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Change Theories

Change Theories

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Change Theories

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Developing Effective Teams

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what's covered
This lesson will cover two theories related to change in the healthcare environment. Specifically, it will cover:
  1. Kotter’s Change Model
  2. Institute for Healthcare Improvement (IHI) Psychology of Change Framework
  3. Reflect

1. Kotter’s Change Model

Professional literature is full of change theories. For the purposes of this course, two will be discussed in detail. The first theory is Kotter’s Change Model. Although not frequently used as a framework for nursing or healthcare-related change initiatives, Kotter’s change model:

  • Has demonstrated effectiveness as it is clear and easy to apply to practice
  • Uses graphics that staff nurses can understand
  • Is clear and easy to apply
  • Presents a structure to address system change designed to address patient safety-related issues (Small, Gist, Souza, Dalton, Magny-Normilus, & David, 2016; Beverly, 2016; Aziz, 2017)
Kotter’s Model (2012) consists of eight steps. These steps are:

step by step
  1. Create urgency
  2. Form a positive coalition
  3. Create a vision for change
  4. Communicating the vision
  5. Empower action
  6. Create quick wins
  7. Build on the change and don’t let up
  8. Make the change stick

8 Step Kotter Model of Change

8 Step Kotter Model of Change

2. IHI Psychology of Change Framework

The other change theory is IHI Psychology of Change Framework, which consists of five interrelated domains of practice that can be used by organizations to promote and sustain change (Hilton & Anderson, 2018). These domains are:

  • Unleash Intrinsic Motivation
  • Co-Design People-Driven Change
  • Co-Produce in Authentic Relationship
  • Distribute Power
  • Adapt in Action
According to the authors, the domains can be used in any order. The key to success in using this model (Figure 1) is to tap into the power of people (Hilton & Anderson, 2018).

IHI Psychology of Change Framework

IHI Psychology of Change Framework

Figure 1. IHI Psychology of Change Framework. By Hilton K, & Anderson A, 2018. Copyright 2018 by Institute for Healthcare Improvement.

big idea
Both Kotter and IHI’s models recognize the need to overcome resistance to change, drive action by creating a sense of urgency for the change, engage people in the change-related activities, measure and monitor progress and sustain the change by focusing on its impact. Data is important to all aspects of these change frameworks.

Video Transcription

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Thomas is a nursing unit manager at a community hospital. Recently, he noted an increase in drug administration errors in the unit. As a result, Thomas decided to review the staffing and assignment data and compared them with the rate of the errors. Data analysis revealed that drug administration mistakes occurred most frequently on weekends when the unit is typically understaffed. This discovery created a sense of urgency to adjust the nursing staff schedule.

The health system is transforming constantly due to various triggers such as the use of technology and social media, consumerism, government regulations, and differences in disease patterns. Meanwhile, nurses are expected to adhere to these changes and improve the quality of patient care. Changes are usually encountered with fear and anxiety. And thus, nurse managers like Thomas have to understand the underlying psychology of change in order to guide their team through them.

The Institute for Healthcare Improvement or IHI's psychology of change framework is an approach to advancing and sustaining improvement in health care. The framework is organized through five interconnected domains. According to the framework, Thomas has to unleash the nursing staff's intrinsic motivation for this shared purpose. Intrinsic motivation means doing something for the inherent satisfaction that it provides without expecting an extrinsic reward or recognition.

Thomas has to help them see how increasing the nursing staff during the weekends and decreasing the number of patients assigned to each nurse will reduce errors. Understanding the value of the change will generate greater engagement and commitment.

In addition, Thomas has to co-design the change along with his colleagues. The people who are affected the most should have input on the changes being made. Another key domain in the framework is co-producing in an authentic relationship, which means building an environment where people are encouraged to express their thoughts. Thus, in our case, Thomas has to listen to his colleagues' concerns about the change and discuss possible solutions.

In addition, it is essential to distribute the power so that each team member's full potential is applied in order to create the best possible outcome.

Back to our case. After listening to the feedback and discussing his plan, Thomas adjusted the schedule so that the entry-level nurses share weekend shifts with more experienced nurses that can show them how to administer drugs correctly.

Finally, it is also important to adapt in action. Thomas should urge the team to follow the new schedule and share their stories of failure and success. He should also keep track of their progress and provide them with both positive and negative feedback.

3. Reflect

As a nurse manager, you have been tasked with implementing a new shift-to-shift hand-off communication process.

Using either Kotter’s Change Model or the IHI Psychology of Change Framework as a foundation for your project, describe your plan to initiate, implement, and evaluate the hand-off communication process.

Please consider using data to create a sense of urgency. Remember you have a variety of sources to gather data. Talk about how you will engage your staff in the plan, and how you will evaluate the success of the implementation.

Authored by Anne E. Lara, Ed. D., MS, RN, CPHQ, CPHRM