The WHEEL of LIFE keep turning through
Balancing all of this intricacy of CHANGE is where the
real CHALLENGE of CHANGE is focused 4
Cycles of Change affecting person
of Loss….Regain hope
Change is necessary for growth—
It produce feeling of anxiety, loss and doubt
It create NEGATIVE STRESS – because it
involves the EXPERIENCE of LOSS
Most people prefer what is FAMILIAR and
COMFORTABLE --- so they question any change
In Health Care – some old habits die hard –
Eg .. Pre-op fasting--- prolonged pre-op fasting
TYPES of CHANGES
Emergent – Emergent change happens at all
levels. Changes that evolve over time as the result of
everyday activities and events
Transformative– Existing social and human
behavior in the systems and structure is changed.
It involves multi disciplinary groups .. designed
and enacted over a period of time
Planned An alteration of the status quo by
means of a carefully formulated program .
CHANGE and RESISTANCE to CHANGE
Like it or not …
Change will happen in the course of time
We can’t CONTROL the change – but we can
control how we respond to or feel about the
Change is not the problem – Resistance to
Change is the problem
Therefore, The best technique to overcome
the resistance to change is using emotional
approach than rational approach. 9
Resistance to Change
Why do people resist change ?
Rational-Technical side – what needs to happen ?
Emotional- Human side – What happens to me?
“People don’t resist change- they resist
being changed”(Peter Senge)
Then - how can I overcome
the Resistance ?
Expecting Resistance to Change and
Planning for it --from the start of your
change management will allow you
to manage objections effectively.
The 8 most common Beliefs and Reasons
that people RESIST CHANGE
1. There isn’t any real need for the change
2. The change is going to make it harder for me to meet
3. The risks seem to outweigh the benefits
4. I don’t think I have the ability to make the change
5. I believe the change will fail
6. Change process is being handled improperly by
7. The change is inconsistent with my values
8. I believe those responsible for the change can’t be
A SERIES of Actions, Changes, or
Functions bringing about a CHANGE
The 6 Steps Change Process
Step- 1. Something's Up !
Recognition of a
Everything is going well ………….
and you are feeling normal.
You begin to get the sensation that
something is different !
Vague awareness ---- change is
approaching ----- “Something’s” Up?
Step- 2 What is it?
The Situation of change is ….
Recognized-Clarified- Named– Described
• You choose your point ---
Problem or Opportunity
…But- you need a Clear Understanding
of the situation to decide the course of action
(Tsunami –……. information –.. not yet arrived !!!
• Raise the Alarm – and get a head start on
Early recognition could have enabled the
action – otherwise Change will stuck …. 16
STEP- 3. What Do I Need To Do?
The situation is known ..
Now ..You need to plan the action
What you need todo ?
How you will implement?
You must develop Implementation plan
Formal or Informal
STEP- 4. I Will Do This
Now there is a plan ---
it must put into action
You know what to do --------
YOU do it
STEP-5. ‘I Am Able To Do This’
The plan is there and you …
modify and make
So that there is a sense that it is working
So… The realization is that the
GOAL can be achieved
STEP-6. ‘I Got Through It. What's
Change is implemented
And things are normal again –
(Not the old normal …. But a new normal
Now you are looking ahead
for a new CHANGE …
5 Types of Response to Change
( Innovators and laggards --Everett Rogers)
1. Innovators – Those who love to change and thrive on
2. Early Adopters. Those who are usually receptive to
change -They are opinion leaders and willing to try
out new ideas in a thoughtful way
3. Early majority. Thoughtful people who accept change
more quickly than average
4. Late majority: People who initially resist change , but
accept change after the majority
5. Laggards : Those who dislike change and are openly
critical and antagonistic
KURT-LEWIN ( 1952)
Father of Social Psychology
Change Management Model
According to Lewin….
”If you want truly understand something
Try to CHANGE it ..”
Change is VITAL to Progress ..
Some Concepts of Lewin’s Theory
The FORCES affect changes
Force Field Analysis
a) Driving Forces:
Things that motivate you for change
b)Restraining Forces: Things that hold you
back from change—this cannot be removed
So it should be countered only by
increasing driving force
When (a) &( b ) are equal-
NO change occurs
Eg .Introducing new infusion pump
The Change agent develop strategies to reduce
restraining forces – fear of using a new device
The individual accept new systems
of values and beliefs -- when there
is an acceptance in the group---
According to Lewin….
To understand the behaviour –
The Person and the Environment
have to be considered as one
constellation of interdependent
Eg. New nurses 26
Lewins theory helps nurses to assess
and change patient’s health behaviour…
Barrier to change ….
How to help the patient become more
accepting to change
Finally completing the change
E.g smoking ……….Obesity
Unfreeze Change/ Refreeze
Unfreezing : When CHANGE is needed
UNFREEZE Old habits
– let them go……………
Find a method for unfreezing.
• Unfreezing is necessary to
overcome the strains of individual
resistance and group conformity.
• Unfreezing can be achieved by the use
of three methods.
–First- Increase the driving forces that
direct behavior away from the
existing situation or status quo.
–Second- Decrease the restraining
forces that negatively affect the
movement from the existing
–Third- Find a combination of the two
methods listed above.
The techniques that motivate staff to be aware
of the coming change – that build recognition
of the need for change.
• Feel discomfort with the present state
when status quo is questioned
“MOVEMENT ” - When change is initiated-
“Moving to a new level or Changing”
Thoughts-- Feelings---Behaviours --- all actions
towards a goal –
This stage involves a process of change in all 3…
thoughts, feeling, behavior, that is in some way
more liberating or more productive.
Patient’s Health Problems are assessed, analysed-
options and alternatives are identified and
actions occurs 32
When Equilibrium is established
CHANGE is established as a new habit-
so that it now becomes the –
Without this stage of refreezing, it is easy to go
back to the old ways
…..Standard Operating Procedure
Complying with a NEW Behavior
Theory and phases are inter related and use
in Nursing Process….
Assessment – Planning – Implementing –
Assessment Lewin’s Unfreezing stage
Planning & Implementation Lewin’s Moving
Implementation & Evaluation Lewin’s
Change Agent-…. Qualities
• Willing to experiment
• Ready to change
• Good understanding of educational
Change agents are responsible for
facilitating the change through:
• Gaining commitment for the changes.
• Facilitating evaluation activities.
• Monitoring and reporting progress of
• Consulting and identifying sources of
• Disseminating lessons learned.
Change Agent ?
A Change Agent can help with Change Efforts
People resist Change --- they fear the
Change agents from inside or outside the
This person is well versed in the system and
can help, guide and assist in change process.
Change agent has a great and vital role
n implementation of change
Eg. Head Nurse Vs New nurse
When agents of change are supported in more
balanced lives -- they are empowered to create
more effective, lasting change in the world
nternal Change agents .. know all working
conditions.. people etc –
• Difficulty is that something is already in practice –
their credibility and ability
Outside Personnel as Change Agent
Challenged with the norms and beliefs and accepted
They do not have knowledge of the policies--- and
when they leave – the work should continue
Advantage is—objectivity --and give honest
feedback without fear of reprisal.
They have broad experience to share.
Characteristic of a Change Agent
1. Clear Vision
A ‘Change Agent’ does not have to be the person in
authority, but have a clear vision and be able to
communicate clearly with others.
• To tap into the strengths of the people and
ways to work toward a common purpose.
*** Must have thorough knowledge
change theory….& Concepts
2. Patience yet Persistent
Change that is meaningful to people-- to embrace
change and see importance.
Most people need to experience something before
they really understand it.
Many can get frustrated that change does not
happen fast enough
The persistence comes in that you will take
opportunities to help people get a step closer
often when they are ready,
Not just giving up on them after the first try.
3. Asks tough questions –
• —- Have accountability.
There should be an emotional connection –
when they move truly ahead.
4.Knowledgeable and leads by example
• Active in learning and working with learners and
can show by example- what learning will have
much more credibility.
• Put themselves in the situation.. where they are
actually involved in that type of learning..
5. Strong Relationships built on Trust –
• People will not accept - if they do not trust the
person that is pushing the change.
• The change agents should be extremely
approachable and reliable.
6. Builds supporting structures
Seeks resources for teaching and learning , ensure
adequate future innovation
• Name one Change Agent(s) ..
at work –whom you are-
constantly in touch with–
from your beginning of
career in Kuwait…………
Yes it is Staff Development Unit ….
Support the change process.
• Help support the change.
• Be an important vehicle to communicate the
reasons for change.
• Provide a mechanism for obtaining feedback.
Changes & Challenges Explained
What is a change?
Types of Changes
Change Process and Response to Change
Theory of Change
Change Agent – … Role