General objective:

 At the end of this class students will be acquainted with Planning for Change.

Specific objective:

 Define Planning for Change.

 Enlist strategies of change.
 Mention about Barriers to change and strategies to overcome.
 Describe various change theories in nursing.
 Explain role of nurse for planned change.

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 PLANNING FOR CHANGE

INTRODUCTION

 Change occurs over time, often fluctuating between intervals of change then a time of
settling and stability.
 Change management involves thoughtful planning and sensitive implementation, and
above all, consultation with, and involvement of, the people affected by the changes.
 If you force change on people normally problems arise.
 Change must be realistic, achievable and measurable.

DEFINITION

Planning:

Planning refers to thinking ahead of time and formulation of preliminary thoughts‖.

Planned change:

o Planned change entails planning and application of strategic actions designed to

promote movement towards a desired goal.

o Planned change is a change that results from a well thought out and deliberates effort to
make something happen. It is the deliberate application of knowledge and skills by a
leader to bring about a change. - Tappen, 1995

Change agent:

A change agent is one who generates ideas, introduces the innovation, and works to bring
about the desired change.

o A change agent is someone who deliberately tries to bring about a change or innovation,
often associated with facilitating change in an organization or institution.
o To some degree, change always involves the exercise of power, politics, and
interpersonal influence..
o A change agent must understand the social, organizational, and political identities and
interests of those involved.
o The change agent should have the following qualities;

o The ability to combine ideas

o The ability to energize others
o Skills in human relations
o Integrative thinking

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 o Flexibility modify ideas
o Persistent, confident and has realistic thinking
o Trustworthy
o Ability to articulate a vision, and
o Ability to handle resistance.

The key principles driving the elements of the Change Management are:

o Targeted Commitment Levels

o Executive Ownership
o Visible, sustained sponsorship
o Deployment/Implementation Support and Monitoring
o Employee Support
o Post Deployment Preparation

Strategies for planned change

In general, three categories of change models exist: empirical-rationale, power-coercive, and

normative-educative model. (Bennis, Benne and Chin [1969], The planning of change)

Rationale- empirical:

o This strategy emphasizes reason and knowledge.

o People are considered rational beings and will adopta change if it is justified and in
their self- interest.
o Here the change agent‘s role is communicating the merit of the change to the group.
o This strategy is useful when little resistance to change is expected.
o It is assumed that once if the knowledge and rationales are given, people will
internalize the need for change and value the result.

Normative- re-educative:

o This is based on the assumption that group norms are used to socialize individuals.
o The success of this approach often requires a change in attitude, values, and/ or
relationships.
o This strategy is most used when the change is based on culture and relationships
within the organization.
o The power of the change agent, both positional and informal, becomes integral to the
change process.

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Power- coercive:

o This approach is based on power, authority, and control.

o Desired change is brought about by political or economic power.
o It requires that the change agent have the positional power to direct the change.
o The outcome of change is often based either on follower‘s desire to please the leader
or fear of the consequences for not complying with the change.
o This strategy is effective for legislated changes.

Barriers to change and strategies to overcome

o It is important to identify all potential barriers to change.

Barrier Discussion Strategy

Desire to remain in
our comfort zone
Inadequate access to
information
Lack of shared vision
Lack of adequate
planning
Lack of trust
Resistance to change
Poor timing or
inadequate time
planned
Fear that power,
relationships, or
control will be lost
Amount of personal
energy needed for
change may be great
Those who become increasingly
attached to a familiar way of doing Rational- empirical
things (comfort zone) often view strategies
change as an unwelcome disruption.
Lack of information, inability to read
Rational- empirical
and understand the available
strategy
resources.
Lack of widespread involvement,
Normative- re
input, and ownership of change will
educative strategy
cripple a change effort.
Involving individuals in planning Rational- empirical
gives a sense of control and decreases and normative- re
their resistance to change. educative strategies
Trust in the change agent and ability Rational- empirical
of self to bring about change is and normative- re
necessary. educative strategies
Co-operation and involvement of the
Normative- re
whole team will only bring effective
educative strategy
and lasting changes.
Introducing change
at a time when
Poor timing and lack of planning can
people are ready to
fail to bring desired change.
change guarantees
success
Every change represents potential for Normative- re
loss to someone. educative strategy
Slow the change
Sometimes change is desired, but
process and give
people are not willing to do what is
time to catch- up and
necessary to effect the change.
energize

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Types of changes

Hohn (1998) identified four different types of change: Change by exception, Incremental
Change, Pendulum Change and Paradigm Change.

Change by Exception:

o This occurs when someone makes an exception to an existing belief system.

o For instance, if a client believes that all nurses are bossy, but then experiences nursing
care, they may change their belief about that particular nurse, but not all nurses in general.

Incremental Change:

o A change that happens so gradually, that an individual is not aware of it.

Pendulum Changes:

o Are changes that result in extreme exchanges of points of view.

Paradigm Change:

o Involves a fundamental rethinking of premises and assumptions, and involve a changing

of beliefs, values and assumptions about how the world works.

Change Theories in Nursing

o Change theories are used in nursing to bring about planned change.

o Planned change involves, recognizing a problem and creating a plan to address it.
o Some change theories used in nursing are Lewin‘s, Lippitt‘s, and Havelock‘s theories of
change.
o The characteristics of change theories are;
o Problem identification
o Plan for innovation
o Strategies to reduce innovation
o Evaluation plan

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Kurt Lewin‟s change theory:

o Kurt Lewin (1890 – 1947) has been acknowledged as the ―father of social change
theories and presents a simple yet powerful model to begin the study of change theory
and processes.
o "Unfreezing" involves finding a method of making it possible for people to let go of an
old pattern that was counterproductive in some way.
o In this stage, the need for change is recognized, the process involves creating awareness,
beginning the change & its acceptance.
o "Moving to a new level" involves a process of change--in thoughts, feelings, behavior,
or all three. The need for change is accepted and implemented in this stage.
o "Refreezing" is establishing the change as a new habit, so that it now becomes the
"standard operating procedure." The new change is made permanent here.
o Lewin also created a model called ―force field analysis which offers direction for
diagnosing situations and managing change within organizations and communities.
o According to Lewin‘s theories, human behavior is caused by forces – beliefs,
expectations, cultural norms, and the like – within the "life space" of an individual or
society.
o These forces can be positive, urging us toward a behavior, or negative, propelling us
away from a behavior.
o Driving Forces Driving forces are those forces affecting a situation that are pushing in a
particular direction; they tend to initiate a change and keep it going.
o In terms of improving productivity in a work group, pressure from a supervisor, incentive
earnings, and competition may be examples of driving forces.
o Restraining Forces Restraining forces are forces acting to restrain or decrease the
driving forces.
o Apathy, hostility, and poor maintenance of equipment may be examples of restraining
forces against increased production.
o Equilibrium Equilibrium is reached when the sum of the driving forces equals the sum
of the restraining forces.

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Lippitt's phases of change theory:

o Lippitt‟s theory is based on bringing in an external change agent to put a plan in place to
effect change.
o There are seven stages in this theory.

Phase 1:

Diagnose the problem

Phase 2:

Assess the motivation and capacity for change

Phase 3:

Assess the resources and motivation of the change agent(commitment the change, power, and
stamina)

Phase 4:

Define progressive stages of change

Phase 5:

Ensure the role and responsibility of the change agent is clear and understood (communicator,
facilitator, and subject matter expert.

Phase 6:

Maintain the change through communication, feedback, and group coordination

Phase 7:

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 Gradually remove the change agent from the relationship, as the change becomes part of an
organizational culture.

Havelock's change model:

o Havelock's change theory has six stages and is a modification of the Lewin's theory of
change.
o The six stages are building a relationship, diagnosing the problem, gathering resources,
choosing the solution, gaining acceptance and self renewal.
o In this theory, there is a lot of information gathering in the initial stages of change during
which staff nurses may realize the need for change and be willing to accept any changes that
are implemented.

John P Kotter's 'eight steps to successful change'

o Each stage acknowledges a key principle identified by Kotter relating to people's response
and approach to change, in which people see, feel and then change:
o Kotter's eight step change model can be summarized as:
o Increase urgency - inspire people to move, make objectives real and relevant.
o Build the guiding team - get the right people in place with the right emotional
commitment, and the right mix of skills and levels.
o Get the vision right - get the team to establish a simple vision and strategy focus on
emotional and creative aspects necessary to drive service and efficiency.
o Communicate for buy-in - Involve as many people as possible, communicate the
essentials, simply, and to appeal and respond to people's needs.
o Empower action - Remove obstacles, enable constructive feedback and lots of support
from leaders - reward and recognize progress and achievements.
o Create short-term wins - Set aims that are easy to achieve - in bite-size chunks.
Manageable numbers of initiatives. Finish current stages before starting new ones.
o Don't let up - Foster and encourage determination and persistence - ongoing change -
encourage ongoing progress reporting - highlight achieved and future milestones.
o Make change stick - Reinforce the value of successful change via recruitment, promotion,
and new change leaders. Weave change into culture.

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General considerations for planning change

o Secure and maintain commitment to change

o Define and communicate desired end state
o Identify critical success factors
o Establish targets and prioritize activities
o Develop a theme
o Understand why the change is desired/ required
o General considerations for planning change
o Secure and maintain commitment to change
o Define and communicate desired end state
o Identify critical success factors
o Establish targets and prioritize activities
o Develop a theme
o Understand why the change is desired/ required

Nurse Leader (manager) as role model for Planned Change

o Implement a comprehensive and coordinated change management program: Discover,

develop, detect.
o Identify ―change agents and engage people at all levels in the organization.

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 o Ensure the message comes from the top, and executives and line managers are
walking the talk.
o Make change visible with new tools and/or environment.
o Ensure clear, concise, and compelling communication.
o Integrate change goals with day-to-day activities, e.g., recruiting, performance
management, and budgeting.
o Address short-term performance while setting high expectations about long-term
performance.
o Help management avoid attempts to short circuit the change management process.
o Foster change in people‘s attitudes first, then focus on change in processes, then
change in the formal structure.
o Manage both supporters and champions, as well opponents and possible detractors.
o Accept that all people go through the same steps – some faster, some slower – and it
is not possible to skip steps.
o Build a safe environment that enables people to express feelings, acknowledge fears,
and use support systems.
o Acknowledge and celebrate successes regularly and publicly

Mistakes by a leader manager

o Fail to provide visible support and reinforce the change with other managers.
o Do not take the time to understand how current business processes would be affected
by change.
o Delayed decision-making, which leads to low morale and slow project progress.
o Are not directly or actively involved with change project.
o Fail to anticipate the impact on employees.
o Underestimate the time and resources needed
o Abdicate ownership of the project to another manager.
o Fail to communicate both the business reasons for the change and the expected
outcome to employees and other managers
o Change the project direction mid-stream
o Do not set clear boundaries and objectives for the project

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Organizational ageing

o The organization has to undergo progress through certain developmental stages within
the organizational structure termed organizational ageing.
o The young organization is characterized by high energy, movement and constant
change and adaptation; while the aged organizations will have established ‗turf
boundaries functioning in an orderly and predictable fashion, and are focused on rules
and regulations.
o In any type of ageing, organizations must find a balance between chaos and stagnation.
Some areas that undergo restructuring during an organizational ageing are;
o Leadership Changes
o Organizational Restructuring
o Outsourcing And Offshoring
o New Technologies And Tools
o New Competitors And Markets

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BIBLIOGRAPHY :

1) Jogindra Vati's Principles & Practice Of Nursing Management & Administration For Bsc
& Msc Nursing Jaypee Brothers Medical Pub (P) Ltd Editon 2013 Pg. No. 196-200

2) Management of Nursing Services and Education Clement I, Elsevier Health Sciences,

2015 pg No. 95-99

3) Joseph S’s Nursing Administration and Management AITBS publishers India Editon 2014
Pg. No. 150-155

4) A Text book on Nursing Management PADMASHREE INSTITUTE OF NURSING.

M.Sc. Nursing II years (2009-2011 batch) 126-134

5) www.study.com/academy/lesson

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