This document outlines the key aspects of managing change processes. It begins by defining change and discussing how people typically react to change. It then explores factors that drive change both externally from the environment and internally within organizations. Three main strategies for implementing change are described: power-coercive, rational-empirical, and normative-re-educative. Lewin's three stage model of change and a systems model of service change are also presented. The document provides guidance on developing a change plan, identifying support and resistance, and working with resistance to change. It concludes by emphasizing the importance of leadership styles in managing the change process.

1. • The Change Process
Clinical Change Proposal
Dissertation NM 6068
Tracy culkin 2008/09

3. Learning OutcomesLearning Outcomes
• Aim
this session will be a revision on the subject of
change management
• Objectives
by the end of the session you should be able to
• Give a definition of change management
• Describe two models utilised for the change
process
• Identify tools which can be used to demonstrate
resistance to change

4. DefinitionDefinition
• Change - to make
different, to alter, to transform
(Geddes & Grosset 2005, p 54)

5. How do you react to change?How do you react to change?
Activity :
• Think about a change that you have experienced at work
• How did you feel about the change?
• Were you involved in initiating the change or was it forced on
you?
• Were you able to influence the change at all?
• Was it clear why the change needed to take place?
• Did you understand exactly what would happen?
• Was there any misunderstanding or disagreement?
• Did it achieve the results that were intended?
• Did it change your work in any way?
• Was it stressful or threatening for you?
• Was anything lost that you valued?
• Was anything gained?

8. What Drives Change?What Drives Change?
• External Environmental Factors
• A ‘STEEP Analysis’ – can help you to identify factors that
might influence change in your organization
• S sociological
• T technical
• E economic
• E environmental
• P political

9. What Drives Change?What Drives Change?
• Internal Organizational Factors
• Multiple factors – such as finance,
budgets, staffing etc.,
• Multiple pressures on departments

10. 3 Different strategies for3 Different strategies for
Implementing ChangeImplementing Change
• Power-Coercive Approach (Telling)
• Seen as the traditional ‘top-down’ approach
• The assumption is that those with less power will comply
• The person with most power controls the change
process
• ‘Knowledge is power’

11. 3 Different strategies for3 Different strategies for
Implementing ChangeImplementing Change
• Rational-Empirical Approach (Selling)
• ‘Knowledge is power’ still applies, but it is the intention to increase
the knowledge of the workforce
• This is also a ‘top-down’ approach, but with more involvement of
those involved

12. 3 Different strategies for3 Different strategies for
Implementing ChangeImplementing Change
• Normative-RE-Educative Approach (Participating)
• This contrasts with the first two approaches
• This is a ‘bottom –up’ approach
• Seen as the optimum approach
• Main features –
• Involves individuals
• Agree on roles and tasks
• Good communication
• Need for change agreed by the participants
• Builds on abilities of those involved
• Includes support for each other

13. Lewin’s (1947) three-stage modelLewin’s (1947) three-stage model
of Changeof Change
• Unfreezing
• Moving
• Re-freezing
(cited Martin 2003, p 105)

14. • Unfreezing stage – people
begin to accept that there is a
need for change.
• Moving stage – when it is
possible to make changes
• Re-freezing – when the
change is consolidated and
the changed state becomes
the new normal state

15. A Systems Model of Service ChangeA Systems Model of Service Change
(Martin 2003, p 108)(Martin 2003, p 108)
Inputs
People
(including
service users)
Resources
Environment
History
Transformation
Interactions
Processes
Activities
Tasks
Outputs
Satisfied service
Users
Goals achieved
Resources used
Reputation

16. Leading Change as a ProcessLeading Change as a Process
(Martin 2003, p11)(Martin 2003, p11)
Awareness
Developing Vision
Developing DirectionInspiring Action
Reviewing, Revising,
Reflecting

17. Leading Transformational ChangeLeading Transformational Change
(Martin 2003, p109)(Martin 2003, p109)
Awareness
Developing Vision
Developing Direction
Inspiring Action
Reviewing, Revising,
Reflecting
Improving services
through interactions,
processes, activities
And tasks
Inputs
People
(including
service users)
Resources
Environment
History
Outputs
Satisfied
service users
Goals achieved
Resources used
Reputation

18. Leading ChangeLeading Change

20. How to tackle ChangeHow to tackle Change
• Devise an overall strategy
• Turn the strategy into a
plan
• Seek sanction from those
in authority
• Implement the plan

21. Developing a Plan for ChangeDeveloping a Plan for Change
• What am I trying to achieve?
• What is the best way of doing
it?
• What tasks and activities are
involved?
• In what order should I do
these?
• What resources do I need?
• How shall I review progress?
• Who will do what and when?

22. Developing a Plan for ChangeDeveloping a Plan for Change
• Aims and Objectives –what are you hoping to
achieve
• Decide on the Change Strategy
• Plan how the Change will be Evaluated to
measure its success
• How will you fund the Change/what is your
budget?
• Consider how Consent will be achieved to
access the Clinical Area
• Consider Ethical Issues that may occur

23. Developing a Plan for ChangeDeveloping a Plan for Change
• Tools to aid planning and Implementation of the
Change
 Gantt Chart
 Forcefield Analysis
 SWOT Analysis
 Charting the Critical Mass

24. Gant ChartGant Chart

25. Identify Support &Resistance toIdentify Support &Resistance to
ChangeChange

26. Identify your environmentIdentify your environment

27. Commitment PlanningCommitment Planning
• Need to build a critical mass of supporters to implement
Change
• Any change situation has a balance of ‘forces’, reducing
constraints is more effective than increasing pressure
• A commitment plan chart will help you to identify those,
who oppose, allow, help or make the change

28. What you need to do!What you need to do!
• Lead the change
process
• Manage the process
• Inspire others

29. You need to consider the styles ofYou need to consider the styles of LeadershipLeadership that arethat are
appropriate for yourappropriate for your ChangeChange

30. Barriers to changeBarriers to change
• It requires people to think differently
• It requires people to do things in
different ways
• It requires people to learn new ways
• It requires additional effort from
people
• Resistance to change
• People are frightened about having to
learn and change

32. Working with ResistanceWorking with Resistance
• Effective communication
• Careful listening
• Careful explanations
• Discuss the reasons for the change and the external pressures
driving it, may help some to understand why it needs to happen
• Encourage participation – in developing the vision or the direction
of the change – may not become enthusiastic, but will tolerate the
change
• Negotiation over particular issues with individuals or groups –can
win people over

33. How you may feel!How you may feel!

34. During this process of writing your dissertation, just thinkDuring this process of writing your dissertation, just think
this is your last hurdle to obtaining your degree!this is your last hurdle to obtaining your degree!

35. ReferencesReferences
• Bridges, W (2002) Managing transition, Making the most of change. London: Nicholas Brealy
• Burnes, B (2000) Managing change: a strategic approach to organisational dynamics. 3rd
edn.
Harlow: Prentice Hall
• Davidson J (2002) The Complete Idiot’ s Guide to Change Management. Indianapolis: A
Pearson Education Company
• Geddes & Grosset (2005) Concise Edition Dictionary and Thesaurus. New Lenark,
Scotland:David Dale House
• Martin V (2003) Leading Change in Health & Social Care. London: Routledge
• Mulhall A (1999) Changing Practice: the theory. London: Nursing Times books
• Turrill T (1993) Change and Innovation. 2nd
edn. Thirsk: Turrill Ltd.