Mariano Marcos State University

GRADUATE SCHOOL
Laoag City
DANICA DANIELLES E. ARCE, R.N.
Master of Arts in Nursing

MANAGEMENT OF CHANGE
A successful management of change process requires significant front-end planning that
makes the implementation go much more smoothly.
FORCES THAT INFLUENCE CHANGE
There are internal and external forces that influence change.
Internal forces originate from inside operations that may result from external
changes and include changing priorities, need for increased productivity, need for
cost containment, staffing pattern changes, shifts in philosophy, work process
changes, and need for quality of work life.
External forces include health care economics, technology, restructuring,
diversity and changing demographics.
Leaders are visionary role models who focus on the future. Managers process the changes
and understand future directions.
LEADER
MANAGER
Is visionary in identifying needed change
Assesses the driving and restraining forces
Is a role model
Identifies and implements strategies
Is sensitive in timing initiatives
Seeks subordinates input
Is creative in identifying solutions
Supports and rewards individual efforts
Focuses on the future
Understand future directions
(Carr DK Johansson)
STRATEGIES FOR EFFECTING CHANGE
Whether working with individuals, groups or systems, the nurse manager is sure to be
involved with management of change. Several strategies for managing change have been
identified.

Empirical-Rational Strategies are based on the assumption that people are rational and
behave according to rational self-interest. It follows then that people should be willing to

adopt change if it is justified and if the people are shown how they can benefit from
change.
Nurse Managers who use empirical-rational strategies are likely want the
appropriate persons for specific positions, Desirous of having people perform jobs for
which they are well qualified, and nurse managers give considerable attention to
recruitment and selection of personnel. Staff development through independent study, inservice education, continuing education and formal degree programs is encouraged.
System analysis, operations research and implementation of research findings are
consistent with the empirical-rational, philosophy, as is long-range futuristic planning.

Normative-Reeducative Strategies are based on the assumption that people act

according to their commitment to sociocultural norms. The intelligence and rationality of
people are not denied, but attitude and values are also considered. The managers pay
attention to changes of values, attitudes, and skills, and relationships in addition to
providing information.
Believing that the basic unit of social organization is composed of individuals, the
manager fosters the development of staff members through means such as personal
counseling, training groups, small groups and experiential learning because people need
to participate in their own reeducation. Organizational development programs are
fostered, and it is typical to collect data about the organization, give data feedback and
analysis to appropriate people, plan ways to improve the system, and train managers and
internal agents. The relationship of internal change agents with other personnel can be a
major tool in reeducating others.

Power-Coercive Strategies involve compliance of less powerful people to leadership,

plans, and directions of more powerful individuals. These strategies do not deny the
intelligence and rationality of people or the importance of their values and attitudes, but
rather they acknowledge the need to use sources of power to bring about change. Use of
strikes, sit-ins, negotiations, conflict confrontation, and administration decisions and
rulings are power-coercive strfategies.

PROCESS OF CHANGE
Lewins framework for the three phases of change are unfreezing, moving and refreezing.
Unfreeze

Move

Refreeze

Unfreezing is the development through problem awareness of a need for change. Even if
a problem has been identified, people must believe there can be an improvement before
they are willing to change. Coercion and the introduction of guilt and anxiety have been

used for unfreezing. Removal of people from the source of their old attitudes to a new
environment, punishment and humiliation for undesirable attitudes, and rewards for
desirable attitude effect change. Stress may cause dissatisfaction with the status quo and
become a motivation factor for change, Points of stress and strain should be assessed.
Change may begin at a point of stress but ordinarily should not be started at the point of
greatest stress. It is most appropriate for it to start with a policy making body that
considers both formal and informal structures. The effectiveness of the change may
depend on the amount of involvement in fact finding and problem solving of all
personnel.
Moving is working toward change identifying the problem or the need for change,
exploring the alternatives, defining goals and objectives, planning how to accomplish the
goals, and implementing the plan for change.
Refreezing is the integration of the change into ones personality and the consequent
stabilization of change. Frequently personnel return to old behaviors after change efforts
cease. Related changes in neighboring systems, momentum to perpetuate the change, and
structural alterations that support the procedural changes are stabilizing factors.

TYPES OF CHANGE
The variables of mutual goal setting, the power ratio between change agent and the client
system, and the deliberativeness of change are differentiating factors in the change process.

Coercive Change non-mutual goal setting, imbalanced power ratio, and one-sided
deliberativeness characterized coercive change.
Emulative Change transition is fostered through identification with and imitation of
power figures.
Indoctrination uses mutual goal setting, has an imbalanced power ratio, and is
deliberative. Subordinates are instructed in the belief of power sources
Interactional Change mutual goal setting, fairly equal power, but no deliberativeness
characterizes interactional change. Parties may be unconsciously committed to changing
one another.
Natural Change includes accidents and acts of God. They involve no goal setting or
deliberativeness.
Socialization Change is directly related to interactional change. An individual conforms
to the needs of a social group. When there is greater deliberativeness on the power side,
change becomes indoctrination.
Technocratic Change is collecting interpreting data bring about change. A technocraft
merely reports the findings of the analysis to bring about change.
Planned Change involves mutual goal setting, an equal power ratio, and
deliberativeness.

LEWIN
1. Unfreezing
2. Moving
3. Freezing

LIPPITT

HAVELOCK

1. Diagnosing the problem

2. Assessing motivation and
capacity for change
3. Assessing change agents
motivation and resources
4. Selecting progressive change
objective
5. Choosing the appropriate role
for the change agent
6. Maintaining change
7. Terminating
relationship

the

ROGERS

1. Building a relationship
2. Diagnosing the problem

1. Awareness
2. Interest

3. Acquiring the relevant

resources
4. Choosing the solution

3. Evaluation

5. Gaining acceptance

5. Adoption

6. Stabilization
renewal

and

4. Trial

self-

helping

Ronald Lippitt, Jeanne Watson and Bruce Westley (1958) have identified seven phases of
planned change. First, the client must feel a need for change. The manager, as the change agent,
can stimulate an awareness of the need, help the client become aware to problems, and indicate
that a more desirable state of affairs is possible. The change agent assesses the clients
motivation and capacity for change and the change agents motivation and resources. Thus
unfreezing occurs.
Next, the helping relationship must be established, and the moving process begun.
Managers, as change agents, must identify with clients problems while remaining neutral so that
they can remain objective. The change agent needs to be viewed as an understandable and
approachable expert. The success or failure of most planned action will depend largely on the
quality and workability of the relationship between the change agent and the client. The problem
must be identified and clarified. Collecting and analyzing data can facilitate this process.
Alternative possibilities for change should be examined. Goals and objectives are planned. The
clients emotional and material resources are examined. Strategies for change are determined.
The success of planned change is evaluated by the implementation of the plans. It is the ative
work of modification that completes the moving process.
The refreezing process occurs during the sixth phase generalization and stabilization.
All too often clients slip back to their old ways after change effort cease. The spread of change to
neighboring systems and to subparts of the same systems aid in the stabilization process. Change
momentum, positive evaluation of the change, rewards for the change and related procedural and
structural changes increase the stabilization. The helping relationship ends, or a different type of
continuing relationship is established. Dependency is the major factor determining when the
relationship will end.
Lippitts seven phases, Ronald Havelocks sixth and Everett Rogers five can all be
clustered to Lewins three.
ROLES OF THE MANAGERS CHANGE AGENT

As a change agent, the manager identifies the problems, assesses the clients motivations
and capacities for change, determines alternatives, explores ramifications of those alternatives,
assesses resources, determines appropriate helping roles, establishes and maintains a helping
relationship, recognizes the phase of the change process and guides the client through them, and
chooses and implements techniques for planned change. Havelock indicates that change agents
facilitate planned change by being a catalyst, solution giver, process helper and resource linker.
FORCE-FIELD ANALYSIS
Lewins force field analysis provides a framework for problem solving and planned
change. Status quo is maintained when driving forces equal the restraining forces, and change
will occur when the relative strength of the opposing forces changes. Consequently, when
planning changes, the manager should identify the restraining and driving forces and assess their
strength.
Driving forces may include pressure from the manager; desire to please the manager,
perception that change will improve ones self-image, and belief that the change will improve the
situation. Restraining forces include conformity to norms, morals and ethics; desire for security;
perception of economic threat or threat to ones prestige and homeostasis; and regularly
mechanisms for keeping the situation fairly constant.
STATUS QUO
Restraining forces
Status quo
Driving Forces

Once the driving and restraining forces have been identified, the managers determine
their relative strengths. Which are the major factors toward or resisting change? Which are
important or moderately important? These might be listed in columns under driving and
restraining and ranked.

Scale: 1=little strength, 2=moderate strength, 3=important strength, 4=major strength

DRIVING FORCES
RESTRAINING FORCES
Rank
Factor
Rank
Factor
1
Pressure from manager
4
Conformity
4
Please manager
4
Security
2
Improve self-image
2
Economic threat
2
Improves situation
3
Threat to prestige
To help visualize these forces, the manager can draw a diagram, write in keywords to
identify the forces, and draw arrows toward the status quo line to represent the strength of the
forces. The longer the line, the stronger the force.
STRENGTH OF DRIVING AND RESTRAINING FORCES
Conformity

Security

Economic threat

Threat to prestige

Improve self-image

Improves situation

Restraining forces
Status quo
Driving Forces
Pressure from manager

Please manager

Next, the managers plan strategies for reducing the restraining forces and strengthening
the driving forces. Managers may do some experiential learning exercises to facilitate the change
of the group norms, explain each persons role in the change with emphasis on security, and
provide some status symbol to reduce the threat to workers identify how the change will improve
their situation. Steps should be taken to improve self-images.
CULTURAL CHANGE IN ORGANIZATIONS
In adaptive culture members of an organization supports each others efforts to identify
and solve problems. The members believe they can manage the problems; have confidence and
enthusiasm; and are receptive to change. In a dysfunctional culture members continue behaviors
that have worked in the past but no longer effective. Culture ruts occur when members do not
adapt to change and continue to function out of habit even when success is not forthcoming.
Culture shock happens when the members realizes that the organization is out of touch with its
setting, mission and assumptions.

1.
2.
3.
4.
5.

FIVE STAGES OF ORGANIZATIONAL PLANNED CHANGE (Kilmann)

Initiate the integrated program of cultural changes
Diagnose the problems
Schedule the tracks
Implement the tracks
Evaluate the results
FIVE TRACKS OF CULTURAL CHANGE

1.
2.
3.
4.
5.

Culture
Management skills
Team building
Strategy structure
Reward system

The five tracks require implementation in order to be successful. The culture track helps
explain organizational differences in decision making and actions, much as personality explain
differences in individuals. The culture track reveals the norms of the organization. It exposes
culture and helps create a new culture. Without an adaptive culture it can be impossible to make
improvements, so removing the cultural barriers has to be accomplished before proceeding to
another tract.
First, one needs to clarify the actual norms. For instance, one could ask members to list
current dos and donts. The member can then list what they want the norms to be and identify the
culture gaps. Culture gaps are often related to:
Task support - norms related to helping others, information sharing, and concern for
efficiency
Task innovation - norms related to performing new activities, trying different
approaches, and being creative
Social relationship norms about mixing business with pleasure band socializing with
coworkers;
Personal freedom norms for pleasing oneself, using self-expression, and exercising
discretion.
Culture gaps are generally largest at lower levels in the organization.
Closing the culture gaps then become an issue. If managers and associates decided than
changes should occur, they can. Adaptive cultures have internal control. Control is social reality
but not necessarily an objective one. To establish decided norms they think would lead to
organizational success.
In management skills track, manager are taught the five steps of problem management:
(1) sensing problems, (2) defining problems (3) deriving solutions (4) implementing solutions
and (5) evaluating outcomes. Next managers examine their personality types. Because one
personality type determines how one will assimilate information and make decisions, managers
should be aware of their style and the styles of associates so they can compensate for their
natural inclinations and acknowledged limitations and develop strong work teams.