Change can be explained to mean a shift or a transition from the usual normal way to a different way. Thus management change is a shift in the current state of affairs and operations in an organization to a desired state. Given the ever-changing clinical operating environment, change management has become a key element in ensuring good performance and success. Some of changes overwhelming nurses include economic hardships, workforce diversity, and the changing technology among many others. To ensure that nurses can cope and sustain all these changes, many researchers have argued that change management should be given a priority in all clinical settings. Management of change could be achieved using entrepreneurship, which should involve planning for change. Nurses should become entrepreneurs and enhance the spirit of providing services to those in need, come up with innovative as well as impactful services based on their experience. This achievement would improve the lives of the sick, their families, as well as other care providers. Therefore, nurses desiring to change must be innovative and hard working to achieve the transformation and overcome resistance. With regard to change management, the aim is to look at the various theories related to change and their application in the clinical setting. Included is analysis of various reasons why nurses should plan and analyze change in the practical environment. Various strategies for ensuring the planned change is sustained in healthcare setting are discussed. Finally, the assignment draws a conclusion of all the main concepts discussed in the assignment.
Why nurses need change
A healthcare environment is an area where diagnosis, treatment and prevention of ailments are done with provision of care and drugs to help fight and prevent diseases by a trained specialist or practitioner of medicine. Nurses need change in their work place as health care environment face a lot of challenges and thus the need for change. The important factor is for nurse leaders to plan and analyze the necessary change to curb the changes. The challenges are because of globalization and technological advancement. Globalization has made the world small and organizations have established their branches in almost all countries (Albrecht, 2010). People have become free to work in any country. This means that workforce has become diverse in terms of nationality and age. The health sector has seen increased growth because of a number of private hospitals being established. This has brought about increased competition amid the civic and the private segment (Palrner et al., 2009). Technology is changing and health care providers are required to keep in pace with it to remain competitive in the market. Because of these challenges, many healthcare providers require that their nurse managers have the right skills needed to plan and analyze change so that it can result to positive effects, such as increased workforce competencies, higher performance, and positive patient outcomes (Biuso, 2008).
Many health care organizations require their nurse employees to take a leading role in managing and maintaining change to improve performance and achieve positive patient outcomes. The health care emphasizes the importance for nurses to plan and strategize on change management, as this is an essential skill in today’s health care organization, which is faced with challenge of changing workforce and technology (Henderson et al., 2006). Nurses have the potential to plan and analyze change to contribute to improvement of service. Planning is an essential component of any change management strategy (Elizabeth, 2006). For a nurse to manage change in their practical environment, they have to develop a plan of implementing and sustaining the desired change in their organization. It is argued that as entrepreneurs, nurses should plan, implement, and maintain desired change in their organization to achieve their organizational goals (Hoerl, & Gardner, 2010). By planning for change, nurses show their commitment to change and hence show the rest of their colleagues on how they intend to manage change. Though analyzing change, nurses can determine the essential elements required for implementing and maintaining it and hence plan properly and appropriately (George & Patrick, 2010).
In planning and strategizing for change, nurses should first create pressure for change to occur. A nurse leader should be able to identify the need for change and communicate it effectively throughout their organization to the rest of their team members to win their support. This is possible though identification of all factors that might force an organization change the way it executes its various functions. Such factors include impact from the improving technology, competition, and workforce diversity among many others (Grace, 2007). Identification for a need to change and making all members in an organization understand the need for that change enables support and commitment from all tem members. This is highly necessary as it ensures that the planned change is successfully implemented and sustained. In addition to identify the need for change, nurse leaders should explain to their team members how they stand to benefit from the planned change (Tes, (2006). For people to support change within any organization, they have to feel they are benefiting in one way or another. Therefore, nurse leaders should plan changes in a way they will benefit their team members to ensure that the planned changes is effectively implemented and sustained (Holman et al., 2007).
Relevant theories related to the clinical environment
Lewin’s change theory involves a three stage model to effective change in an organization mainly the unfreezing stage followed by change and refreeze stage. The theory tries to explain the behavior that exists in an organization and how behavior works in opposite direction to oppose change and cause a shift in the balance of forces (Katherine et al., 2007). The theory was developed by Kurt Lewin and it involves three stages, and it is widely used in clinical contexts. The first stage of this theory is known as the unfreezing stage and is followed by the second stage called moving stage than the final stage, which is the refreezing stage (Kerridge, 2012). According to this theory, there are two forces of change, the driving, and the resisting. The resisting forces are the employees who do not embrace change whereas the driving ones are the ones who push for change and support it (Overhage, 2007). This theory is highly applicable in today’s modern health setting. Nurses should act as the driving force for positive change in health care organization. This is true because the nurses are the main stakeholders in the clinical setup. They should be able to evaluate their organizations and identify things that need change, plan the desired change, and push for it by convincing their employers and the other employees within their organization (Linda, 2009).
Rogers’ change theory was developed by Everette Rogers. It is a modification of lewin’s theory. It is based on five stages. The first step in this theory is awareness. Awareness stage will help nurses resistant to change to be made aware of the changes taking place in their organizations and the importance of embracing these changes to achieve their organizational goal. After awareness, the second stage is interest, in which a nurse leader should ensure that nurses develop interest in the changes taking place. Evaluation is the third stage whereby the changes are evaluated on basis of their negative and positive impacts on the organizations. After evaluating the changes, it is important they are implemented and if they prove beneficial to the organization, they are adopted (Patrick & Barry, (2011).
Theory of reasoned action and planned behavior; According to this theory, a person’s performance is highly determined by the person’s aim to execute that particular performance. The theory suggests that for any change to occur, an individual must have a positive attitude towards the desired behavior and should have positive influence from the surrounding environment (Thomas et al., 2007). Influence may be from people such as peers and working colleagues. According to the theory of reasoned action and planned behavior; for a nurse to change his or her attitude towards change and embrace it, his or her attitudes towards change should first change, especially through awareness and positive influence from his or her colleagues (Timothy, 2008).Therefore, it is important that nurse leaders ensure that all nurses are made aware of importance of planned change in order to instill a positive attitude in them towards it. They should also balance their team members appropriately to ensure that nurses who embraced and support change get to influence other on the opposition side to win them over on their side (Twentyman et al, 2006).
Spradley’s change theory; the theory was developed incorporating eight steps that help to manage change in a given organization. The first step is recognizing the change symptoms to diagnose the problem that need a change. After identifying the problem, alternative solutions are evaluated and the best change to address the problem is identified. The next stage involves planning on how to implement the change and the actual implementation of the desired change takes place. After its implementation, the change is evaluated and various strategies lay down to stabilize it (Rasul, (2010). The theory is highly applicable in clinical contexts. Before implementing any change, nurse leaders should evaluate it to estimate it is benefits and shortcoming in the organization. Even after implementation, nurses should reevaluate the change and come up with ways of stabilizing it in cases where it is found beneficial to the organization (Simon, 2011).
Social cognitive theory, people can change through experience and interaction with others. The theory argues that change in behavior is also affected by environmental and personal factors. The theory suggests that for a person to change; one should believe in oneself and have ability and motivation to perform the desired behavior .Therefore for any meaningful changes to take place in the clinical setting, nurse leaders should lead by example to influence positively their team members (William et al., 2006). A nurse leader should be able to plan and implement change and above all embrace it so the other nurses can learn to embrace and support positive changes in their work environment (Kritsonis, 2006). According to the social cognitive theory, effective change management can be achieved in health care institutions whereby nurses in support of the planned change influence the ones resisting change by constantly reminding them the importance of the various changes occurring in their organizations. The scholars here agree that planned change is effective in yielding a different health environment (Malloch et al., 2006).
The importance of planning and analyzing change in the health care setting
Among the change theories discussed above Lewin’s theory is the most applicable in the clinical context because it considers change to be a result of transformations in the forces present in the symbolic field. Following the challenges the heath care setting is facing, change has proven paramount and the theories above could help in achieving planned change and therefore, positive results. Where change is aspired, entrepreneurship is inevitable because innovation guides change. Heath practitioners aspiring change are bound to become entrepreneurs ( Mclnnes & Kidd, 2006). An entrepreneur can be defined as an individual with innovative and prompt solution to most of the problems and challenges facing an organization. Nurse leaders should choose the kind of entrepreneurship, which is likely to cause positive change. Among the existing types of entrepreneurs, include social entrepreneur is an individual who is motivated by a desire to facilitate and change the social environment of an organization. Such individuals are ambitious, persistent, and highly effective in addressing various social problems because they have the ability to accept the world as it is (Oreg, 2006). The social entrepreneur is driven by the desire and emotions to address some of the big issues affecting people in the community such as diseases, poverty among others. All healthcare organizations should be social entrepreneurs in order to address the various health issues especially among the poor communities. A good example of a good social entrepreneur in health care setting is an organization by the name PATH. This organization collaborates with NGOs and the government to come up with solutions top persistence health issues such as AIDS, malaria and provide free vaccinations especially in poor rural communities, in order to improve their health (Dwayne & Patrick, 2007).
A serial entrepreneur can be defined as an individual with an ability to always come up with new business ideas and start new businesses. A serial entrepreneur possesses the ability to assess risk associated with new business ideas and hence comes up with ways of minimizes such risks. He/she can be asset to the health care system because he/she can emerge new clinical approaches to aid the currently care dilemmas. A good example of a derail entrepreneur is Thomas Alva Edison who has been credited with numerous innovations, such as invention of the light bulb (Griscti & Jacono, 2006). In addition are lifestyle entrepreneurs; these are people who run a business based on their passions and not the aim to make profit to combine their personal interests with their talents to earn a living while working on field they have interest in (Jennifer & Patrick, 2012). Last are co-operative entrepreneur who are individuals with the ability to collaborate with other entrepreneurs in other to develop business projects (John et al., 2009).Entrepreneurs are individuals who posses many characteristics among them being: self confident, self driven, highly innovative, good managers of time and money. possess the ability to network just to mention but a few. Social entrepreneurship as a change model is highly applicable in healthcare setting. If health care organizations embrace social entrepreneurship, they will be able to come up with solution to various health issues within the community and hence have a positive social change (Kaplan et al., 2010). Social entrepreneurship as a change model in healthcare setting should be adopted because it will lead to more saved lives and more people especially the vulnerable receiving quality health care. The government alone cannot ensure sufficient health care to all people. Therefore, social entrepreneurship in health care setting will play a critical role in ensuring that healthcare in vulnerable communities is developed and improved (Chaudhry et al., 2006).
Strategies that can be used to ensure planned change is employed
Although human beings are always resistant to change and more so on the work place because of the fear of the unknown. An organization can use some strategies that will effective application of change in the organization. The department heads should know and understand the factors that cause people to be resistant to change. One of elements that present obstacles to sustaining change in any organization is resistance from people. For any change to be sustained, a nurse leader should react appropriately to this resistance. To ensure the implemented change is sustained, nurses have to ensure that its’ driving force is greater than its opposing forces (George et al., 2007). According to Lewin’s theory, sustenance of change in an organization is possible through refreezing. This means that a favorable environment in the organization culture that supports the implemented change is created. Change can be sustained in an organization through empowering action. This involves creating opportunities to involve all the employees within the organization. This way, every employee can feel appreciated and hence will remain committed in ensuring that the planned change is sustained. It is highly important that nurse managers provide directions each day to keep employees informed on what is required to sustain the change (Eugene et al., 2006).
Change in an organization can also be sustained through generation of short-term goals so they are easily achievable. When employees achieve the goals set by the planned change, they embrace the change and remain committed in ensuring the change is sustained (Heading, 2009). The change should also allow frequent negotiations with employees in the organization to provide them with the best. If employees are well catered for by the implemented change, they wholly embrace and remain motivated to achieve the set goals. It is thus important that nurse leaders identify all the elements that can support the planned change and hence ensure they are strengthened. One of these elements is transformational leadership (Michelle & LeAnn, 2010).Transformational leader have the ability to lead by example hence can influence other people in their organization to not only embrace change but also sustain it. Transformational leaders are also able to identify factors that might hinder and block the planned change, such as ineffective communication, lack of employee involvement and hence avoid or eliminate them to sustain the planned change (Dwayne et al., 2007).
Another thing that can sustain planned change in an organization is through appreciation and reward system. When employees are appreciated and rewarded for their hard work, they can embrace, and support change ensuring that it is sustained. A nurse leader should also establish effective leadership systems to ensure that information essential for sustaining the implemented change. When employees are informed of what is always expected of them, they act appropriately ensuring the implemented change is strengthened and hence maintained (Bret et al., 2007). Adoption of an organizational structure is essential for sustaining change. Through an organizational structure, nurses can adopt the desired ethics and behavior. This is highly important, as it will lead to sustenance of implemented change. This is because an organizational structure advocates for ethics and behavior that will support the implemented change in the organization (Braithwatie et al., 2009).
Another factor that ensures sustenance of implemented change in organization is provision of support and training for the employees. Health care providers should support their employees through training and education. This ensures the employees are trained on skills needed to adopt the planned change. Nurses can really learn a lot and know the importance of change in their organization, and this enables them to support it (Drayton et al., 2006). Leaders in organization can lead to sustenance of planned change by learning the importance of celebrating success. Through setting short-term goals, employees can achieve them easily. It is highly important that leaders learn how to celebrate success through such things, such as increased holidays and wage increment; they embrace the change and remain committed in ensuring that it is maintained. Thus leaders in any organization must recognize the need for effective change in the organization as the employee will follow what their leaders do, thus leaders should lead by example (Booth, 2007).
Change management in the modern healthcare setting is highly important. This is because the sector is facing various changes in terms of workforce, various duties, and patient needs among many others. In order to manage all these change, health care organizations have to ensure their nurse leaders are trained on essential skills required to manage change. Various theories of change can be applied in management of change in clinical environment. Some of these theories include Social cognitive theory, the theory of Reasoned Action and Planned Behavior, Spradley’s change theory, and Lewin’s change theory among many others. The theory by Lewin is the most applicable, as it highlights what is to be done before implementing change and what is to be done to sustain it in the organization. Clearly, it is important that nurses plan and analyze change. Some of the factors that make planning and analyzing of change in heath care setting are, driving forces for change are identified and enhanced, and the opposing forces for change are identified and minimized. Through planning for change, nurses can involve all their team members to ensure the desired change is effectively implemented. Because not everybody in an organization supports change, nurse leaders should identify sources of human resistance to change and try to eliminate it in order to sustain it. Effective leadership, employee involvement, rewards and effective communication all play an important role in ensuring the planned change is sustained within an organization.
Albrecht, S. (2010). Understanding employee cynicism toward change in healthcare contexts. International Journal of Information Systems and Change Management, 4(3), 194-209
Biuso, C.N. (2008), Supporting Quality in Care in General Practice: The Collaborative Approach. Australian Journal of Primary Health, 14(2), 46-52.
Booth, B. (2007). A quality framework for Australian general practice. Aust fam Physician, 36(2), PP8-11
Braithwatie, J.G., Greenfield, D., and Westbrook, M.T. 2009. Contrasting and converging perspectives on organizational culture and climate. Culture and climate in health care organization. London: Palgrave-Macmillan.
Bret, E.F., Rieckmann, T., Nunes, E., Miller, M., Arfken, C., Edrnunclson, E., and McCarty,D. (2007). Organization Readiness for change and opinions toward treatment innovation. Journal of Substance Abuse Treatment, 33(2), 183-192.
Chaudhry, B., Wang, J., Wu, S., Maglione, M., Mojica, W., Roth, E., Morton, S. C., and Shekelle, P.G. (2006). Systematic Review: Impact of Health Information Technology on Quality, efficiency, and costs of Medical Care. Ann Intern Med, 144 (10), E12-E22 . not mention this reference inside assignment
Drayton, W., Brown, C., and Hillhouse, k. (2006). Integrating social entrepreneurs into the ”health for all” formula. Bull World Health Organization. 84(8), 591
Dwayne, D. S., George, W., and Grace, A.R. (2007). Liking the elements of change: Program and client responses to innovation. Journal of Substance Abuse treatment, 33 (2), pp. 201- 209.
Dwayne, D.S., and Patrick, M.F. (2007). Moving innovations into treatment: A stage-based approach to program change. Journal of Substance Abuse Treatment, 33 (2), pp 111- 120.
Elizabeth, I.C., Barbara, M., Gavin, J.C., and Kevin, M. (2006). Tuberculosis in Sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment. Lancet, 367(9514), 926-937.
Eugene, P.S. et al (2006). Effects of motivational interviewing training on mental health therapist behavior. Drug and Alcohol Dependence, 82 (3), 269-275.
George, W.J., and Patrick, M.F. (2010). Treatment program operations and costs. Journal of Substance Abuse Treatment, 42 (2), 125-133.
George, W.J., Kirk, M.B., Dwayne, S.D., and Grace, A.R. (2007). Counselor perceptions of organizational factors and innovations training experiences. Journal of Substance Abuse Treatment, 33 (2), 121-192.
Grace, A.R. (2007). Assessing program needs and planning change. Journal of Substance Abuse treatment, 33(2) , 121-129.
Griscti, O., and Jacono, J. (2006). Effectiveness of continuing education programs in nursing: literature review. Journal of Advanced Nursing, 55 (4), 449-456.
Heading, G. 2009. Strategic leadership, culture, and change in health devices. Discussion paper. New South Wales, AU: The Cancer Institute.
Henderson, A., Winch, S., and Heel, A. (2006). Partner, learn, progress: a conceptual model for continuous clinical education. Nurse Education Today, 26 (2), 104-109.
Hoerl, R.W. and Gardner, M.M. (2010),Lean Six Sigma, creativity, and innovation. International Journal of Lean Six Sigma, 1(1), 30-38.
Holman, P., Devance, T., and cady, S. 2007. The change handbook: the definitive resource on today’s best methods for engaging whole system .2ed ed. San Francisco: Barrett-Koehler.
Jennifer, E. B., and Patrick, M.F. (2012). Program needs and change orientation: implication for counselor turnover. Journal of substance Abuse Treatment, 42 (2), 159-168.
Jennifer, E. B., Danica, K., and Patrick, M.F. (2012). Innovation adoption as facilitated by a change-oriented workplace. Journal of substance Abuse Treatment, 42 (2), 179-190.
John, S.B., Wells, E., Rosengren, D., Hartzler, B., Beadnell, B., and Dunn, C et al . (2009). Agency context and tailored training in technology transfer: A pilot evaluation of motivational interviewing training for community counselors. Journal of substance Abuse Treatment, 37 (2), 191-202.
Kaplan, H., Bracly, P.W., Dritz, M.C., Hooper, D.K., Linam, W.M., Froehle, C.M.. and Margolis, P. (2010). The influence of context on quality improvement success in health care: A systematic review of the literature. Milbank Quarterly. 88 (4), 500-559.
Katherine O., Joe, G., Rowan-Szal, G., and Simpson,D. et al. (2007). Using organizational assessment as a tool for program change. Journal of substance Abuse Treatment, 33 (2), 131-137.
Kerridge, J. (2012). Leading change: 2-planning. Nursing Times, 108(5), 23-25.
Kritsonis A. Comparison of Change Theories.2006. International Journal of Scholarly Academic Intellectual Diversity; 8:1.
Linda R. (2009). Harvard university- Social Enterprise Conference. Thunder Bird, 1(1), 1-10
Malloch, K., Porter, O., and Grady, T. 2006. Introduction to Evidence-Based Practice in Nursing and Health Care. Massachusetts: Jones and Bartlett Publishers.
Mclnnes, D.S., and Kidd, M.R. (2006). General practitioners’ use of computers for prescribing and electronic health records: results from a national survey. MJA, 185(2), 88-91.
Michelle, S., and LeAnn, O. 2010. Strategic planning for nurses: change management in health care. Massachusetts: Jones and Bartlett Learning.
Oreg, S. (2006). Personality, context, and resistance to organizational change. European Journal of Work and Organizational Psychology, 15(1), 73-101.
Overhage, J.M. (2007). Health information exchange: Lex Parsimoniae. Health Affairs, 26(5), w595-597.
Palrner, I., Akin, G., and Dunford, R. 2009. Managing Organizational Change: A Multiple Perspectives Approach. 2nd ed . Toronto: McGraw-Hill Ryerson.
Patrick, M.F., and Barry, S.B. (2011). Implementation research: Issues and prospects. Addictive Behaviors, 36 (6), 566-569.
Rasul, S. (2010). Secrets of a serial Entrepreneur: A Business Dragon’s Guide to Success. New Jersey: John Wiley and Son.
Simon, G. (2011). Co-operative entrepreneurs. Enterprising Matters eMagazine, 1(1), 1
Tes, J.B. (2006). Information mastery and the 21st century doctor: change management for general practitioners. MJA, 185 (2), 92-93.
Thomas, A.M., Mady, C., and John, B. (2007). Outcomes, performance, and quality-what’s the difference? Journal of Substance Abuse Treatment, 32 (4), 331-340.
Timothy, P.C. (2008). Blending addiction research and practice: strategies for technology transfer. Journal of substance Abuse Treatment, 35 (2), 156-160.
Twentyman, M., Eaton, E., and Henderson, A. (2006). Enhancing registered nurses capacity for supporting learning in the clinical context. Nursing times, 102(14), 35-37.
William, R.M., James, L. S., Jeffery, A.S., and Gregory, S.B. (2006). Disseminating evidence-based practices in substance abuse treatment: A review with suggestions. Journal of substance Abuse Treatment, 31 (1) , 25-39.