2. 1. What is a change?
Change (a dynamic process in which an individual’s behavior is altered in response to a stressor)
is an inherent part of life. It is the process that causes individuals to adapt. Whether it is planned or
unplanned, change is both inevitable and constant. Change can be constructive or destructive and is
stressful to individuals because it activates the GAS.
Nurses must be able to initiate and cope with change. Proficiency in critical-thinking and
problem-solving skills is necessary to initiate positive change.
The pace of change is rapidly increasing in health care agencies, which have been changing and
continue to change in response to consumer demands. “Change is inevitable and nurses have the
qualities and a strategic position to participate actively” (Joel, 1998, p. 7).
CHARACTERISTICS OF CHANGE
• Is an inevitable part of life.
• May be eustressful or distressful.
• Can be self-initiated or externally imposed.
• Can occur abruptly or have a gradual onset with insidious progression.
• Energy is required to effect change, as well as to resist change.
2. What are the purpose of change?
3. Explain
a. Kurt Lewin’s Theory of change
A classic theory of change was developed by Lewin (1951), who stated that the change process
occurs in three stages: unfreezing, moving, and refreezing. In the unfreezing stage, the person
recognizes a need for change and becomes motivated to move in a new direction. Stage two, changing,
is the actual implementation of the change. In the third stage, refreezing, new changes are incorporated
into behavior and these new behaviors stabilize. Because the change process is dynamic, these stages
are not rigid. The process of change may quickly move through all stages, or it may become “stuck” in
one stage.
Planned change is when you put a series of actions into place to achieve a predetermined goal.
Unplanned change on the other hand has unpredictable outcomes. In nursing, Lewins change theory can
be used to bring about planned change.
Apply the unfreezing stage. The unfreezing phase of Lewins thoery is when you find a problem
that you need to solve and determine what resistance there is to creating change that will resolve the
problem. In this stage, you try to reduce the amount of resistance.
Apply the moving stage. In the moving stage of this theory, you find a solution that can resolve
the problem and bring about change, gather resources that you will need for implementation and then
put a plan into place to implement the solution.
3. Apply the refreezing stage. This is when the change is evaluated to see if it has been accepted by
the staff and if its is, it becomes a part of your establishment and is made permanent.
b. Lippitt’s Theory of Change
Lippitt's change theory is based on bringing in an external change agent to put a plan in place to
effect change. There are seven stages in this theory and they are diagnose the problem, assess
motivation, assess change agent's motivation and resources, select progressive change objects, choose
change agent role, maintain change, terminate helping relationships. This theory can be used in nursing
to effect change.
1 Diagnose the problem. In this step, the nurse leader, staff nurse or health care personnel
notices and diagnoses a problem. The need for change is then made known to other members of staff
who will be affected, so that meetings can be held to decide on how to move forward.
2 Assess motivation. Find out if those that will be affected by the change are willing to let it
happen or are opposed to it. Check to see if the change can be accomplished based on available
resources like money. Come up with solutions that will address all possible problems that may be
encountered on the road to change.
3 Check to see if the change agent can do the job. Determine if the change agent hired from
another firm has what it takes to do the job by way of stamina, experience, acceptance by the nurses
and other staff, a genuine desire to see the change project succeed and the right personality.
4 Write a plan to implement the change. The plan should contain detailed steps that include
timetables and deadlines. Responsibilities are then assigned to all parties involved in making the change
happen.
5 Determine the role of the change agent. Let everyone working on the change project know
what the role of the external change agent will be so that there will be no confusion as to what his job is,
thus preventing misunderstandings or resentment.
6 Maintain the change. In this step of Lippitts's change theory, the change project is monitored
for progress. All parties involved in the change project communicate with each other and the change
agent to update themselves on the progress of their individual tasks.
7 Terminate the helping relationship. In this stage, the external change agent is let go by
whoever hired him and supervised his work. Also, at this stage the change is made permanent by
creating rules and policies that have to be followed.
4. Explain the 3 stages of planned
change.
Planned change occurs in a three-step process:
1. Unfreezing
2. Moving
3. Refreezing
Unfreezing
During unfreezing, conditions are viewed as stable,
or “frozen.” Change begins with a felt need, a desired goal
that has not been achieved. When one individual shares a
felt need with another individual, unfreezing has begun.
During the unfreezing phase, the current condition is
analyzed critically.
4. The goal of the unfreezing phase is to clarify the present situation and make persons aware of
the need for change by creating dissatisfaction with the situation. The target of change can be attitudes,
knowledge, and/or behaviors. A change agent encourages group members to raise questions and
explore their feelings and attitudes about present conditions. When group members acknowledge their
dissatisfaction with the present situation, they begin to commit themselves to the change process. For
change to occur, a plan that maximizes driving forces and minimizes restraining forces is made.
Moving
The goal of the moving phase is to achieve the desired change. The moving phase is also known
as the changing phase because it is during this phase that the change is implemented. The moving phase
depends on the outcome of the unfreezing phase. If the equilibrium has been upset in a favorable
fashion—driving forces exceed restraining forces—then the desired change can occur. Moving ends
when the change has been fully implemented; that is, the desired change in knowledge, attitude, or
behavior has occurred. When the target has been changed, refreezing can occur.
Refreezing
The goal of the refreezing phase is stabilization of the change. The new knowledge, attitude, or
behavior learned during the moving phase must continue to be practiced until it becomes as familiar as
the one that preceded it. The change agent can help the group to refreeze by actions that help to
legitimate the change, such as providing articles for the group to read about others who have made the
same or a similar change.
Refreezing represents the end point in the change process and indicates that the change has
been fully accepted and internalized. The change agent knows that refreezing has occurred when group
members consistently demonstrate the new attitude or behavior and talk positively about it, their words
and actions being congruent. Once it has been determined that refreezing has occurred, the group’s
performance should be evaluated periodically to confirm that the planned change is indeed refrozen.
5. What are the causes of
resistance to change?
Many people tend to resist
change because of the energy required
to adapt. Conversely, energy is also
required to resist change, or to maintain
the status quo. Individuals differ in their
ability to tolerate (or even thrive on)
change.
There are no absolute
guarantees that the change activity will
lead to positive outcomes; this
uncertainty about outcomes is a major
barrier to change.
5. 6. Explain the Principles of Organizational change.
Four Principles of Organization System Change
A. Principle of Self-Creation: A human organization exists as a process of creative advancement in
which the organization ceaselessly defines itself and sustains itself.
This principle specifies the primary conditions which a human organization as a complex
adaptive system must satisfy so as to maintain its existence. This principle can be further elaborated into
three complementary rules.
A-1 Rule of Depedent Arising : The emergence of a human organization is a result contingent
upon the match of the internal systemic causes and external situational conditions.
A-2 Rule of self-discipline: To sustain its structure, a human organization must carry out the
metabolic function in a self-disciplined way.
A-3 Rule of value commitment: To justify the legitimacy of its existence, a human organization
must ensure that its value proposition is valid and is being effectively delivered all the time.
B. Principle of Binary-Mode of Existence: Human organization has two modes of existence, namely,
regular mode and transitional mode, and each has its own conditions of dependent arising and rules
of behavior.
The regular mode is suitable to the relatively stable environment. The transitional mode is
suitable to the environment that displays significant changes. Two sets of rules, each of which governs
one of the respective modes of behaviors, are identified as follows.
B-1 Rule of regular mode behavior: When in regular mode, a human organization will self-
correct, with minimum work, the perturbations caused by the environment to conserve the integrity of
its structure.
B-2 Rule of transitional mode behavior: When the external disturbance exceeds certain limits
and the existing order can no longer be restored by the regular self-correction force, then a human
organization will build up energy and prepare itself to be transformed into a new structure which will be
sustainable in the new environment.
C. Principle of Phase Transformation: The phase change process of a human organization,
macroscopically, starts from the disorganization of the old structure and finishes with the emergence
of a new structure. Microscopically, the phase change process involves a self-catalyzed quantitative to
qualitative transformation which diffuses from the level of individual constituent members to the
whole organization.
The phase transformation principle governs the behavior of a complex system when it is in the
mode of transition. The macro- and microscopic processes mentioned above can be further elaborated
as below.
C-1 Rule of macro transformation process: Once entering the transitional mode, there are two
forces competing for the governance of the organization state, namely the conservation inertia and the
transformation thrust. and there are also direct and indirect approaches to accomplish a successful
phase change. The difference between these two approaches is whether the conservation inertia has
been effectively resolved at the beginning stage of the change process.
C-2 Rule of micro transformation process: The change of the macro state of a human
organization stems from the change of behavior patterns occurring at the level of the individual
constituent member, which in turn is started from the change in his/her cognition state; then through a
process of co-evolution, such a change at the individual level will grow into a macro phase change at the
organization level.
6. D. Principle of Bifurcation: The history of a human organization is a history of bifurcation and choice
that are governed by the following two rules.
D-1 Rule of irreversibility: The bifurcation of an organization change process is an irreversible
dependent arising phenomenon, i.e., as the response of the inner causes to the altered outer conditions
reaches a certain critical level, a phase change of the organization becomes inevitable; however, which
particular one the system will choose among the bifurcated paths of evolution is contingent upon the
specific combination of the inner and outer factors at the instant of change.
D-2 Rule of inheritance: The evolution of an organization at any stage is inherited from the
system status of its previous stage.
