Effective Leadership in Healthcare

NUR09402

Change Management

Mandy Gentleman
Caroline Paton
27.07.22
 Change Management
Change...what does it mean to you?

Working in contemporary healthcare change is something you will

experience many times as we strive to develop and improve
healthcare. 
Change will happen at various levels and to succeed and thrive, you
need to know how to manage change from a personal, team, and
leadership perspective. 
Change can include:
Service organisation and improvement at various levels
Team development and improvement
Individual development, personal and professional growth
How do you view change? 
You may feel a range of things including: anxiety, distrust, that it is a
challenge that you want to take on? 
Change Management
Managing change is one of the most
important skills for a manager and leader in
health care today... Imagine being able to
introduce change in such as way as to
strengthen the team, minimising conflict and
stress, and bring about improvements in care.
By paying attention to the process of change,
and the feelings change engenders, an
effective leader can do just that"
(Sullivan and Garland, 2010)
 What do we mean by
change?
Change is the process of making something different from what
it was.
Change is situational: the development of a new service, starting
a new job, restructuring of a team or merging services.
Transition is psychological: the process people go through to
come to terms with change.
An effective leader/manager must learn to manage both the
situation and the people it affects.
Without proper care and attention to the psychology of change,
the effectiveness of individuals and the team will suffer, potential
consequences of this include conflict, lower productivity and
possible deficits in care.
 Change
Changes can be planned or unplanned, it might be
welcome (an opportunity, advancement or fulfilment of
a goal) or unwelcome (a change that is anticipated to
cause distress or inconvenience).
Unplanned and welcome changes can create an
emotional boost and can build trust and optimism.
Unplanned and unwelcome changes are often labelled
‘disasters’ in that often result in a sense of distress and
loss of control.
Healthcare professionals immediate response is often to
rally together and get through the situation, only
experiencing the impact of the change later on.
Planned Change
This is what the theorists are referring
to when they talk about change.
There will always be those who see the
change as welcome, and those who see
it as unwelcome.
Those who see the benefits of change
push for its success, becoming the
driving force, whilst those who see the
change more in terms of loss will resist
becoming the restraining force.
 Planned Change
Teams members will see the change as an
opportunity and take on new roles, learn new
skills to improve the service delivery.
Other team members may be resistant; they are
concerned about the need to take on new and
unfamiliar responsibilities and the necessity to
work differently.
To succeed skilled planning of the practical
aspects of change is required, such as, pace,
training, budgeting and also working with the
emotional responses and concerns of the staff
the change will impact.
 Change Theories
Lewin’s (1951) force-field model: Social-psychological view of the change process.
Behaviour is a dynamic balance of forces working in opposite directions within the field
(organisation).
Driving forces facilitate change because they push participants in the desired direction.
Restraining forces impede changes because they push participants in the opposite
direction.
To plan change you need to analyse the forces and shift the balance in the direction of
the change through a three step process: unfreezing, moving and refreezing.
Change occurs by adding a new force, changing the direction of a force or changing the
magnitude of any one force.
Strategies for change are aimed at increasing driving forces, decreasing restraining forces,
or both.
Lewin’s Force-Field Model

Unfreezing: Motivate participants by getting them ready for change.

Building trust and discussing need for change, identify problems and
generate solutions.

Move: Participants identify benefits of the change, identify the challenges

and drawback of current way of working.

Refreeze: Reinforce the new patterns of behaviour, benefits of new way of

working are recognised and become embedded within the organisation.
What are the benefits of using Lewin’s change model?
Lewin’s change model is good and still used all these years later because it’s based upon sound behavioural
psychology that is designed to understand why people resist change and put the forces in place to drive people
to change.  One of the biggest reasons that Lewin’s change management model is good is that it uses clear
concepts and illustrations that make change management easy for many to understand."

"It’s Easy to Understand: Some change frameworks can take a lot of training to learn, and people can easily get
lost within a sea of acronyms. Lewin’s change theory is relatively straight forward, with three main stages to
follow and a few steps within each one; The Force Field Analysis in Lewin’s change model is also a simple
concept that people can catch onto easily and begin using right away."

"It Focuses on Behaviours: The behavioural psychology used in Lewin’s change model gets to the heart of what
causes people to either resist or support change. This focus on people is actually in agreement with many other
change models out there that also focus on the human element of change.

"The Model Makes Sense: When going through the Lewin’s change model, the Unfreeze, Change, Freeze logic
makes sense to many people. Its simplicity helps people get a better understanding of change management
without getting lost in a lot of industry jargon or complicated steps."
What is lacking from the Lewin’s Change Model?
"It’s Not Detailed Enough: Some think that Lewin’s change management model is a little
too simple. The steps within each phase can be interpreted in different ways, and it’s
often necessary to “fill in the blanks” using another change management model."

"It’s Too Rigid & Doesn’t Reflect Modern Times: The Freeze stage of Lewin’s model sometimes comes
under scrutiny by those that say it’s too rigid because it “freezes” behaviours that will only need to be
unfrozen again in the future due to how fast technology advances and causes companies to
constantly change to keep up. They feel the last stage should be more flexible. It can be argued that
the Lewin’s change theory may be somewhat outdated since it was developed in 1947 well before
technology became such a central part of today’s workplaces."

"It Can Be Seen as Combative, Rather Than Nurturing: With the emphasis on breaking up
the equilibrium during the Unfreezing process, and basically “shaking things up,” Lewin’s
three-step model can be seen as combative. Instead of fostering a nurturing change
environment, some say it puts too much focus on the two opposing forces fighting to gain
the advantage."
Lippitt’s Change Model
Lippitt, Watson and Westley (1958) extended
Lewin’s theory to a seven-step process and focused
more on what the change agent, the person who
initiates and manages the change, must do rather
than in the evolution of the change itself.
Emphasis on the participation of key members of
the target system throughout the change process,
particularly during planning.
Communication skills, rapport building and
problem-solving strategies are key in this model.
 Lippitt’s Change Model - Seven Steps
Information is continuously exchanged throughout the process. The seven steps are:
1. Diagnose the problem - Key people.
2. Assess the motivation and capacity for change – Solutions, constraints, structure and function of an
organisation.
3. Assess the resources and motivation of the change agent. This includes the change agent’s
commitment to change, power, and stamina – Important step.
4. Choose progressive change objects. In this step, action plans are developed and strategies are
established.
5. The role of the change agents should be selected and clearly understood by all parties so that
expectations are clear.
6. Maintain the change. Communication, feedback, and group coordination are essential elements in this
step of the change process.
7. Gradually terminate from the helping relationship. The change agent should gradually withdraw from
their role over time. This will occur when the change becomes part of the organisational culture
 Changes are more likely to be stable if they
spread to neighbouring systems or to subparts
of the system immediately affected.

Changes are better rooted.

Benefits The individual meets other problems in a

similar way, then adopts the same innovation,
or the problem spreads to other
departments/areas.

The more widespread imitation becomes, the

more the behaviour is regarded as normal and
the change is scaled up.
Rogers’s diffusion of innovation
Rogers (1983) adopts a different approach from Lewin
and Lippitt which focus on situational change (often
unwelcome change) and focuses on the adoption of
innovative practices.
5-step innovation-decision process details how the idea is
first generated to confirmation of whether to be adopted
or rejected.
This model emphasis the reversible nature of change,
may initially adopt a proposal but later discontinue with
the change or the reverse.
It may be that full implementation is not successful but
maybe changes made or implemented again at a late
date.
Adoption Lifecycle, " The Chasm 
Innovators to Laggards
 Bridges (2003) suggests that change is easy it
is the human response to change that needs
Bridges’s to be well managed in order to secure success.

transition Bridges focuses on the change agent and

provides the leader/manager with an
model of ‘emotional barometer’ to help assess the
progress along the transitional path.
change He describes three stages “endings,” the
“neutral zone,” and “new beginnings” (Bridges
(2003) 2003). “Endings” describes the letting go
process, how individuals relinquish old ways of
approaching situations as well as old identities
that inform those ways of being in the world.
 Stage 1: Ending, Losing, and Letting Go
People enter this initial stage of transition when you first present them with change. This stage is often marked with
resistance and emotional upheaval, because people are being forced to let go of something that they are comfortable
with.
• At this stage, people may experience these emotions:
• Fear.
• Denial.
• Anger.
• Sadness.
• Disorientation.
• Frustration.
• Uncertainty.
• A sense of loss.
People have to accept that something is ending before they can begin to accept the new idea. If you don't
acknowledge the emotions that people are going through, you'll likely encounter resistance throughout the entire
change process.
 Stage 2: The Neutral Zone
In this stage, people affected by the change are often confused, uncertain, and impatient.
Depending on how well you're managing the change, they may also experience a higher workload
as they get used to new systems and new ways of working.
• Think of this phase as the bridge between the old and the new – people may still be attached to
the old, and it probably won't yet be clear what the new even is.
At this point people might experience:
• Resentment towards the change initiative.
• Low morale and low productivity.
• Anxiety about their role, status or identity.
• Scepticism about the change initiative.
Despite these, this stage can also be one of great creativity, innovation, and renewal. This is a great
time to encourage people to try new ways of thinking or working.
 Stage 3: The New Beginning

The last transition stage is a time of acceptance and energy.

People have begun to embrace the change initiative. They're
building the skills they need to work successfully in the new way,
and they're starting to see early wins from their efforts.
At this stage, people are likely to experience:
• High energy.
• Openness to learning.
• Renewed commitment to the group or their role.
The change process
The change process is similar to the
problem solving process and involves four
steps:
1. Identifying the problem (opportunity)
including data collection and analysis
2. Planning
3. Implementation
4. Evaluation
Emotions associated with change
 Fisher’s Transition Curve (2012)
Helps people recognise and make sense of the process of change and transition, both within the
workplace and your personal life.
 Kotter (1996) Model of Change

Kotter's (1996) model of change is an eight step process.  The steps are:

• Phase I (steps 1–3) "creating a climate for change": 1) establish a sense of
urgency for change; 2) create a guiding coalition; 3) develop a vision and
strategy; 
• Phase II (steps 4–6) "engaging and enabling the whole organisation": 4)
communicate the change vision; 5) empower broad‐based action; 6) generate
short‐term wins; 
• Phase III (steps 7–8) "implementing and sustaining change": 7) consolidate
gains and produce more change; 8) anchor the new approaches in the culture
Kotter stresses that the steps should be followed in order, missing steps may
speed up the process, but may reduce chances of success.
Resistance to change
Expected for a number of reasons: lack
of trust, vested investment in the status
quo, fear of failure, loss of status or
income, misunderstanding and belief
that change is unnecessary or that it
will not improve the situation (Yukl,
2002).
Employees may dislike or disapprove of
the person responsible for
implementing the change or distrust
the change process.
 Expect Resistance
Listen carefully to who says what, when and circumstances.
Open resisters are easy to work with than covert resisters.
Resistance can have positive and negative aspects – can allow for clarity and explanation
but if persists can wear people down especially when continues into the planning phase.
 Communicate openly and honestly
 Understand the resistance to change
 Maintaining support and confidence in staff even if they are resistive to change
 Emphasise the positive outcomes from initiating change
 Finding solutions to problems that are obstacles to change
 Leading Change
 Ability to combine ideas from unconnected sources
 Ability to energise others by keeping interest level up and
demonstrating a high personal energy level
 Interpersonal skills, communication is probably the important factor
in promoting change.
 Integrative thinking – Ability to see the big picture and keep the end
in mind while managing the small steps required to achieve success
 Flexibility to modify ideas/Persistence to non-productive tampering
 Confidence
 Realistic thinking
 Trustworthiness
 Articulate the vision
 Ability to handle resistance
 References
Bridges, W. (2003) Managing Transitions. Making the most of change. Nicholas Brealey.
Chin, R. and Benne, K.D. (1969) General strategies for effecting changes in human systems. In Bennis, W.G.,
Benne, K. D. and Chin, R. (eds), The Planning of Change (2nd ed). Holt, Rinehart and Winston.
Fisher, J. (2012) Fisher, J. (2012) The process of Transition. Available at: https://www.r10.global/wp-
content/uploads/2017/05/fisher-transition-curve-2012-1.pdf (Accessed: 28 June 2021).
Kotter, J. P. (1996) Leading Change. Harvard Business Scholl Press.
Lewin, K. (1951) Field Theory in Social Science. Harper and Row.
Lippitt, R., Watson, J. and Westley, B. (1958) The Dynamics of Planned Change. Harcourt, Brace.
Rogers, E. (1983) Diffusions of Innovations (3rd ed) Free Press
Sullivan, E.J. and Garland, G. (2010) Leading and Managing Change and Transition. In Sullivan, E.J. and
Garland, G. (eds) Practical Leadership and management in healthcare: for nurses and allied health
professionals. Pearson.
Yukl, G. (2002) Leadership in Organisations (5th ed) Prentice Hall