 By Khairunnisa.

Mansoor
Senior Instructor
AKU-SONAM
2024
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Concept of Change
Change is a permanent part of life. No matter who we are,
where we live, how old or young, we all make changes in
our lives. Most of us struggle with change…
The ways we change inside, the ways we grow and learn,
and become transformed are because of the changes in
our lives.”

Orlando A, Anaam C. The Change Agent

http://www.nelrc.org/changeagent/
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Objectives
 Describe change and planned change
 Discuss the significance of change in the health care
organizations.
 Discuss various change theories and its application.
 Discover various techniques for dealing with resistance.
 Analyze the role of a nurse as a change agent.

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Concept of Change
 Change is a continually unfolding process rather than an event. The
process begins with present state, is disrupted, moves through a
transition period and ultimately comes to desired state.
(Sullivan & Decker,2009)

 Planned change is a decision to make a deliberate effort to improve

the system. (Huber,2014)

 A change can range from the personal level, to the departmental

level, or to the institutional and governmental levels. (Hader,2013)

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 Significance of change in the health care
organizations.
➢ Mandatory for growth
➢ Emergent of evidence base practice
➢ Market competition.
➢ Customer’s need or demand
➢ New Resources
➢ Government laws and regulations.
➢ Technological developments.

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Change agent

An individual who influences decisions in a desirable

direction. The change agent:
◦ develop the need for change
◦ diagnose the problem
◦ establish information exchange channels
◦ create an intent to change in the clients
◦ translate an intent into action
◦ stabilize adoption and prevent discontinuance

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 Nurses as Change Agent
● 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.

● The nurse acts as a change agent by identifying and

implementing new and more effective approaches to
problems.

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 Theory of Change

(the process of initiating change) (establishing a new status

(understanding change is needed) quo).

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Unfreeze
Identify the problem/ diagnose the problem

Formulate Goals

Determine stakeholders’ needs

Examine driving and restraining forces

Pre-change planning is involving key stakeholders in problem identification, goal setting,

and action planning.

Involving stakeholders in change planning increases staff buy-in.

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Unfreeze

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Force Field Analysis
Driving Restraining
Need of community Low Level of Commitment from
nursing force due to security
issues
Financial resources available Cultural issue
Renowned organization Short period of time for
implementation

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Change
Analyze Analyze Data

Look Look for the staff, resistance to change

Manage Manage the resistance

Develop Develop strategies to reduce the restraining forces

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Resistance to change

Self-interest Fear Personal

failure

loss of status lack of trust Cost

or power

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change acceptance categories

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
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• Laggard: High levels of skepticism; openly resist change
Overcoming Resistance
Educate and Involvement
Communicate
Training stakeholders

Assure guidance Be ready to Promote Positive

and support Negotiate Attitudes

Build trust https://youtu.be/_

relationship _IlYNMdV9E

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Strategies to Change
1. Power-Coercive strategies
2. Empirical-Rational model
3. Normative-Reeducative strategies

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Power-Coercive strategies
 Power by legitimate authority, economic sanctions or
political clout
 Rewards, and punishments to induce change
 law, policy or financial appropriations
Useful
 consensus is unlikely & resistance is anticipated
 Change is critical & time is short

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Empirical-Rational model

 Bringing about change through persuasion backed by

special knowledge, empirical data, and rational argument.
 Relies on expert power.
 Relies on belief that reason guides people’s decisions and
actions.
 Produces longer-lasting and internalized change

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Empirical-Rational Model:
 Focus: This model emphasizes the rational aspects of change, such as
providing evidence-based rationale for the change and offering
incentives to motivate individuals to adopt the change.
 Approach: The Empirical-Rational model assumes that individuals
are rational beings who will change their behavior if they
understand the logic behind the change and perceive it as beneficial.
It relies on information dissemination, persuasion, and incentives to
encourage adoption of the change.
 Example: In the context of implementing a new healthcare protocol,
the Empirical-Rational model might involve presenting research
findings demonstrating the effectiveness of the new protocol,
offering financial incentives for compliance, and providing training on
how to implement the protocol correctly.

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Normative-Reeducative strategies

Relies strong interpersonal skills

Engages people in a collaborative process of identifying values, assumptions, and

goals from which support for change will naturally emerge.

Relies on belief that people respond to sociocultural norms and expectations of

others

Time consuming but likely to yield high commitment.

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Normative-Reeducative Strategies:
• Focus: Normative-reeducative strategies focus on changing the underlying norms,
values, and beliefs within an organization to facilitate change. This approach
recognizes that change involves more than just rational decision-making; it also
requires addressing cultural and social factors that influence behavior.
• Approach: Normative-reeducative strategies aim to alter organizational culture by
challenging existing norms that resist change and promoting new norms that align
with the desired change objectives. This may involve education, leadership
support, communication, and participatory decision-making to foster a culture that
embraces the change.
• Example: Continuing with the healthcare example, Normative-Reeducative
strategies might involve promoting a culture of patient-centered care by
emphasizing the importance of empathy, collaboration, and continuous learning
among healthcare providers. This could involve educational programs, leadership
messaging, and creating opportunities for staff to participate in decision-making
processes related to patient care.

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Change
 Draft the plan for implementation
◦ Resources
◦ Define Timeline
◦ Define responsibilities
 Implement the change
◦ Communication and providing information
◦ Training and skill practice

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Refreeze
 Evaluate the effectiveness
 Periodic spot-checking and continued data monitoring
can solidify the change as the department’s new status
quo.
 Celebrate wins with staff while continuing to share
evidence of success in staff meetings or with
departmental communication boards

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Kotter’s Eight-Step Change Model

• 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.

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Video Time
 https://aku.percipio.com/courses/780763c1-4be1-48fe-
9f63-c4faf4e6dce8/videos/a058bd17-e1d2-4f03-a424-
66a58d9d8154?tab=resources

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Connection time
Change Application
 Develop a proposal for introducing a
telehealth clinic in your community for
elderly using the Lewin change model
to guide your planning process.
Additionally, conduct a force field
analysis to identify factors that may
facilitate or hinder the implementation
of this change within your department.

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Connection time
Change Application
 Develop a proposal for introducing a
smoking cession program for nursing
and medical students in your university
using the Lewin change model to guide
your planning process. Additionally,
conduct a force field analysis to
identify factors that may facilitate or
hinder the implementation of this
change within your university.

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Connection time
Change Application
 Develop a proposal for introducing a self-
directed teaching and learning courses
such as ethics, tropical communicable
disease and psychology in summer
vacation in your university using the
Lewin change model to guide your
planning process. Additionally, conduct a
force field analysis to identify factors that
may facilitate or hinder the
implementation of this change within
your university.

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 Connection time

 Q1. Why this change is important?

 Q2. What are the driving forces and resistance in your
case?
 Q3. What are the actions required to plan this change?
 Q3. What are the strategy to implement change?

 Q4. How can this change be evaluated and sustain?

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Change Application

 Read the article in which author used Lewin change

framework to introduce the Bar-coded medication
administration technology at one of the hospital facility.
Applying Lewin’s Change Management Theory to the
Implementation of Bar-Coded Medication Administration
http://cjni.net/journal/

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 Summary
● Change agent is someone who brings about a change in an organization.
● Change management is very vital and essential to close the gaps between
requirement and result.
● Organization may produce better result on each change by using change
management.
● Nurses have 2 roles as change agent: initiating change and implementing change
● There are 3 stages of change management proposed by Lewin: Unfreeze, change
and refreeze
● Regardless of any specific setting, 3 general strategies can be followed:
Power-coercive strategy, Empirical rational strategy and normative-re educative
strategy
● It is important to overcome the challenges while implementing the change.
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References
 Hader R,. (2013) The only constant is change. Nursing management. 44(5).
 Lehman, L.K (2008) Change Management Magic or Mayhem? Journal for
nursing staff development. 24(4) 176-184.
 Gesme, D. & Wiseman, M. (2010)How to Implement Change in Practice.
Journal of oncology practice. 6(5) 257-259.
 Marquis, B. L., & Huston C. J. (2009). Leadership roles and management
functions in nursing: Theory and application (6th ed.). Philadelphia: Wolters
Kluwer Health.
 Baulcomb, J. (2003) Management of change through force field analysis.
Journal of Nursing Management. 11(4)275-280.
 Mitchell, G. (2013) Selecting the best theory to implement planned change.
Journal of Nursing Management. 20(1)32-37.

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References
● Bright Hub PM. (2010). Havelock’s theory of change management: 6 easy steps to change. Retrieved from
https://www.brighthubpm.com/change-management/86803-havelocks-theory-of-change/.
● Jouany, V. & Martic, K. (2022). Change Management: Definition, Best Practices & Examples. Retrieved
from https://blog.smarp.com/change-management-definition-best-practices-examples.
● Pomare, C., Churruca, K., Long, J. C., Ellis, A. L., & Braithwaite, J. (2019). Organisational change in
hospitals: a qualitative case-study of staff perspectives. BMC Health Services Research volume. DOI:
https://doi.org/10.1186/s12913-019-4704-y
● P. Kotter, J., & A. Schlesinger, L. (2013). Choosing Strategies for Change [Ebook] (p. page 1). Retrieved
from https://projects.iq.harvard.edu/files/sdpfellowship/files/day3_2_choosing_strategies_for_change.pdf.
● Sullivan, E. J. (2012). Effective leadership and management in nursing (8th ed.). Pearson.
● Sacerdote, L. (2014). Resistance to change: three models to overcome it [Blog]. Retrieved from
https://www.linkedin.com/pulse/20141117124359-4962385-resistance-to-change-three-models-to-overcome
-it
● The 5 types of organizational change management | Best guide. (n.d.). Airiodion (AGS). Retrieved from
https://www.airiodion.com/types-of-organizational-change/
● Why Change Management. (n.d.). Retrieved from
https://www.prosci.com/resources/articles/why-change-management 33
Thank You

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