How Do We Manage Change?

1. Change Management

Change management is essential for nursing leadership in order to promote organizational progress and visionary thinking. It is also by managing change that leaders can mitigate stress for not just their staff, but also for themselves. While much of this change management is supported at the C-suite level, it is important for nurse leaders at all levels to understand how to support themselves and each other in managing change.

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2. Lewin’s Change Management Model

One change management theory that has been found to be very effective in the healthcare setting is the theory of Kurt Lewin, the father of social psychology. Lewin theorized a three (3) stage model of change:

1. Unfreezing
2. Changing
3. Refreezing

When using this model, staff are required to replace or reject prior learning. In order to do so in a less stressful way, following Lewin’s model is very effective in mitigating stress.

2a. Unfreezing
Unfreezing involves identifying a way of helping staff let go of “the way we have always done things” or, the old pattern of work production that was often counterproductive. This stage is necessary so that staff can overcome the strains of individual resistance and group conformity.

There are three methods that can lead to the accomplishment of unfreezing:

1. Increase the driving forces that direct behavior away from the status quo.
2. Decrease the restraining forces that negatively affect the movement from the status quo.
3. Find a combination of the first two methods that leads to staff letting go of the “way it used to be.”

While some changes are necessary due to things like electronic medical records, new technology or new equipment, some changes come about because of fluctuations in organizational structure or workflow. Certainly, providing nurses ways to become vested in the organization will increase the odds of success.

Some other helpful ways of helping staff see the need to move beyond the status quo are:

• Identifying both official and unofficial leaders of the unit and involving them in the change.
• Providing staff with the reasons for the change especially emphasizing how the change will benefit both the nurse and the patient.
  
  

2b. Changing
The change stage, which is also called “moving to a new level” or “movement,” involves a process of change in thoughts, feeling, behavior or all three, that is in some way more liberating or more productive. It can be assumed that now that the staff is welcoming to change, implementing the change will be well-received. It is always important to emphasize how the change addresses the mission and vision of the institution and how, once implemented, patient care and patient outcomes will improve.

2c. Refreezing
The refreezing stage consists of establishing the change as the new way of doing things so that it now becomes the “standard operating procedure.” Without this final stage, it can be easy for the nurse to go back to old habits. In fact, research supports that it takes 28 days for a new practice to become a habit. During this stage, it is important that rounding takes place to ensure that changes are being implemented according to protocol and consistently. If gaps in implementation are identified, education can be provided to support the new, changed behavior.

Authored by Elsie Crowninshield, RNP, DNP, CCRN, NE-BC and Adele Webb, Ph.D., RN, FNAP, FAAN

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