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  1. 1. Chapter 13 Change, Innovation, and Conflict Management
  2. 2. Objectives <ul><li>Upon completion of this chapter, the reader should be able to: </li></ul><ul><ul><li>Define change from personal, professional, and organizational perspectives </li></ul></ul><ul><ul><li>Identify the change theorists </li></ul></ul><ul><ul><li>Discuss the concept of the learning organization </li></ul></ul><ul><ul><li>Identify driving and restraining forces of change within a structured setting context </li></ul></ul><ul><ul><li>Discuss change strategies </li></ul></ul>
  3. 3. Objectives <ul><ul><li>Discuss the role and characteristics of a change agent in the change process </li></ul></ul><ul><ul><li>Utilize the change process to plan, implement, and evaluate a change project </li></ul></ul><ul><ul><li>Discuss the concept of innovation in health care </li></ul></ul><ul><ul><li>Identify conflict situations </li></ul></ul><ul><ul><li>Identify steps in the conflict management process </li></ul></ul>
  4. 4. Definition of Change <ul><li>Change </li></ul><ul><ul><li>Making something different than it was  </li></ul></ul><ul><li>In many instances, the outcome remains the same, but the process is changed </li></ul><ul><li>Living organisms must constantly adapt to changes in the environment in order to thrive </li></ul>
  5. 5. The Changing Health Care Environment <ul><li>Access to information has transformed the relationship between the patient and health care providers </li></ul><ul><li>Evidence-based practice is changing the way decisions are made regarding health care treatment and how nursing care is delivered </li></ul><ul><li>Changing demographics within the population have resulted in a diversity of cultures and languages </li></ul>
  6. 6. The Changing Health Care Environment <ul><li>The aging of the baby boomers </li></ul><ul><li>The rising costs of health care services </li></ul><ul><li>The underinsured/noninsured </li></ul><ul><li>Patient safety </li></ul>
  7. 7. Types of Change <ul><li>Personal change </li></ul><ul><ul><li>Voluntary change with the goal of self-improvement </li></ul></ul><ul><li>Professional change </li></ul><ul><ul><li>Deliberate change with the goal of improving professional ability/status </li></ul></ul><ul><li>Organizational change </li></ul><ul><ul><li>A planned change in an organization to improve efficiency </li></ul></ul>
  8. 8. Traditional Change Theories <ul><li>Lewin’s force-field model </li></ul><ul><li>Lippitt’s phases of change </li></ul><ul><li>Havelock’s six-step change model </li></ul><ul><li>Rogers’ diffusion of innovations theory </li></ul>
  9. 9. Lewin’s Force-Field Model <ul><li>Unfreezing </li></ul><ul><ul><li>The current or old way of doing something is flawed </li></ul></ul><ul><li>Moving </li></ul><ul><ul><li>The intervention or change is introduced and explained </li></ul></ul><ul><li>Refreezing </li></ul><ul><ul><li>The new way of doing is incorporated into the routines or habits of the people affected </li></ul></ul>
  10. 10. Lippitt’s Phases of Change <ul><li>Diagnosis of the problem </li></ul><ul><li>Assessment of the motivation and capacity for change </li></ul><ul><li>Assessment of the change agent’s motivation and resources </li></ul><ul><li>The selection of progressive change objectives </li></ul><ul><li>Choosing an appropriate role for the change agent </li></ul><ul><li>Maintenance of the change once it has been started </li></ul><ul><li>Termination of the helping relationship </li></ul>
  11. 11. Havelock’s Six-Step Change Model <ul><li>Planning stage </li></ul><ul><ul><li>Build a relationship, diagnose the problem, and acquire resources </li></ul></ul><ul><li>Moving stage </li></ul><ul><ul><li>Choose the solution and gain acceptance </li></ul></ul><ul><li>Refreezing stage </li></ul><ul><ul><li>Stabilization and self-renewal </li></ul></ul>
  12. 12. Rogers’ Diffusion of Innovations Theory <ul><li>Five-step innovation/decision-making process </li></ul><ul><ul><li>Awareness, interest, evaluation, trial, adoption </li></ul></ul><ul><li>Believes change can be rejected initially and adopted at a later time </li></ul><ul><li>Believes change is reversible and initial rejection does not mean the change will never be adopted </li></ul>
  13. 13. Commonalities among the Change Models <ul><li>All the theories relate to the process of “unfreezing, moving, freezing” </li></ul><ul><li>Many of the theories describe linear processes that move in a step-by-step manner </li></ul>
  14. 14. Differences among the Change Models <ul><li>Some theories do not work well in complex or nonlinear situations </li></ul><ul><li>Some theories work better for one type of change than another </li></ul>
  15. 15. Chaos Theory <ul><li>Belief that chaos is not random, but may have order </li></ul><ul><li>Order emerges through fluctuations and chaos </li></ul><ul><li>Nurses and organizations must be able to organize and implement change quickly and forcefully </li></ul><ul><li>Does not work well for linear change </li></ul>
  16. 16. Learning Organization Theory <ul><li>Emphasis is on interrelationships of all parts of the organization </li></ul><ul><li>Organizations respond to changes by using a learning approach </li></ul><ul><li>Focus on communication, education, and cooperation among all parts of organization </li></ul>
  17. 17. The Change Process <ul><li>Planned change in the work environment is similar to planned change on a personal level </li></ul><ul><li>Basic reasons to introduce change  </li></ul><ul><ul><li>To solve a problem  </li></ul></ul><ul><ul><li>To improve efficiency </li></ul></ul><ul><ul><li>To reduce the unnecessary workload for some group </li></ul></ul><ul><li>To plan change, one has to know what has to be changed </li></ul>
  18. 18. Steps in the Change Process <ul><li>Assessment </li></ul><ul><li>Planning </li></ul><ul><li>Implementation </li></ul><ul><li>Evaluation </li></ul>
  19. 19. Assessment <ul><li>Identify the problem or the opportunity for change </li></ul><ul><li>Collect and analyze data </li></ul><ul><li>Data collection and analysis should come from different sources </li></ul><ul><ul><li>Structural (physical space or configuration) </li></ul></ul><ul><ul><li>Technological (lack of wall outlets, poorly situated computer locations, lack of computers) </li></ul></ul><ul><ul><li>People (commitment of staff, levels of education, and interest in the project) </li></ul></ul>
  20. 20. Planning <ul><li>Identify the who, how, and when of change </li></ul><ul><li>Identify the target date </li></ul><ul><li>Goals and outcomes clearly determined and stated in measurable terms </li></ul>
  21. 21. Implementation <ul><li>Plan goes live </li></ul><ul><li>Provide information </li></ul><ul><li>Competency-based education </li></ul><ul><li>The benefits stated as positive outcomes actually begin to materialize </li></ul>
  22. 22. Evaluation <ul><li>The effectiveness of the change is evaluated according to the outcomes identified during the planning and implementation steps </li></ul><ul><li>The most overlooked step </li></ul><ul><li>Time intervals for evaluation should be identified and allowed to elapse before modifications and declarations of failure are asserted </li></ul>
  23. 23. Responses to Change <ul><li>The more the relationships or social mores are challenged, the more resistance to change </li></ul><ul><li>Factors affecting resistance to change </li></ul><ul><ul><li>Trust </li></ul></ul><ul><ul><li>The ability to cope with change </li></ul></ul><ul><ul><li>Evaluation of the immediate situation </li></ul></ul><ul><ul><li>Anticipated consequences of change </li></ul></ul><ul><ul><li>Individual’s stake </li></ul></ul>
  24. 24. Responses to Change <ul><li>Innovator </li></ul><ul><ul><li>Change embracer; enjoys the challenge; often leads change </li></ul></ul><ul><li>Early adopter </li></ul><ul><ul><li>Open and receptive, but not obsessed with change </li></ul></ul><ul><li>Early majority </li></ul><ul><ul><li>Enjoy and prefer the status quo, but do not want to be left behind </li></ul></ul>
  25. 25. Responses to Change <ul><li>Late majority </li></ul><ul><ul><li>Followers; often skeptics </li></ul></ul><ul><li>Laggards </li></ul><ul><ul><li>Last group to adopt change; prefer tradition </li></ul></ul><ul><li>Rejectors </li></ul><ul><ul><li>Openly oppose and reject the change </li></ul></ul>
  26. 26. The Change Agent <ul><li>Leads the change process </li></ul><ul><li>Manages the change process and group dynamics </li></ul><ul><li>Understands the feelings of the group </li></ul><ul><li>Maintains momentum and enthusiasm </li></ul><ul><li>Maintains vision of change </li></ul>
  27. 27. The Change Agent <ul><li>Communicates change, progress, and feelings </li></ul><ul><li>Knowledgeable about the organization </li></ul><ul><li>Trustworthy </li></ul><ul><li>Respected </li></ul><ul><li>Intuitive </li></ul>
  28. 28. Innovation <ul><li>The process of creating new services or products </li></ul><ul><li>Change and innovations are different </li></ul><ul><ul><li>Change deals with any modification </li></ul></ul><ul><ul><li>Innovation is restricted to new modifications in ideas and practices </li></ul></ul><ul><li>Innovation is a team event </li></ul>
  29. 29. Types of Change Strategies <ul><li>Power-coercive </li></ul><ul><ul><li>Uses authority and threat of job loss to gain compliance with change </li></ul></ul><ul><li>Normative-reeducative </li></ul><ul><ul><li>Uses social orientation and the need to have satisfactory relationships in the workplace as a method of inducing support for change </li></ul></ul><ul><ul><li>Focuses on the relationship needs of workers </li></ul></ul>
  30. 30. Types of Change Strategies <ul><li>Rational-empirical </li></ul><ul><ul><li>Uses knowledge as power base </li></ul></ul><ul><ul><li>Assumes that once workers understand the organizational need or the meaning of the change they will change </li></ul></ul>
  31. 31. Conflict <ul><li>Two or more parties holding differing views about a situation </li></ul><ul><li>Disagreement about something of importance to each person involved </li></ul><ul><li>Ability to resolve conflict is an important part of change management </li></ul><ul><li>Conflict is not necessarily bad </li></ul>
  32. 32. Sources of Conflict <ul><li>Allocation/availability of resources </li></ul><ul><li>Personality differences </li></ul><ul><li>Differences in values </li></ul><ul><li>Internal/external pressures </li></ul><ul><li>Cultural differences </li></ul><ul><li>Competition </li></ul><ul><li>Differences in goals </li></ul><ul><li>Issues of personal/professional control </li></ul>
  33. 33. Types of Conflict <ul><li>Intrapersonal </li></ul><ul><ul><li>Disagreement in philosophy or values, policy or procedure </li></ul></ul><ul><li>Interpersonal </li></ul><ul><ul><li>Personality conflict </li></ul></ul><ul><li>Organizational </li></ul><ul><ul><li>Competition for resources </li></ul></ul>
  34. 34. The Conflict Process <ul><li>Antecedent conditions </li></ul><ul><li>Perceived and/or felt conflict </li></ul><ul><li>Manifest behavior </li></ul><ul><li>Conflict resolution or suppression  </li></ul><ul><li>Resolution aftermath </li></ul>
  35. 35. Meaning of Conflict <ul><li>Individuals form an idea or concept of what the conflict is about </li></ul><ul><li>Four aspects of conflict </li></ul><ul><ul><li>Facts </li></ul></ul><ul><ul><li>Goals </li></ul></ul><ul><ul><li>Methods of goal achievement </li></ul></ul><ul><ul><li>Values or standards used to select the goals or methods </li></ul></ul>
  36. 36. Conflict Management <ul><li>Avoiding </li></ul><ul><ul><li>Ignoring the conflict </li></ul></ul><ul><li>Accommodating </li></ul><ul><ul><li>Smoothing or cooperating </li></ul></ul><ul><ul><li>One side gives in to the other side </li></ul></ul><ul><li>Competing </li></ul><ul><ul><li>Forcing </li></ul></ul><ul><ul><li>The two or three sides are forced to compete for the goal </li></ul></ul>
  37. 37. Conflict Management <ul><li>Compromising </li></ul><ul><ul><li>Each side gives up something and gains something </li></ul></ul><ul><li>Negotiating </li></ul><ul><ul><li>High-level discussion that seeks agreement </li></ul></ul><ul><ul><li>Not necessarily consensus </li></ul></ul><ul><li>Collaborating </li></ul><ul><ul><li>Both sides work together to develop optimal outcome </li></ul></ul>
  38. 38. Conflict Management <ul><li>Confronting </li></ul><ul><ul><li>Immediate and obvious movement to stop conflict at the very start </li></ul></ul>
  39. 39. Strategies to Facilitate Conflict Management <ul><li>Open, honest communication </li></ul><ul><li>Private, relaxed, comfortable setting for discussion  </li></ul><ul><li>Expectation of compliance to results by both sides </li></ul>
  40. 40. Leadership and Management Roles <ul><li>Model conflict resolution behaviors  </li></ul><ul><li>Lessen perceptual differences of parties </li></ul><ul><li>Assist parties to identify resolution techniques </li></ul><ul><li>Create environment conducive to conflict resolution </li></ul><ul><li>If conflict cannot be resolved, minimize or lessen perceptions of conflicting parties </li></ul>