PowerPoint Presentation

DIRECTING CHANGE

.Presenter : Mr. Mahesh Kumar sharma MSc Nursing CON, AIIMS

Few quotationsOnly I can change my life. No one can do it for me. Carol Burnett We all have big changes in our lives that are more or less a second chance. Harrison Ford (1942 ), Things do not change; we change. Henry David Thoreau (1817 - 1862), Walden (1970)

Introduction Change is unavoidable, part of life. Few changes are under our control.

Some things we can intentionally changeour behaviors, thoughts, feelingshabits.

Successful, self-changing individuals follow a powerful and, perhaps most important, controllable and predictable course.

Introduction The key of successful change is to use the right strategy for the right time.

There are no magic pills, pins or plans.

We can learn new skills, draw upon your inner strength, enhance our self-sufficiency, and avoid becoming dependent on others for solutions; thus building our self-confidence for the future. -changing for good (book)

CHANGE

Definition of change: Implies making an essential difference, often amounting to a loss of original identity or a substitution of one thing for another.Examples: New email system Transition from paper to electronic Requisitions Introduction of a new technology Distribution of workers in newly built hospital building

Specific forces that are acting as stimulants for changeNature of the workforce- eg More cultural diversity Increase in professionalsTechnology- eg More computers and automation

Economic shock- eg Interest rate fluctuations Foreign currency fluctuations

Specific forces that are acting as stimulants for changeCompetition- eg- Growth of new global competitorsSocial trends- eg- Increase in college attendance Delayed marriages by young people

World politics eg: Collapse of Soviet Union Iraqs invasion of Kuwait

FORMS OF CHANGE Planned Change: To improve the ability of the organization to adapt to changes in its environment.To change the behaviour of its employees.

Unplanned Change: Changes in government regulations Changes in the economy.

Directing change Thoughtful planning Sensitive implementation of change in consultation And with the involvement of the people affected by the changes.

Organizational changeIt is any alteration in People (attitudes, expectations, perception, behaviour).

Structure(work specialization, departmentalization ,chain of command, span of control, centralization , formalization, job redesign, actual structure design).

Organizational change Contd..Technology (work processes, methods & equipment)

What provokes Organizational Change?

Achievement of a goal.Counteracting some major outside driving force. eg.- substantial cuts in funding.Evolving to a different level in their life cycle eg. from traditional government to an e- government.Appointment of a new chief executive when his /her new and unique personality and views, changes the entire organization.

CHANGE MANAGEMENTChange management is not: Managing the technical side of change Just communication plans

It is the process, tools and techniques to manage the people-side of change to achieve the required outcome.

Trans-theoretical model [TTM] of behaviour change

This model explains the stages of individual behaviour change. It is based on analysis and use of different theories of psychotherapy; hence the name trans-theoretical model.

Trans-theoretical model [TTM] of behaviour change

TMBC and quitting tobacco A tobacco user in this stagePrecontemplationGives no thought to quitting use, and has no intention to quit in the near future (i.e., within next 6 months)ContemplationHas begun to examine their tobacco use and desire to quit; Is weighing the pros and cons of quitting tobacco

TMBC and quitting tobacco PreparationHas made a commitment to quit (usually within next 30 days), and has begun developing a plan for quittingActionHas put their plan for quitting tobacco into action (< 6 months)MaintenanceHas successfully sustained abstinence for at least 6 months

THE ROLE OF CHANGE AGENTS

Change Agent -The individual or group who undertakes the task of introducing and managing a change in an organization. Change agents are of two types: Internal Change Agents: are appointed to oversee the change process, and they are from within the organization.External Change Agents: are external , such as outside consultants. They bring an outsider's objective view to the organization.

They can be internal managers or employees who 19

Internal change agents AdvantagesThey know the organization's past history, its political system, and its culture.

Careful about managing change because they must live with the results of their change efforts.DisadvantagesMay easily be accused of favouritism.

As very close to the organization, devoid of an objective view of what needs to be done.

External change agents AdvantagesMay be preferred by employees because of their impartiality.If employees perceive the change agents as being trustworthy, possessing important expertise, they are easily accepted and can function well.

Disadvantages Face certain problems, because of limited knowledge about the organization's history. May be viewed with suspicion by the organization members.

Theories on changeLewins theory

Rogers theory

Reddins theory

Havlocks theory

Spradleys theory

KURT LEWIN S THEORY OF CHANGEUNFREEZING

CHANGING

REFREEZNG

STAGES OF ORGANIZATINAL CHANGEUNFREEZING: Old ideas and practices has to be kept aside, so that new ones can be learned.CHANGING : New ideas and practices are learned helping an employee think, reason and perform in new ways; its a time of confusion, disorientation, overload and despair.REFREEZING : What has been learned is integrated into actual practice or routine behaviour.

ie. unlearning the old practices,so 24

STAGES OF ORGANIZATINAL CHANGE contd..As the Organization works its way through these stages, there can be a negative impact on Productivity. This is referred to as the Productivity Dip.

APPLICATION OF LEWINS THEORY IN NURSING Unfreezing: The nurse manager is motivated by the need to create the change and affected nurses are made aware of this need. The need for change in nursing is assessed fromQuality monitoring and benchmarkingPatient complaints, or consumer consultationReporting of adverse eventsStaff speaking up about obstacles, errors, or opportunities for improvement. Unfreezing reduces resistance and helps readiness for change.

APPLICATION OF LEWINS THEORY IN NURSING contd.

Moving stage- Implementing the solutions identified as most appropriate, for a planned change. Requires destabilising the equilibrium between the forces driving and restraining the group. Restraining force -Lack of knowledge and skills actsDriving force-Training for staff to develop new skills required in changed practice.

APPLICATION OF LEWINS THEORY IN NURSING contd..FREEZING: The new way of doing things is reinforced, aligned with other organizational procedures and routines, and thus, institutionalised .

Research studyImplementation of anursingprofessional practice model of care in a pediatric hospital.Mullen JE,Asher LM. Pediatr Nurs.2007 Nov-Dec;33(6):499-504METHODOLOGY A children's hospital was selected to implement professional practice model to optimize outcomes for patients, families, nursingstaff, and the organisation. periodic education, intonursing procedures, and assisting nurses in using the model at the bedside were used to implement the model and sustain the culturechange RESULT:The model of care was successfully implemented in both the inpatient and outpatient areas.

ROGERS THEORYEverette Rogers modified Lewin's change theory and created a five-stage theory of his own.

The five stages are awareness, interest, evaluation, implementation and adoption.

This theory is applied to long-term change projects.

It is successful when nurses who ignored the proposed change earlier adopt it because of what they hear from nurses who adopted it initially

REDDINS THEORYHe has developed a planned change model that can be used by nurses. Maximum information is important to the success of change. At least announcements should be made by management.That a change will be madeWhat the decision is and why it was madeHow the decision will be implementedHow the implementation is progressing

REDDINS THEORY CONTD.7 Techniques by which change can be accomplishedDiagnosisMutual setting of objectivesGroup EmphasisMaximum informationDiscussion of implementationUse of ceremony and ritualResistance Interpretation

HAVLOC THEORYHavelock's theory of change is a linear model that generally resembles Lewin's model, with an emphasis on planning and an understanding of the possibility that people and systems may be resistant to change.

The 6 Aspects of Havelock's Theory of Change.

Relationship. It states that relationship with the system in need of change needs to be established. This could be regarded as a stage of "pre-contemplation" where things are going along as usual.Diagnosis.Once the agent of change is comfortable with the system as it is, the person or entity being evaluated needing change is evaluated to see if there is any awareness of a need for change. Acquire resources for change.At this change, the need for change is understood and the process of developing solutions begins by gathering as much information as possible that is relevant to the situation that requires change.

HAVLOC THEORY contd.Selecting a pathway. It is when a pathway of change is selected from available options and then implemented.Establish and accept change.Once the change has been put in place, it must be established and accepted. Maintenance and separation.Now that the change is successful, the change agent should monitor the affected system to make sure that it is successfully maintained

DiagnosisDuring this contemplation phase, the subject of change must decide whether or not change is needed or desired. Often the change process can end prematurely here because the subject decides that change is either not needed or not worth any effort to correct.Establishing pathway; Individuals and organizations are often resistant to change, so careful attention must be given to make sure that the change becomes part of new routine behavior. After change has been accepted, the change process can be declared successful.Maintenance and separation; . Once the change has become the new "normal," the change agent can separate from the person or organization that was changed. At this stage, we hope that the person or organization has learned enough about themselves and the change process that they can maintain their new behaviors.

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Spradleys model of change Based on Lewins theory the model has been developed; 8 step model of changeThe following are the steps :RECOGNISE THE SYMPTOMS-There is evidence that something needs change.DIAGNOSE THE PROBLEM-Gather and analyse the data to discuss the cause.Communicate with the staff.Read appropriate materials

Spradleys model of change-contd3.ANALYSE THE ALTERING SOLUTIONS- by brain storming, creative thinking assess the risks and benefits set a time ,plan resources and look for obstacles.

4.SELECT THE CHANGE:Choose the option that is likely to succeed and affordable.

Spradleys model of change-contd5.PLAN THE CHANGE: It includes Specific measurable objectives and actions. A time table Plan the resources Budget An evaluation method such as programme evaluation review technique(PERT). A plan for resistance management.

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Spradleys model of change-contd 6.IMPLEMENT THE CHANGE- Plot the strategy Prepare involve, train, assist and support those who will be affected by the change. 7.EVALUATE THE CHANGE-Analyse the achievement of objectives and audit. 8. STABILIZE THE CHANGERefreeze. Monitor until stable.

RESEARCH STUDYMaking the transition tonursingbedside shift reports.Wakefield DS,Ragan R,Brandt J,Tregnago M. Jt Comm J Qual Pat2012 BACKGROUND:For hospitalized patients, nurse shift reports between the off going and oncoming nurses, must include all critical information about a patient's plan of care, and that information must be well communicated. METHOD: Study compared bed side shift report with the routine shift report and the difference and feasibility was evaluated by examining baseline patient satisfaction scores, reviewing the existing shift report processes, and identifying potential barriers and facilitators in moving to bedside shift reports.

RESEARCH STUDY CONTD.. RESULTS: For the first six months following implementation of bedside shift reports, there were significant increase in patient satisfaction scores from the 20th to > 90th percentile when compared with similarnursingunits in peer institutions. CONCLUSIONS: Although the transition to bedside shift reports met with some resistance, the transition was made smoother by extensive planning, training, and gradual implementation. On the basis of this pilot study, the decision was made to adopt bedside shift reports in all inpatientnursingunits in five hospitals.

ORGANIZATIONAL CHANGE MANAGEMENT

ORGANIZATIONAL CHANGE MANAGEMENTTwo approaches to organization change:Organizational development(OD): Formal top -down approach.

Grass root approach: An unofficial and informal bottom-up change.

The goals of Organization Change Management

To design, implementation, measurement and maintenance of an organizations change initiative successfully . To enhance the on-going capacity for managing change.

Managing Organizational ChangeChange management requires a system of doers

Each gear plays a specific role based on how they are related to change

Executives and senior managers-roleParticipate actively and visibly throughout the project. Communicate directly with employees.

Not just signing checks and project charters!

Middle managers and supervisors-Why are they important?They are close to the people who adopt the change. They play a role in all types of change in the organization.They need to be trained to be successful.

Middle managers and supervisors -rolesRole 1 Communicator Role 2 Advocate Role 3 Coach Role 4 LiaisonRole 5 Resistance manager

Liaison- a means of communication between different groups or units of an organization

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Project teamWhy are they importantDrive the technical side of change Design solutions Develop solutions Deliver solutions

Project team-roleDesign the actual change.Manage the technical side of the change.schedule, resources, work breakdown structure, budget etc. Engage with change management team/resource. Integrate change management plans into project plan.

Project support functions

Bring specific experience, knowledge, tools and expertise to the project. Sometimes act as the change management resource. Key pieces of the technical and people side.Eg: human resource department , communication , training etc.

How to accomplish organisational change?Get senior management agreement (i.e. conflicting goals can kill the project!)Identify a leader who can articulate the reasons for and advantages of the change.Translate the vision for change into a realistic plan and then carry out the plan.Involve people from every area of the organization.

Widely communicate the potential need for change. Communicate what you're doing about it. Communicate what was done and how it worked out with the help of examples. Communicate that Senior Management backs this strategy unanimously.

Get as much feedback about practical aspects from employees Include what they think the problems are and what should be done to resolve them. If possible, work with a team of employees to see how to manage the change.

Don't get wrapped up in doing change for the sake of change Know why you are making the changeWhat goals do you hope to accomplish?Communicate the goals.

Plan the change Plan how to reach the goals, What is required to reach the goals, How long might it take to accomplish the goals. Plan how will you know that , you have reached your goals or not? Focus on the coordination of the departments/programmes from organization.

Delegate decisions to employees as much as possible This includes granting them the authority and responsibility to get the job done. As much as possible, let them decide how to do the project.

Managing organizational changeDon't try to control change-but rather expect it, understand it and manage it. Include closure in the plan- Acknowledge and celebrate your accomplishments.Read some resources about organizational change- including new trends ,forms and structures regarding change management.Consider using a consultant- Ensure the consultant is highly experienced in organization wide change.

Managing change-role of managerFacilitate and enable change. Manage the change in a way that employees can cope with it. Understand the situation from an objective standpoint. Help people by make them to understand reasons, aims, and ways of changing by responding positively, according to employees own situations and capabilities. Increasingly, the manager's role is to interpret, communicate and enable - not to instruct and impose.

Strategies for advancing evidence-based practice in clinical settings. J N Y State Nurses Assoc.2004 Levin RF,Melnyk BM. BACKGROUND:Evidence-based practice (EBP) is a problem-solving approach that incorporates the best available scientific evidence, clinicians' expertise, and patients' preferences and values. METHODOLOGY:Researchers developed the ARCC (Advancing Research and Clinical practice through close Collaboration) model for the purpose of implementing EBP. A pilot study was conducted to test the ARCC model at 2 acute-care sites.

Contd.. RESULT:

This pilot study shows what all are necessary for the successful implementation of EBP in the acute-care setting. These essentials include identifying EBP leaders, redefining nurses roles to include EBP activities, allocating time and money to the EBP process, and creating an organizational culture that fosters EBP.

Reasons for failure of change managementResearch indicates that two-thirds of all organizational changes fail. Some causes for failure are:A lack of commitment from the top.Change overload.Lack of incentives tied to the change initiative.A lack of training.

KEY POINTS IN DIRECTING CHANGETo move from good intentions to good results, there is a need to realize that ,we (the changers) may be living in the future state, while everyone else (the changees) is living in the present.Effective change management MUST be focused on individuals change.Individual change is a process.Need the right people involved and engaged in the right ways.Begin with end in mind.

Resistance to changeEfforts by employees to block the intended change is referred to as Resistance to Change.Any employee behavior designed to discredit, delay or prevent the implementation of a work change is known as resistance to change.

Unified social response to changeAbsenteeism Strike Demand Indifference Harder workSabotage

Destruction of property or obstruction of normal operations, as by civilians or enemy agents in time of war.-sabotage69

How prevalent is Resistance to Change?

It is generally acknowledged that in an average organization, when the intention for change is announced:

15% of the workforce is eager to accept it.15% of the workforce is dead set against it.70% is sitting on the fence, waiting to see what happens.

Resistance to changeResistance to change can be categorized into two sources: 1. Individual resistance 2. Organizational resistance.

Individual resistance to change:

Efforts by which an employee block the intended change. Individual sources of resistance to change reside in basic human characteristics such as perceptions, personalities , needs etc.

Reasons for individual resistance to change1.Economic ReasonsFear of technological unemployment. Fear of increased work hours and less pay. Fear of demotion and thus reduced wages. Fear of speed-up and reduced incentive wages.

Reasons for individual resistance to change-contd 2.Fear of the Unknown: Change often bring substantial uncertainty and ambiguity into what was once a comfortable situation for them.3.Fear of Loss: When a change is impending, employees may fear losing their jobs, particularly when an advanced technology is introduced .4.Feeling Of Insecurity: change threatens their feeling of safety.

Reasons for individual resistance to change-contd5.Peer Pressure :Whenever change is unwilling to the peers, they force the individual who want to accept change to resist change.

6.Social Displacement: Introduction of change often results in disturbance of the existing social relationships ie. breaking up of work groups.

Reasons for Organizational Resistance1.Resource Constraints: Financial, material and human resources may not be available to the organization to make the needed changes. 2.Structural Inertia: In an organization where jobs are narrowly defined, lines of authority are clearly spelled out, change would be difficult.

Reasons for Organizational Resistance-contd3.Sunk Costs: Some organizations invest a huge amount of capital as fixed assets. If an organization wishes to introduce a change ,then difficulty arises because of these sunk costs.4. Threat to expertise: Change in organizational pattern may threaten the expertise of specialized groups. Therefore specialist usually resists change.

Management Of Resistance To ChangeEducation and Communication: Communication about impending change The details of the change should be clear to the employees- how, why, what.Make clear the rationale behind the change.

Management Of Resistance To Change contdParticipation: It is difficult for individuals to resist a change decision in which they are participating. Prior to making a change, those opposed can be brought into the decision process.When employees are allowed to participate, they are likely to assist the change.

Management Of Resistance To Change contdEmpathy and Support: Provide empathy and support to employees who have trouble in dealing with the change.Active listening is an excellent tool for identifying the reasons behind resistance and for uncovering fears.Negotiation: To exchange something of value for the lessening of the resistance.Negotiation is a tactic when resistance comes from a powerful source.

Management Of Resistance To Change-contdManipulation: Manipulation refers to twisting and distorting facts to make them appear more attractive, withholding undesirable information and creating false rumours to get employees to accept a change.

Management Of Resistance To Change contd..Coercion: Coercion is the application of direct threats or force on the resisters.They essentially force people to accept a change by explicitly or implicitly threatening them with the loss of their jobs, promotion possibilities and transferring them.Coercion is mostly applied where speed is essential in implementing change and the change initiator possesses considerable power.

Explicit-said or explained in clear way82

Examples showing bad management of change

The following employee excuses demonstrate that change is being managed badly and that employees are increasingly demotivated:

Repetitive Change Syndrome It is often caused by series of organizational initiatives that are started ,but not completed, results in the blurring up of the programmes.Although resistance to change can initiate changes, it can also slow the pace of change and ultimately cause it to fail.

SummaryChange Organizational changeForms of changeTrans theoretical model on behavioural change.Change agentsTheories on changeIndividual change managementOrganizational change managementResistance to change

CONCLUSIONChange must be continually managed to yield sustained results.A consistent process of measuring the results of the change initiative combined with a rewards program that reinforces the desired behaviour is the backbone of an effective change program.

Everyone thinks of changing the world, but no one thinks of changing himself. Leo Tolstoy

Change is the law of the universe. What you think of as death, is indeed life. In one instance you can be a millionaire, and in the other instance you can be steeped in poverty. Yours and mine, big and small - erase these ideas from your mind. Then everything is yours and you belong to everyone.

Referenceshttp://www.businessballs.com/changemanagement.htmColin A. Carnall. Managing change4th edition, New fetter lane, London,2007.pgs:7-48Managing change.pdf for Govt office for the South WestStephen P. Robbins, Mary Coulter. Organization and managementpg:360-364Principles_ of management_ notes_ pdf

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