Change Theories Change Management and

Change Theories Change management and resistance in healthcare: A seven-step model It is often said that the one constant in any organization is change. Healthcare organizations have had to weather tremendous changes over the past decade. A number of social factors, including changes in the health insurance system and the need for more nurses and other staff members to treat an aging population have demanded greater responsiveness and flexibility amongst nurse practitioners.

Yet resistance to change in healthcare organizations, partially because of the need for routines to dispense high-level care, can be great amongst nurses and other trained professionals. Varying routines and standard operating procedures while still providing consistently high-quality care is an eternal challenge. A Clinical Nurse Leader must understand why individuals may be resistant to change to be able to overcome psychological obstacles when introducing new technology or reconfiguring the organization or procedures of a specific department. Even under the best of circumstances, change resistance is not uncommon.

Just like someone who is grieving will often go through certain stages before coming to terms with reality, so will an individual confronting change. A change manger must be aware of these 'stages' of change resistance and acceptance, which are often understood as a seven-step model: The first stage of confronting change, shock, reflects the fact that change is often unexpected. The second phase, denial, is when organizational members resist the inevitability of the need to change, even (or especially) if management explains to them why change is required (Recklies 2010).

In healthcare organizations, if the changes regarding patient care are imposed by managers who are not healthcare providers themselves, the change resistance may be even greater during these first two phases. This is why a Clinical Nurse Leader can be so valuable in putting the need for change into language the staff can comprehend. Thirdly comes rational understanding, whereby the explanation for change is intellectually understood, but not fully accepted on an emotional level (Recklies 2010).

When conveying a rational explanation for the needed change, input from individuals with real knowledge about the technical demands of nursing and care is required: for example, if changes are necessitated by financial cutbacks, reductions in staff cannot simply be imposed. The staff cannot be left to 'sort things out' with fewer resources. An audit of how to do more with less may be required and nurses will only 'buy into' the new plan if it can be medically justified (Campbell 2008).

Even after the rational nature of the change proposal is accepted, there may still be resistant, restraining forces upon the need for change. Emotional acceptance is a separate, fourth stage after rational acceptance. "Only if management succeeds to create willingness for changing values, beliefs, and behaviors, the organization will be able to exploit their real potentials. In the worst case, however, change processes will be stopped or slowed down here" (Recklies 2010).

Having a sense of urgency combined with a rationale behind the change is required to propel and drive change acceptance ahead in the organization. According John Kotter's theory of enabling change, managers above all must create a sense of urgency, along with a guiding team and a vision for the organization to accept changes (Campbell 2008). If the need for change is accepted, rationally, then emotionally, then gradually workers will become more willing and open to learn, and to incorporate the change into the organization's standard operating procedures.

Individuals are more apt to accept change if, for example, they are convinced that it will improve patient care in the long run, than if the directive is merely dispensed as required because 'management says so.' The critical aspect of fifth phase of the change process of "learning" is how changes are introduced. Communicating is an essential aspect of 'buy-in' but so is fostering a positive sense within the organization about the proposed changes by 'creating early wins' (Campbell 2008).

This will lead to an increase in people's perceived own competence in their new roles. Unfortunately, starting with easier projects is not always feasible, but even if it is not, a Clinical Nurse Leader must be particularly sensitive to feedback from members of the organization at this 'learning' time and even when confronting setbacks, focus the organization's attention on achievable short-term goals. During the sixth stage, or "realization stage," staff begins to "understand which behavior is effective in which situation. This, in turn, opens up their minds for new experiences.

These extended patterns of behavior increase organizational flexibility. Perceived competency has reached a higher level than prior to change" and individuals are more capable of learning autonomously, and with an open mind, from their own, practical experiences (Recklies 2010). Finally, during the seventh integration stage, the change has become the organizational norm. Even under the best of circumstances, old attitudes may be entrenched. "Change within a health care organization means that individuals must transition from one identity to.