Initiating and Managing Change

Change can be viewed as a positive event whereby new ideas, approaches, ways of conducting business, or general everyday activities undergo a restructuring or re-evaluation to produce a revitalized perspective. Change also can be viewed as a not so positive event whereby individuals feel threatened or lose their sense of security. Generally, individuals tend to resist any type of change; they are secure with the status quo, like the comfort of a routine, fear the unknown, and fear the change itself. Change can be equated with some degree of risk and can be frightening to some. Myths and assumptions about the outcome of a change are always evident and in many cases are fueled by personal attitudes to change.

The perceptions of change vary, but the occurrence of change is consistent; it is inevitable. A major influence on the result of change is the manner in which it occurs and the individuals who facilitate it.

Types of Change:

An unplanned change occurs in a haphazard manner and results in unpredictable outcomes. This type of change does not offer individuals affected by its results a voice in its development or implementation. The manner in which it evolves produces great potential for negative outcomes. In organizations an unplanned change has far reaching effects, especially if the organization is large. Communication in large organizations can be problematic depending on the number of channels through which the communication flows. Rumors, misinterpreted statements, and written memos can result in confusion which can lead to disgruntled employees and, if the confusion reaches the population served by the organization, poor public relations. On a unit level an unplanned change can affect the smooth operation of the activities of the unit and have the same results as an organizational unplanned change, except on a smaller scale.

A planned change is purposeful; it is designed to include mutual goal setting and equal input from all individuals who will be affected by it. It occurs through the change process which is similar to the nursing process involving assessment, planning, implementation, and evaluation. A planned change has potential for positive outcomes. In organizations planned change involves representation in the change process from all groups who will be affected by the change. This may include representation from the population served by the organization. Communication in a planned change moves from the top downward, from the bottom upward, and from side to side; everyone affected by the change should receive all relevant information in a manner that can be interpreted equally by all groups. On a unit level a planned change should involve everyone on the unit so that everyone has an opportunity to define, shape, and facilitate the change.

Strategies for Change: In addition to power-coercive, empirical-rational, and normative-reeducative strategies for change that are reviewed in the text are facilitative strategies which make individuals aware of the availability of assistance to adapt to the change and persuasive strategies which attempt to bring change partly through bias in the way the message is delivered. The nurse executive/manager who participates in and facilitates change has to use not only change agent skills, but also has to be an educator/trainer, a role model, a researcher, a technical expert, and a resource person.

Facilitative strategies can be used when resistance to the change is expected. For example, an organization that is moving into computer based documentation can offer inservices, seminars, or one-on-one teaching to educate employees about computers and allow time for practice.

Persuasive strategies can be used to change attitudes and behaviors. Nurses use persuasive strategies all the time. For example, teaching a person to self administer insulin in many cases requires encouragement, support, teaching, and positive reinforcement, all of which can facilitate the person to accept and become comfortable with insulin administration.

Resistance to Change: While some individuals outwardly demonstrate a resistance to change through verbal interactions, there are also those individuals who use a more passive approach. The nurse executive/manager should be alert to non-verbal and/or passive indicators that the change process may be impeded. For example, indicators of resistance to change by individuals may be:

• constantly forgetting to follow through on the change
• consistently non-compliant
• not meeting deadlines or participating in the change process
• demonstrating an inability to participate in the changed behavior
• becoming angry
• blaming others for non-change
• claiming to be too busy to learn about or follow through on the change

If these behaviors are evident, perhaps the nurse executive/manager should assess the situations in which these occur and determine whether they should be taken at face value or assessed as resistors to change.