Change Management


Article Author:
Jennifer Barrow


Article Editor:
Tammy Toney-Butler


Editors In Chief:
Sherri Murrell


Managing Editors:
Avais Raja
Orawan Chaigasame
Khalid Alsayouri
Kyle Blair
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Abbey Smiley
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beenish Sohail
Hajira Basit
Phillip Hynes
Sandeep Sekhon


Updated:
6/18/2019 3:22:10 AM

Introduction

Change is inevitable in health care. A significant problem specific to health care is that almost two-thirds of all change projects fail for many reasons, such as poor planning, unmotivated staff, deficient communication, or excessively frequent changes[1]. All healthcare providers, at the bedside to the boardroom, have a role in ensuring effective change. Using best practices derived from change theories can help improve the odds of success and subsequent practice improvement.

Suppose a health care provider works in a hospital department that has experienced a 3-month increase in unwitnessed patient falls during the hours surrounding shift change. Evidence-based changes in the current shift change process would likely decrease patient falls; however, departmental leadership has attempted unsuccessfully to fix this problem twice in the past 3 months. Staff continues to revert to previous shift change protocols to save time, which leaves patients unmonitored for extended periods. What can departmental leadership and staff do differently to create sustained, positive change to serve the department’s patients and employees?

The answer may lie within the work of several change leaders and theorists. Although theories may seem abstract and impractical for direct healthcare practice, they can be quite helpful for solving common healthcare problems. Lewin was an early change scholar who proposed a three-step process for ensuring successful change[2]. Other theorists like Lippitt, Kotter, and Rogers have added to the collective change knowledge to expand upon Lewin’s original Planned Change Theory. Although each change theory is different with unique strengths and weaknesses, the theories’ commonalities can provide best practices for sustaining positive change.

Lewin’s Theory of Planned Change includes the following change stages[2]:

  • Unfreezing (understanding change is needed)
  • Moving (the process of initiating change)
  • Refreezing (establishing a new status quo).

Lippitt, building on Lewin’s original theory, created the Phases of Change Theory that encompass the following change phases[3]:

  • Becoming more aware of the need for change
  • Develop a relationship between the system and change agent
  • Define a change problem
  • Set change goals and action plan for achievement
  • Implement the change
  • Staff accept the change; stabilization
  • Redefine the relationship of the change agent with the system.

Kotter’s Eight-Step Change Model, created in 1995, include the following change management steps[3]:

  • Create a sense of urgency for change
  • Form a guiding change team
  • Create a vision and plan for change
  • Communicate the change vision and plan with stakeholders
  • Remove change barriers
  • Provide short-term wins
  • Build on the change
  • Make the change stick in the culture.

Finally, Rogers’ Diffusion of Innovation Theory introduced these five change phases[4]:

  • Knowledge (education and communication to expose staff to the change)
  • Persuasion (use of change champions to pique staff interest; peers persuading peers)
  • Decision (staff decide whether to accept or reject the change)
  • Implementation (putting new processes into practice)
  • Confirmation (staff recognize the value and benefits of the change and continue to use changed processes).

Issues of Concern

All change initiatives, no matter how big or small, unfold in three major stages: pre-change, change, and post-change. Within those stages, healthcare providers working as change agents or change champions should select actions that match change theories. One of the most critical aspects of pre-change planning is involving key stakeholders in problem identification, goal setting, and action planning[5]. Involving stakeholders in change planning increases staff buy-in. These stakeholders should include staff from all shifts, including nights and weekends, to create peer change champions for all shifts[5].

One particular portion of Rogers’ change theory identifies the various rates with which staff members accept changes through the process of innovation diffusion. During pre-change planning, change agents should assess their departmental staff to determine which staff belong to each category. Rogers described the different categories of staff as innovators, early adopters, early majority, late majority, and laggards[4]. He further qualified those change acceptance categories with the following descriptions:

  • Innovator: passionate about change and technology; frequently suggest new ideas for departmental change
  • Early adopter: high levels of opinion leadership in the department; well-respected by peers
  • Early majority: Prefer the status quo; willing to follow early adopters when notified of upcoming changes
  • Late majority: Skeptical of change but will eventually accept the change once the majority has accepted; susceptible to increased departmental social pressure
  • Laggard: High levels of skepticism; openly resist change[4].

Most departmental staff will likely belong to the early or late majority. Change agents should focus their initial education efforts on Innovator and Early Adopter staff. Early adopters are often the most pivotal change champions that persuade early and late majority staff to embrace change efforts[4].

One final critical assessment change leaders should incorporate a force field analysis, which is a significant component of Lewin’s early change theory. A force field analysis involves a review of change facilitators and barriers at work in the department. Change leaders should work to reduce change barriers through open communication and education while also aiming to strengthen change facilitators through staff recognition and various incentives.

One of the biggest mistakes a change leader can make during the midst of change implementation is failing to validate that staff members are performing new processes as planned. Ongoing leader engagement throughout change execution will increase the chances of success[5]. Staff resistance remains common during this stage. Change leaders may find it helpful to conduct another Force Field Analysis during this changing phase to ensure no new barriers have emerged[3]. Further strengthening of change facilitators through staff engagement, recognition, and sharing of short-term wins will help maintain momentum. Staff may require additional on-the-spot training to overcome knowledge deficits as the change process continues. Finally, leaders must continue to monitor progress toward goals using information like patient satisfaction, staff satisfaction, fall rates, and chart audits[3].

Once the change has become part of the department’s new culture, change leaders still must periodically validate departmental processes and solicit staff feedback. Change agents can redefine their relationship with the staff to take on a less active role in the change maintenance process. However, once the change leader begins to release control over the change process, staff members may slowly revert to old, negative behaviors. Periodic spot-checking and continued data monitoring can solidify the change as the department’s new status quo. Change managers should celebrate wins with staff while continuing to share evidence of success in staff meetings or with departmental communication boards[5].

Clinical Significance

Change is inevitable, yet slow to accomplish. While change theories can help provide best practices for change leadership and implementation, their use cannot guarantee success. The process of change is vulnerable to many internal and external influences. Using change champions from all shifts, force field analyses, and regular supportive communication can help increase the chances of success[5]. Knowing how each departmental staff member will likely respond to change based on the diffusion of innovation phases can also indicate the types of conversations leaders should have with staff to shift departmental processes.


  • Image 5802 Not availableImage 5802 Not available
    Contributed by Jennifer Barrow, MSN
Attributed To: Contributed by Jennifer Barrow, MSN

Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Change Management - Questions

Take a quiz of the questions on this article.

Take Quiz
What role acts as a catalyst in shifting an organization and culture to a new way of thinking and behaving?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which group requires the greatest sensitivity when beginning the change process?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which best describes how personal change affects organizational change?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the most desirable profile to aid the organizational developer in the action phase of change management?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following describes the role of Nursing Professional Development educators at the "organizational, community, state, national, and international levels," according to the American Nurses Association?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following best describes the role of a change agent?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
Which of the following is least characteristic of a change agent?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
During which phase of Lewin's Theory of Planned Change would a change manager establish a new status quo within the organization?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A change manager is using a force field analysis to analyze barriers and facilitators of change in his organization. The manager notices that there are more strong barriers to change than there are facilitators of change. Which action would be most likely to lead to effective, sustained change in this organization?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
A change manager working with an organization hoping to change electronic health record platforms plans to require all staff to complete mandatory computer training to learn about the new informatics system. The change manager knows that the team will accept this change at varying rates based on Rogers' Diffusion of Innovations Theory. Which of the following types of staff should the change manager target be a superuser and change champion for the organization?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up
What is the first step of Kotter's Eight-Step Change Model?



Click Your Answer Below


Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.


Sign Up

Change Management - References

References

Using Diffusion of Innovations Theory to implement the confusion assessment method for the intensive care unit., Bowen CM,Stanton M,Manno M,, Journal of nursing care quality, 2012 Apr-Jun     [PubMed]
Using a change model to reduce the risk of surgical site infection., Burden M,, British journal of nursing (Mark Allen Publishing), 2016 Sep 22     [PubMed]
Selecting the best theory to implement planned change., Mitchell G,, Nursing management (Harrow, London, England : 1994), 2013 Apr     [PubMed]
Leading change: a concept analysis., Nelson-Brantley HV,Ford DJ,, Journal of advanced nursing, 2017 Apr     [PubMed]
Lewin's Theory of Planned Change as a strategic resource., Shirey MR,, The Journal of nursing administration, 2013 Feb     [PubMed]

Disclaimer

The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Nurse-Elder Adult Care. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Nurse-Elder Adult Care, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Nurse-Elder Adult Care, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Nurse-Elder Adult Care. When it is time for the Nurse-Elder Adult Care board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Nurse-Elder Adult Care.