Managing Change and Innovation

PRESENTED BY:

ANNE MARJORIE I. FUTALAN, RN

Learning Objectives:
At the end of the report, the learners shall be able to: define what is change. identify the forces of change. differentiate the views of the change process. discuss organizational inertia and resistance to change. enumerate the techniques for managing change. be aware of the contemporary issues and know how to manage change. distinguish ways in stimulating innovation.

What is Change?
NOTHING IS PERMANENT BUT CHANGE. - HERACLITUS (C. 500 BC)

 managing change and innovation did not always fit comfortably together. Thats not surprising. Managers are people who like order. They like forecasts to come out as planned. In fact, managers are often judged on how much order they produce. Innovation, on the other hand is often a disorderly process. Many times, perhaps most times, innovation does not turn out as planned. As a result, here is tension between managers and innovation. -Lewis Lehro (about the first years at Minnesota Mining and Manufacturing)

 I cant understand why people are frightened of new ideas. Im frightened of old ones. - John Cage

Change fosters growth and innovation; progress cannot occur without change. The ability to create and manage meaningful change is an essential skill for nurses in the 21st century. If nurses are to be leaders of change, it is imperative that they understand the changes occurring in the health-care arena, use political clout to have a hand in the changes, and master the change process. - Rebecca A. Jones

Change
Means to be different, to cause to be different or to

alter Process of making something different from what it was Is inevitable, if not always welcome Is necessary for growth, although it produces anxiety and fear May be personal or organizational Can occur suddenly or incrementally Can be macro or micro change May be planned or unplanned

Unplanned Change
Also called reactive change, accidental change or

change by drift Usually occurs suddenly and in response to some event or set of circumstances For example: an unanticipated rise in patient census may precipitate the need for a change in patient assignments. Decisions are made and change follows as a reaction to an event.

Planned Change
Entails planning and application of strategic actions

designed to promote movement toward a desired goal

Deliberate and proactive

For

example, changing staffing patterns from extensive use of unlicensed personnel to an allprofessional staff requires time and planning.

Planned Change
More likely to occur incrementally, over time Responds to anticipated events in the environment

or community
Deliberate application of knowledge and skills by a

leader to bring about a change

Change Agent
One who generates ideas, introduces the innovation,

and works to bring about the desired change A person skilled in the theory and implementation of planned change One who works to bring about a change
In organizational planned change, the manager is

often the change agent

Change Agent
The individual or group that seeks to lead change May be from inside or outside the organization May have formal lines of authority or may be

informal leaders In either case, the change agent is responsible for moving those affected by the change through the process and implementing the change.

Change Agent
Effective change agents are masters of change.

They do three things correctly: 1. they sense the right moment to initiate the plan, 2. they find supporters for their ideas, and 3. they have vision (Bruning, 1983).

Change Agent
The successful change agent earns the respect and

trust of the target system (individuals, groups, or organizations) by communicating openly and honestly, offering assistance, and demonstrating ability.
A change agents success depends on communication

style, interpersonal skills and expert power. Ongoing communication is integral to the role of the change agent.

Roles of the Change Agent

VISIONER Communicator Advisor Coach Provider of Feedback FACILITATOR Challenger Advocate Educator Empowerer IDEA PERSON Problem Solver Objective Observer Resource Linker Problem finder

Forces of Change
INTERNAL OR EXTERNAL DRIVING AND RESTRAINING

Internal Forces vs. External Forces

Internal Forces Stem from within the organization Include organizational values and beliefs, culture and past experiences with change External Forces Come from outside the organization Can be social influences, economic factors, or legislation

Driving Forces vs. Restraining Forces

Lewin theorized that people maintain a state of

status quo or equilibrium by the simultaneous occurrence of both driving forces (facilitators) and restraining forces (barriers) operating within any field.

Driving Forces vs. Restraining Forces

Driving forces Advance/push a system toward change Facilitate change because they push participants in the desired direction Include a desire to please ones boss, to eliminate a problem that is undermining productivity, to get a pay raise, or to receive recognition

Driving Forces vs. Restraining Forces

Restraining Forces Pull away/impede a system from change Impede change because they push participants in the opposite direction Include conformity to norms, an unwillingness to take risks, and a fear of the unknown

Driving Forces vs. Restraining Forces

Lewins model maintained that for change to occur,

the balance of driving and restraining forces must be altered. The driving forces must be increased or the restraining forces decreased.

Views of the Change Process

LEWINS FORCE FIELD MODEL

LIPPITTS PHASES OF CHANGE

HAVELOCKS MODEL ROGERS DIFFUSION OF

INNOVATIONS

LEWINs Force Field Model

Lewins (1951) change strategies fall within his threestep process: 1. Unfreezing occurs when the change agent convinces members of the group to change or when guilt, anxiety, or concern can be elicited. 2. Movement occurs when the change agent identifies, plans, and implements appropriate strategies ensuring that driving forces exceed restraining forces. 3. Refreezing occurs when the change agent assists in stabilizing the system change so that it becomes integrated into the status quo.

Kurt Lewins Model

UNFREEZING CHANGE REFREEZING

COMFORT ZONE

DISCOMFORT ZONE

NEW COMFORT ZONE

LIPPITTs Phases of Change

Lippitt and colleagues (1958) extended Lewins

theory to a seven-step process and focused more on what the change agent must do than on the evolution of change itself.
They emphasized participation of key members of

the target system throughout the change process, particularly during planning. Communication skills, rapport building and problem-solving strategies underlie their phases.

LIPPITTs Phases of Change

1. Diagnose the problem. - Involve key people in data collection and problem solving. 2. Assess the motivation and capacity for change. - What are the financial and human resources constraints? - Are the structure and function of the organization conducive to changes? - What are the possible solutions, and which are preferred?

LIPPITTs Phases of Change

3. Assess the change agents motivation. - This assessment is important. - Consider the change agents own commitment to change, energy level, future ambitions, and power bases. - Starting a change and dropping it midstream can waste valuable personal energy and undermine the confidence of colleagues and subordinates.

LIPPITTs Phases of Change

4. Select progressive change objects. - Develop the action plan, evaluation criteria, and specific strategies. 5. Choose a change agent role. - The change agent can act as cheerleader, expert, consultant or group facilitator. - Whichever role is selected, all participants should recognize it so expectations are clear.

LIPPITTs Phases of Change

6. Maintain the change. - Communication, feedback, revision, and coordination are essential components of this phase. 7. Terminate the helping relationship. - The change agent withdraws from the selected role gradually as the change becomes institutionalized.

HAVELOCKs Model
Havelock (1973) described a six-step process also a modification of Lewins model. Unfreezing a. Building a relationship b. Diagnosing the problem c. Acquiring resources Moving d. Choosing the solution e. Gaining acceptance Refreezing f. Stabilization and self-renewal

ROGERS Diffusion of Innovations

1. Knowledge. The decision-making unit is introduced to the innovation and begins to understand it. 2. Persuasion. A favorable (or unfavorable) attitude toward the innovation forms. 3. Decision. Activities lead to a decision to adopt or reject the innovation. 4. Implementation. The innovation is put to use, and reinvention or alterations may occur. 5. Confirmation. The individual or decision-making unit seeks reinforcement that the decision was correct. If there are conflicting messages or experiences, the original decision may be reversed.

Comparison of Change Models

Lewin
1. Unfreezing 2. Moving 3. Refreezing

Lippitt
1. Diagnose problem 2. Assess motivation 3. Assess change agents motivations and resources 4. Select progressive change objects 5. Choose change agent role 6. Maintain change 7. Terminate helping relationships

Havelock
1. Building a relationship 2. Diagnosing the problem 3. Acquiring resources 4. Choosing the solution 5. Gaining acceptance 6. Stabilization and self-renewal

Rogers
1. 2. 3. 4. 5. Knowledge Persuasion Decision Implementation Confirmation

Emerging Models of Change

Senges Five Disciplines of Learning Organizations

Discipline 1: Personal

Developing and clarifying a

Mastery Discipline 2: Mental Models

Discipline 3: Building

Shared Vision
Discipline 4: Team

Learning Discipline 5: Systems Thinking

personal vision Building an internal picture of the world; the lens through which the world is viewed Translating personal vision into a collective vision and developing a culture of common caring Fostering shared, participative decision making Shifting from fragmentation to holism

Chaos Theory
Chaos actually has an order. Changes that seem to occur at random are, in reality,

the result of a complex order.

Complex systems give rise to complex and

interrelated behaviors.

Organizational Inertia and Resistance to Change

Organizational Inertia
is the tendency of a mature organization to continue

on its current trajectory.

tendency to remain in the same state rather than to

move toward change.

Organizational Inertia
two elements - resource rigidity and routine rigidity

1. Resource rigidity - stems from an unwillingness to invest - relates to the motivation to respond 2. Routine rigidity - stems from an inability to change the patterns and logic that underlie those investments - relates to the structure of that response.

Organizational Inertia

In the face of rapid or discontinuous external change,

it is the organizational inertia that must be overcome if an organization is to survive.

Overcoming Organizational Inertia

Threat perception in organizations experiencing

discontinuous change is often thought to be the impetus necessary to prompt organizational change, a change in inertia, by decreasing the current inertia through changes in resources and routines.
While threat perception is a response catalyst, it has

been found to decrease inertia in some cases, a good thing, but increase inertia in other cases.

Resistance to Change
Resistance almost always accompanies change

because change alters the balance of the group.

Today, resistance is recognized as a natural and

expected response to change.

The level of resistance depends on the type of change

proposed.

Resistance to Change
Nursing leaders also must recognize that

subordinates values, educational levels, cultural and social backgrounds, and experiences with change (positive and negative) will have a tremendous impact on the degree of resistance. It is easier to change a persons behavior than an entire groups behavior. It is easier to change knowledge levels than attitudes.
All major change takes time.

Resistance to Change
Pesut (2000) classifies individuals in response to their propensity to seek change:
Crusaders are change agents who see problems in

the present and want to make things better for the future.
Tradition bearers are the preservers of what is best

from the past and the present.

Sources of Resistance
Technical Concerns Psychosocial Needs Threat to persons Position and Power Perhaps the greatest factor contributing to the

resistance encountered with change is lack of trust between the employee and the manager or the employee and the organization.

Recognizing Resistance

ACTIVE Attacking the idea Refusing to change Arguing against change

PASSIVE Avoiding discussion Ignoring the change Refusing to commit to the change Organizing resistance of other Agreeing but not acting people

Recognizing Resistance
Statements of Resistance: We tried that before. It wont work. No one else does like that. Weve always done it this way. We cant afford it. We dont have the time. It will cause too much commotion. Youll never get it past the board.

Recognizing Resistance
Statements of Resistance: Lets wait a while. Every new boss wants to do something different. Lets start a task force to look at it; put it in the agenda.

Positive Aspects of Resistance

Encourages sharper focus and problem-solving Prevents the unexpected. Forces the change agent to clarify information, keep

interest level high and establish why change is necessary A stimulant as much as it is a force to be overcome Motivates the group to do better what it is doing now, so that it does not have to change

Negative Aspects of Resistance

If it persists beyond the planning stage and well into

the implementation phase Wears down supporters Redirects system energy from implementing the change to dealing with resisters Morale can suffer.

Recognizing Resistance

Open resisters are easier to deal with than closet

resisters. Look for nonverbal signs of resistance, such as poor work habits and lack of interest in the change. Once resistance has been recognized, action can be taken to lower it or even eliminate it.

Lowering Resistance
Information dissemination Disconfirmation of currently held beliefs Provision of psychological safety

Command

Techniques for Managing Change

Three classic strategies for effecting change in others were described by Bennis, Benne and Chinn (1969).

Rational Empirical Strategy

the power ingredient is knowledge (using current

research as evidence to support change) and reason change agent assumes that resistance to change comes from lack of knowledge and that humans are rational beings who will change when given factual information documenting the need for change (justification) and in their self-interest used when there is little anticipated resistance to the change or when the change is perceived as reasonable

Normative - Re-educative Strategy

Power ingredient is skill in interpersonal

relationships Takes into account social and cultural implications of change Based on the assumption that group norms are used to socialize individual Requires winning over those affected by the change Success is often relationship-based

Power - Coercive Strategy

Based on the application of power by legitimate

authority, economic sanctions, or political clout and control Change agent orders change and those with less power comply Useful when a consensus is unlikely despite efforts to stimulate participation by those involved, when much resistance is anticipated, time is short and the change is critical for organizational survival

Power - Coercive Strategy

very effective for legislated changes Changes accomplished using this strategy are usually

short-lived if people have not embraced the need for the change through some other mechanism.

BARRIER
Desire to remain in our comfort zone. Inadequate access to information. Lack of shared vision. Lack of adequate planning. Lack of trust.

STRATEGY
Rational-empirical Rational-empirical Normative-re-educative Rational-empirical & Normative-re-educative Rational-empirical & Normative-re-educative

Resistance to change.

Normative-re-educative

Poor timing or inadequate time planned. Good timing Fear that power, relationships, or control Normative-re-educative will be lost Even when change is desirable, the amount of personal energy required for the change to occur is doomed to be great. Good timing

Contemporary Issues and Managing Change

MANY FORCES ARE DRIVING CONTEMPORARY HEALTH CARE.

Contemporary Issues
Rising health care costs

- External pressure exerted by federal and state governments, insurance companies, employees, labor unions and the public to control spending and redirect health care from expensive inpatient care to more cost-effective outpatient care
Declining reimbursement

- major payors of health care are pressuring for better management of resource consumption

Contemporary Issues

Workforce shortages

Increasing technology
Information availability Growing elderly population

Contemporary Issues
Burritt (2005) suggests that these dynamic forces

have led to a progressive destabilization in some health care organizations to such an extent that they threaten viability.
The reality then is that todays health care agencies

are continually instituting change to upgrade their structure, promote greater quality, and keep their workers.

Contemporary Issues
Today,

most health care organizations find themselves undergoing continual change directed at organizational restructuring, quality improvement, and employee retention.

Changing context of nursing practice

Traditional Realities
Emerging Realities

Institutionally based

Mobility based or

care Process oriented Procedurally driven Based on mechanical and manual intervention

multisettings Outcome driven Best practice oriented Emphasized by technology and minimally invasive intervention

Changing context of nursing practice

Traditional Realities
Emerging Realities

Provider driven

User driven

Treatment based
Reflective of late stage

Health based
Geared for early

intervention Based on vertical relationships

intervention Based on horizontal clinical relationships

Stimulating Innovation

INNOVATION
The introduction of something new Result of creativity In nursing service organizations, it is the key to

survival and growth in nursing and health care A way to gain personal satisfaction, rewards and recognition while organization survives, thrives and prospers Ex. Brgy. Tanod Program/System; NBS (Piso sa Bata)

Climate for Creativity

Provide intellectual environment giving employees

recognition, prestige and opportunities to participate

Support sense of ownership and commitment in

planning work and decision making

Inspire,

show confidence, give praise, support, nurture and have patience

Ways to Promote Creativity

Assist in developing new ideas Encourage

risk-taking while buffering resistant

forces Provide time for individual effort Provide opportunity for professional growth Encourage interaction with others outside the group Promote constructive intragroup and intergroup competition

Learning Exercises:

Making Change Possible

Identify a change that you would like to make in your personal life (such as losing weight, exercising daily, or stopping smoking). List the restraining forces keeping you from making this change. List the driving forces that make you want to change. Determine how you might be able to change the status quo and make the change possible.

Learning Exercise:

What Is Your Attitude Toward Change?

How do you typically respond to change? Do you embrace it? Seek it out? Accept it reluctantly? Avoid it at all cost? Is this behavioral pattern similar to your friends and that of your family? Has your behavior always fit this pattern, or has the pattern changed throughout your life? If so, what life events have altered how you view and respond to change?

References:
BOOKS: Jones, Rebecca A. (2007). Nursing Leadership and Management: Theories, Processes and Practice, International Ed. Philadelphia, PA: F.A. Davis Company. pp. 167-181. Marquis, Bessie L. & Carol J. Huston. (2009). Leadership Roles and Management Functions in Nursing: Theory and Application, 6th Ed. Philadelphia, PA. Lippincott Williams & Wilkins. pp. 166-180. Sullivan, Eleanor J. & Phillip J. Decker. (1997). Effective Leadership and Management in Nursing, 4th Ed. CA, USA: Addison Wesley Longman, Inc. pp. 265-281. Tappen, Ruth M. Weiss, Sally A. & Diane K. Whitehead. (2001). Essentials of Nursing Leadership and Management, 2nd Ed. Philadelphia, PA: F. A. Davis Company. pp. 111-119.

References:
INTERNET:
Innovation. Retrieved Aug. 12, 2011 @ 6:00 PM. Available: http://innovationzen.com/blog/2006/ 11/17/the-definition-of-innovation/. Organizational Inertia. Retrieved Aug. 12, 2011 @ 6:10 PM. Available: http://createadvantage.com /glossary/organizational-inertia.