the
system. The system remains stable, and the
equilibrium is maintained.
Second-order or Discontinuous
Change
The equilibrium of the system is disrupted as
the fundamental properties of the system are
changed.
Building a Capacity for Change
Establish effective lines of
communication.
Secure community support.
Acquire support for the new program
concept.
Drive fear out of the schoolhouse.
Building A Capacity For Change
Work out bargaining agreements.
Acquire necessary approval from all
agencies.
Identify sources of needed resources.
Become knowledgeable of effective
change strategies.
Fullan’s Change Agentry Theory
The leader establishes readiness for change
by identifying and creating four leadership
capacities.
These leadership capacities must be
compatible with four organizational capacities.
Leadership Capacities
Personal vision
Inquiry
Mastery
Collaboration
The Change Process
Assessment
Planning
Implementation
Evaluation
Steps In The Change Process
1. Identify the problem or opportunity
2. Collect necessary data and information
3. Select and analyze data
4. Develop a plan for change, including time frame & resources
5. Identify supporters and opposers
6. Build a coalition of supporters
7. Help people prepare for change
8. Prepare to handle resistance
9. Provide feed back to keep every one informed
10. Evaluate effectiveness of change
Change Strategies
Power-Coercive Strategy
Empirical-Rational Model
Normative-Re Educative
Strategies
Power- Coercive Strategy
Based on the application of power by
legitimate authority or political clout.
Changes are made through law,
policy or financial appropriations.
Enforce changes by restricting
budgets or creating policies
Power- Coercive Strategy Cont..
Health care reform legislation is an
example of power- coercive strategy by
federal government.
Used when much resistance is
anticipated, time is short and the
change is critical for the organizational
survival.
Empirical–Rational
A Non-coercive Approach
The leader assembles and presents the
necessary information regarding the
desired change.
Empirical- Rational Model
In empirical-rational change strategies, the
power ingredient is knowledge.
The assumption is that people are rational and
will follow their rational self interest.
It is also assumed that change agent who has
knowledge has the expert power to persuade
people to accept a rationally justified change
that will benefit them.
Empirical-Rational Model cont..
New ideas are invented and communicated and diffused to
all participants.
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 theses strategies
The benefits of change for staff and resaerch documenting
improved patient outcomes are the major driving forces.
Normative–Re-educative
A Consensus Approach
The leader seeks change using a
consensus approach.
Normative-Re educative Strategy
People act in accordance with social norms and
values.
Informational and rational arguments are
insufficient to change people’s pattern of action.
Change agent must focus on noncognitive
determinants of behavior.
People’s roles and relationships, attitudes and
feelings will influence their acceptance of change.
Normative-Re educative Strategy cont.
In this model, the power ingredient is not authority
or knowledge but skill in inter personal relationships.
The change agent does not use coercion but
collaboration.
Members of target system are involved throughout
the change process and time consuming strategy.
Well suited to the creative problem solving needed
in nursing and health care today.
References
Chin, R., & Benne, K. D. (1969). General strategies for effective change
in human systems. In W. G. Bennis, K. D. Benne, & R. Chin (eds.),
The planning of change (2nd ed.). New York: Holt, Rinehart &
Winston.
Conley, D. T. (1997). Roadmaps to restructuring: Charting the
course of change in American education. Eugene: University
of Oregon (ERIC Clearinghouse on Educational
Management).
Fullan, M. (1999). Change force: The sequel. New York: Falmer Press
Lewin, K. (1951). Field theory in social sciences. New York: Harper &
Row.
Schmidt, W., & Finnigan, J. (1992). The race for the finish line: America’s
quest for total quality. San Francisco: Jossey-Bass
