1. What is a change? Change (a dynamic process in which an individual’s behavior is altered in response to a stressor)is an inherent part of life. It is the process that causes individuals to adapt. Whether it is planned orunplanned, change is both inevitable and constant. Change can be constructive or destructive and isstressful to individuals because it activates the GAS. Nurses must be able to initiate and cope with change. Proficiency in critical-thinking andproblem-solving skills is necessary to initiate positive change. The pace of change is rapidly increasing in health care agencies, which have been changing andcontinue to change in response to consumer demands. “Change is inevitable and nurses have thequalities and a strategic position to participate actively” (Joel, 1998, p. 7).CHARACTERISTICS OF CHANGE• Is an inevitable part of life.• May be eustressful or distressful.• Can be self-initiated or externally imposed.• Can occur abruptly or have a gradual onset with insidious progression.• Energy is required to effect change, as well as to resist change.2. What are the purpose of change?3. Explaina. Kurt Lewin’s Theory of change A classic theory of change was developed by Lewin (1951), who stated that the change processoccurs in three stages: unfreezing, moving, and refreezing. In the unfreezing stage, the personrecognizes a need for change and becomes motivated to move in a new direction. Stage two, changing,is the actual implementation of the change. In the third stage, refreezing, new changes are incorporatedinto behavior and these new behaviors stabilize. Because the change process is dynamic, these stagesare not rigid. The process of change may quickly move through all stages, or it may become “stuck” inone stage. Planned change is when you put a series of actions into place to achieve a predetermined goal.Unplanned change on the other hand has unpredictable outcomes. In nursing, Lewins change theory canbe used to bring about planned change. Apply the unfreezing stage. The unfreezing phase of Lewins thoery is when you find a problemthat you need to solve and determine what resistance there is to creating change that will resolve theproblem. In this stage, you try to reduce the amount of resistance. Apply the moving stage. In the moving stage of this theory, you find a solution that can resolvethe problem and bring about change, gather resources that you will need for implementation and thenput a plan into place to implement the solution.
Apply the refreezing stage. This is when the change is evaluated to see if it has been accepted bythe staff and if its is, it becomes a part of your establishment and is made permanent.b. Lippitt’s Theory of Change Lippitts change theory is based on bringing in an external change agent to put a plan in place toeffect change. There are seven stages in this theory and they are diagnose the problem, assessmotivation, assess change agents motivation and resources, select progressive change objects, choosechange agent role, maintain change, terminate helping relationships. This theory can be used in nursingto effect change. 1 Diagnose the problem. In this step, the nurse leader, staff nurse or health care personnelnotices and diagnoses a problem. The need for change is then made known to other members of staffwho will be affected, so that meetings can be held to decide on how to move forward. 2 Assess motivation. Find out if those that will be affected by the change are willing to let ithappen or are opposed to it. Check to see if the change can be accomplished based on availableresources like money. Come up with solutions that will address all possible problems that may beencountered on the road to change. 3 Check to see if the change agent can do the job. Determine if the change agent hired fromanother firm has what it takes to do the job by way of stamina, experience, acceptance by the nursesand other staff, a genuine desire to see the change project succeed and the right personality. 4 Write a plan to implement the change. The plan should contain detailed steps that includetimetables and deadlines. Responsibilities are then assigned to all parties involved in making the changehappen. 5 Determine the role of the change agent. Let everyone working on the change project knowwhat the role of the external change agent will be so that there will be no confusion as to what his job is,thus preventing misunderstandings or resentment. 6 Maintain the change. In this step of Lippittss change theory, the change project is monitoredfor progress. All parties involved in the change project communicate with each other and the changeagent to update themselves on the progress of their individual tasks. 7 Terminate the helping relationship. In this stage, the external change agent is let go bywhoever hired him and supervised his work. Also, at this stage the change is made permanent bycreating rules and policies that have to be followed.4. Explain the 3 stages of plannedchange.Planned change occurs in a three-step process: 1. Unfreezing 2. Moving 3. RefreezingUnfreezing During unfreezing, conditions are viewed as stable,or “frozen.” Change begins with a felt need, a desired goalthat has not been achieved. When one individual shares afelt need with another individual, unfreezing has begun.During the unfreezing phase, the current condition isanalyzed critically.
The goal of the unfreezing phase is to clarify the present situation and make persons aware ofthe need for change by creating dissatisfaction with the situation. The target of change can be attitudes,knowledge, and/or behaviors. A change agent encourages group members to raise questions andexplore their feelings and attitudes about present conditions. When group members acknowledge theirdissatisfaction with the present situation, they begin to commit themselves to the change process. Forchange to occur, a plan that maximizes driving forces and minimizes restraining forces is made.Moving The goal of the moving phase is to achieve the desired change. The moving phase is also knownas the changing phase because it is during this phase that the change is implemented. The moving phasedepends on the outcome of the unfreezing phase. If the equilibrium has been upset in a favorablefashion—driving forces exceed restraining forces—then the desired change can occur. Moving endswhen the change has been fully implemented; that is, the desired change in knowledge, attitude, orbehavior has occurred. When the target has been changed, refreezing can occur.Refreezing The goal of the refreezing phase is stabilization of the change. The new knowledge, attitude, orbehavior learned during the moving phase must continue to be practiced until it becomes as familiar asthe one that preceded it. The change agent can help the group to refreeze by actions that help tolegitimate the change, such as providing articles for the group to read about others who have made thesame or a similar change. Refreezing represents the end point in the change process and indicates that the change hasbeen fully accepted and internalized. The change agent knows that refreezing has occurred when groupmembers consistently demonstrate the new attitude or behavior and talk positively about it, their wordsand actions being congruent. Once it has been determined that refreezing has occurred, the group’sperformance should be evaluated periodically to confirm that the planned change is indeed refrozen.5. What are the causes ofresistance to change? Many people tend to resistchange because of the energy requiredto adapt. Conversely, energy is alsorequired to resist change, or to maintainthe status quo. Individuals differ in theirability to tolerate (or even thrive on)change. There are no absoluteguarantees that the change activity willlead to positive outcomes; thisuncertainty about outcomes is a majorbarrier to change.
6. Explain the Principles of Organizational change.Four Principles of Organization System ChangeA. Principle of Self-Creation: A human organization exists as a process of creative advancement inwhich the organization ceaselessly defines itself and sustains itself. This principle specifies the primary conditions which a human organization as a complexadaptive system must satisfy so as to maintain its existence. This principle can be further elaborated intothree complementary rules. A-1 Rule of Depedent Arising : The emergence of a human organization is a result contingentupon the match of the internal systemic causes and external situational conditions. A-2 Rule of self-discipline: To sustain its structure, a human organization must carry out themetabolic function in a self-disciplined way. A-3 Rule of value commitment: To justify the legitimacy of its existence, a human organizationmust ensure that its value proposition is valid and is being effectively delivered all the time.B. Principle of Binary-Mode of Existence: Human organization has two modes of existence, namely,regular mode and transitional mode, and each has its own conditions of dependent arising and rulesof behavior. The regular mode is suitable to the relatively stable environment. The transitional mode issuitable to the environment that displays significant changes. Two sets of rules, each of which governsone of the respective modes of behaviors, are identified as follows. B-1 Rule of regular mode behavior: When in regular mode, a human organization will self-correct, with minimum work, the perturbations caused by the environment to conserve the integrity ofits structure. B-2 Rule of transitional mode behavior: When the external disturbance exceeds certain limitsand the existing order can no longer be restored by the regular self-correction force, then a humanorganization will build up energy and prepare itself to be transformed into a new structure which will besustainable in the new environment.C. Principle of Phase Transformation: The phase change process of a human organization,macroscopically, starts from the disorganization of the old structure and finishes with the emergenceof a new structure. Microscopically, the phase change process involves a self-catalyzed quantitative toqualitative transformation which diffuses from the level of individual constituent members to thewhole organization. The phase transformation principle governs the behavior of a complex system when it is in themode of transition. The macro- and microscopic processes mentioned above can be further elaboratedas below. C-1 Rule of macro transformation process: Once entering the transitional mode, there are twoforces competing for the governance of the organization state, namely the conservation inertia and thetransformation thrust. and there are also direct and indirect approaches to accomplish a successfulphase change. The difference between these two approaches is whether the conservation inertia hasbeen effectively resolved at the beginning stage of the change process. C-2 Rule of micro transformation process: The change of the macro state of a humanorganization stems from the change of behavior patterns occurring at the level of the individualconstituent member, which in turn is started from the change in his/her cognition state; then through aprocess of co-evolution, such a change at the individual level will grow into a macro phase change at theorganization level.
D. Principle of Bifurcation: The history of a human organization is a history of bifurcation and choicethat are governed by the following two rules. D-1 Rule of irreversibility: The bifurcation of an organization change process is an irreversibledependent arising phenomenon, i.e., as the response of the inner causes to the altered outer conditionsreaches a certain critical level, a phase change of the organization becomes inevitable; however, whichparticular one the system will choose among the bifurcated paths of evolution is contingent upon thespecific combination of the inner and outer factors at the instant of change. D-2 Rule of inheritance: The evolution of an organization at any stage is inherited from thesystem status of its previous stage.