Change Theories and Relevance in Health Care; Types of Change, Change Agents, and Models of Change.

Change Theories and Relevance in Health Care

This guide is about change theories and relevance in health care. Study it to gain insights that you can use when writing about change in health care settings.

Introduction to Change Theories and Relevance in Health Care Guide

How to properly cope with change is one of the top issues for complicated healthcare organizations. Many of the essential elements driving the push for change, whether in a clinical or hospital context, include rising healthcare costs, decreased reimbursement, labour force shortages, new technology, and the expanding older population. “As a result, modern healthcare organizations must constantly implement change in order to modernize their structure, promote higher quality, and retain their employees” (Marquis & Huston, 2017).

Healthcare businesses must make adjustments on a regular basis to improve organizational structure, patient satisfaction, and staff retention. It’s crucial to remember, however, that not every organizational transformation initiative is a success. “The substance of change, the method of change, the context of the organization, and the individuals within the organization who are participating with the change are all factors that impact the outcomes of change” (Walker, Armenakis, & Bernerth, 2007).

The goal of this study is to give background information and understanding of change theories that are used to execute change in organizational structures such as healthcare. Healthcare organizations can implement effective change to meet the demands of the ever-changing healthcare system by examining and implementing change theories such as Kurt Lewin’s models of change, Burrowes and Need’s Contemporary Adaption of Lewin’s model, complexity science and adaptive systems, and Edward Lorenz’s Chaos Theory.

This article will also cover crucial aspects of change implementation, such as the change agent. Finally, how these ideas might be applied to healthcare to aid in the implementation of effective change will be discussed. Because healthcare is always evolving, it’s critical to grasp the many theories of change, the elements that influence change, and when change is required to improve patient happiness, staff satisfaction, and sustain a successful flourishing business.

Types of Change

What are the types of change?

Change through drift and planned change are two forms of change that may be seen in companies and even in a person’s life. Prior to the mid-nineteenth century, individuals often debated whether they should interfere in a problem or allow nature to take its course (Tiffany & Johnson-Lutjens, 1998). Prior to this period, the thought was more in accordance with the change by drift technique, in which there is no control over change or effort put into it. It’s referred to as unintentional change, as opposed to planned or deliberate change.

The leader’s skills and expertise are utilized to influence and execute change inside the company throughout planned transformation (Marquis & Huston, 2017). By the 1950s, people’s attitudes on change and how it should be handled had shifted. People begin to wonder how and when to prepare for change, rather than if acting was essential to effect change.

“Progress took on a meaning that commanded the application of science in the service of humanity and said that specialists should satisfy people’s needs according to their interpretations of those needs” (Tiffany & Johnson-Lutjens, 1998). Healthcare organizations were expanding, technology was progressing, and the requirements of the patient population were expanding and changing at the same time. It was critical for these organizations to not just acknowledge the need for change, but also to develop effective actions to bring about and sustain it.

Change Agents

Who is a change agent?

A change agent is a person who is knowledgeable about the theory and execution of planned change, and their abilities may have a significant impact on whether the change is successful or not (Marquis & Huston, 2017). The change agent ensures that all parts of the organization that will be impacted by the change are balanced. The management or an internal source is often the change agent, however, external sources are employed in certain cases. Role modelling, mentorship, and facilitation are examples of positive change agent behaviours that encourage change among peers and leaders (Davis, 2017).

The change agent should be present throughout the whole change process. They will continue to provide assistance to peers who have been impacted by change as well as comment on the change’s consequences. Change is never easy, and it often elicits sentiments of accomplishment and pride, as well as feelings of loss and worry, in those who are touched.

The change agent must then apply developmental, political, and relational knowledge to cope with these sentiments. This will guarantee that people who are opposed to change do not undermine the process (Marquis & Huston, 2017). Successful change agents must be able to create connections, communicate effectively, plan and analyze change, and assume responsibility throughout implementation. It’s crucial to remember that having a capable change agent isn’t enough to make change work (Marquis & Huston, 2017).

Models of Change

John Kotter’s Model of Change

What is John Kotter’s model of change?

Dr John Kotter, an organizational science professor, is best recognized for his eight-step change model and its application to organizational transformation. He introduced the 8-step approach, which he believed was necessary for effective organizational transformation, in 1995. (Educational Business Article, 2017). Many attempts may be made to support change, but firms that follow Kotter’s approach are more likely to create an atmosphere that promotes change success.

First, if an event has happened that necessitates change, Kotter advises acting quickly. After an issue has been recognized, the next stage is to assemble a team that will enable and execute change. “In respect to organizational transformation, past research has consistently shown the role of the leader and leadership style in achieving effective organizational change” (Balogun & Hailey, 2008). This group will create a vision, which is the model’s third stage. The vision will then be communicated to all those who will be affected by the change by the team.

Empowering action is the fifth phase, in which leaders promote risk-taking and unconventional ideas and activities (Wheeler & Holmes, 2017). Following that, the change agent, team leaders, and other team members create short-term successes. These short-term victories are noticeable and encourage change to move forward. By achieving these victories, the team will be able to proceed to step seven, where they will be reminded not to give up.

To gain momentum, it’s critical to highlight positive outcomes throughout the change process. Making the change stick is the final step in the model. The change agent and team will continue to be involved to ensure that the changes are maintained and that the benefits continue to be realized (Wheeler & Holmes, 2017). This eight-step method can help organizations successfully implement change.

Kurt Lewin’s Model of Change Theory of Nursing

What is Kurt Lewin’s model of change theory?

Kurt Lewin was a German-American psychologist who is credited with being the father of contemporary social psychology. He studied group dynamics, experimental learning, and action research. Lewin’s three-phase change paradigm from the 1950s still guides how planned change is carried out today. This model explains the competing forces that seek to preserve the status quo while also pushing for change (Lewin, 1947). The three stages of change that Lewin articulated in this concept are unfreezing, mobility, and refreezing.

Unfreezing

According to Lewin and his studies, for an organization to successfully execute change, it must be planned, which necessitates the system’s unfreezing (Hussain, T.H., Lei, Akram, Haider, Hussain, S.H., & Ali, 2016). When the change agent stresses the need for change and persuades group members that change is required, the process of unfreezing begins. Because the change agent evokes such a reaction in others, this phase is commonly referred to as dissatisfaction. This allows others to realize that change is required. Internal or external dissatisfaction is required to encourage change.

It is critical for the change agent to be able to clarify conflicting priorities and underline the necessity for change to occur in order for this change attempt to be effective (Marquis & Huston, 2017). The change agent must also be able to overcome people who are resistant to change. People who resist change are more likely to be stressed and need to be comforted, putting additional pressure on the change agent. When this happens, motivation suffers (Rockwell, 2015). Instead of consoling such individuals, Rockwell proposes that the change leader should ask, “What would you want to do about it?”

Movement

The movement phase is the next stage in Lewin’s theory. The change agent is in charge of identifying, planning, and implementing effective strategies. They also make certain that the driving forces outnumber the restraints. Because change is a difficult process, it needs meticulous preparation, precise scheduling, and, if feasible, progressive implementation (Marquis & Huston, 2017).

When dealing with and appropriately responding to the increased stress felt by all those affected by the change, the importance of the change agent’s leadership skills becomes apparent. The change agent’s role in the movement phase is to provide inspiration, set goals, build trust, and make change a priority (Zenger & Folkman, 2015).

Refreezing

Refreezing is the final phase of Lewin’s theory. The goal of this phase is to integrate the change into the status quo, so the change agent must assist in system stabilization (Marquis & Huston, 2017). Change will be ineffective if this phase is skipped, and pre-change behaviours will return. During this time, the change agent must be very supportive and reinforce the adaptive efforts taking place in all affected organizational members.

“Many researchers have shown that the most important variable in terms of the success of change is people, as without people’s support, no matter how good the change program is, the change will not be successful” (Mangundjaya, Utoyo, & Wulandari, 2015).

Kurt Lewin’s change model may be used to a variety of circumstances involving the implementation of change in the healthcare context. Lewin’s Theory of Change may be used to make a change in surgical procedure to reduce the danger of post-operative infection or to assist a patient in making a lifestyle change to lose weight. Since the 1950s, this approach has aided in the advancement of healthcare reform.

Lewin’s Theory of Driving & Restraining Forces

What is Lewin’s five field force analysis?

“Force field analysis” was added by Kurt Lewin to his theory. People maintain the status quo, according to him, because of driving and restraining forces. The facilitating forces are referred to as facilitators, while the restraining forces are referred to as barriers (Marquis & Huston, 2017). Human behaviour is caused by forces, according to this part of Lewin’s theory, which can include beliefs, values, expectations, cultural norms, and life experiences.

Supervisory pressure, monetary incentives, and competitive and societal pressures may all be positive or driving elements. Restraining circumstances, on the other hand, often limit one’s capacity to adapt to change. This could be due to apprehension about change, a high price tag, or a lack of time or energy (Kaminski, 2011). When considering driving and restraining forces, the change agent must take into account a variety of factors.

This theory has numerous applications in the field of health care. The health care team and the patient should recognize both the driving and restraining forces that will affect their outcome when providing patient care and setting treatment goals. If a patient requires ongoing monitoring for a condition but faces too many obstacles, such as a lack of transportation, insurance, or the inability to miss work, the change that is required for their condition is unlikely to occur. This patient, on the other hand, may seek assistance and make the necessary changes if the clinic or hospital assisted with transportation and offered payments based on income.

How is Lewin’s Model adapted in modern health care practice?

Nina Burrowes and Adrian Needs shared a more recent adaptation to Lewin’s model in 2009. Their conversation was organized into a five-step change model (SCM). They reasoned that breaking down the change process into steps would make it easier to assess readiness for change (Burrowes & Needs, 2009). When there is no intention to change behaviour, it is called precontemplation or Stage 1.

The next stage is contemplation, in which the individual or organization considers making a change. At this point, the change agent might think about how to motivate people even more. Stage 3 is referred to as preparation, and it is during this stage that the individual intends to make a change. In stage 4, the individual takes action and actively changes his or her behaviour.

The maintenance process then moves on to the fifth and final step. The change agent ensures that the change is maintained and that relapse is avoided in the final stage. Burrowes and Needs imply that individuals who follow this model of change may spiral around several times before successful change occurs by depicting the stages of change in a cycle (Prochaska & DiClemente, 1982).

In the field of healthcare, this SCM paradigm is often employed in the rehabilitation context. “This could lead to improved selection processes for rehabilitation programs, reduced dropout from programs, more efficient use of resources, and development of interventions to improve readiness to change,” according to the researchers (Burrowes & Needs, 2009).

Bennis, Benne, & Chinn’s Theory for Effective Change

What is Bennis, Benne, and Chinn’s theory for effective change?

When it comes to behavioural methods, Bennis, Benne, and Chinn established three strategies for successful transformation in 1969. Not only must the change agent be conversant with the phases of change, but he or she must also be aware of the application of behavioural tactics to support change (Marquis & Huston, 2017). The change agent may pick the most suitable method and enhance the rate of success by being aware of the individual or group impacted by change.

The first set of behavioural strategies is rational-empirical, in which the change agent recognizes that resistance stems from the lack of knowledge of others. Because the change agent recognizes this, he or she can provide factual information about the need for change (Marquis & Huston, 2017). This strategy could be used to assist a patient in losing weight by providing information on the health risks associated with obesity as well as resources to assist with dieting.

Change in normative-reeducative tactics is effected by peer pressure. In terms of power, this approach varies from the power-coercive strategy. In the normative-reeducative technique, the change agent has no legitimate influence over others. The change agent encourages the patient’s spouse and family members to support him or her throughout this time. The change agent uses the power-coercive approach to coerce power through possessing authority (Marquis & Huston, 2017). In a power-coercive method, the change agent may offer every meal for the patient who is attempting to lose weight by controlling their menu options and forcing them to consume healthier meals.

Complexity and Complex Adaptive Systems Change Theory

What is the complexity and complex adaptive systems change theory?

Complexity science has arisen as a result of ever-changing technology and the discoveries of the subatomic universe and quantum physics. According to this view, the world is as complicated as the people who live in it (Marquis & Huston, 2017). Individual and body system behaviours, healthcare procedures, and thinking are all factors to consider while caring for a patient, according to complexity science theory (Cornforth, 2013). These variables are not only complicated and dynamic, but they are also unique to each patient, allowing for a more holistic approach to medical therapy (Cornforth, 2013).

The Complex Adaptive Systems (CAS) hypothesis is based on complexity research, and it says that the system’s underlying components are unstable, causing adjustments. CAS allows for the adaption of ambiguity during change rather than attempting to forecast change via phases of development. These adaptations are nonlinear, which means they are unpredictably and uncontrollably unpredictable (Cornforth, 2013). When it comes to healthcare organizational transformation, the emphasis should be on the micro-level rather than the macro level. It is critical for the change agent to be able to concentrate on the connections between each piece as part of this shift (Marquis & Huston, 2017).

Because treatments and objectives are dependent on numerous elements that are customized, and patient results are not always predicted, both complexity science and complex adaptive systems change theory may be particularly valuable in healthcare. It might be difficult for healthcare providers to forecast what will happen with various treatments when dealing with a patient who has many chronic conditions, but by assessing the patient’s individual symptoms and looking at the big picture, a better result should be obtained. It would be counterproductive to treat each of the patient’s diagnoses individually.

Chaos Theory

What is the chaos theory of change?

Change Theories and Relevance in Health Care
Chaos Theory

Edward Lorenz, a meteorologist in the 1960s, set out to enhance weather forecasting methods, which subsequently created the foundation for the chaos theory. What he concluded was that even modest adjustments in settings may have extremely significant consequences. Along with that, he emphasized that these changes frequently look chaotic and uncontrolled, although they are not.

The chaos theory is aimed at identifying the underlying order in what appears to be random data (Marquis & Huston, 2017). (Marquis & Huston, 2017). Chaos theory is more coherent with how change happens over a person’s lifetime. There are cycles of unpredictability and turmoil, yet stability may also occur at times (Bussolari & Goodell, 2009). (Bussolari & Goodell, 2009). In the emergency room, chaos theory is often beneficial. It might seem disorderly and chaotic, but if one individual, such as a change agent, steps in, it can be stabilized (Marquis & Huston, 2017). Despite the fact that the emergency room seems to be in full disarray, there is order.

Conclusion

The healthcare system is always changing to suit the requirements of patients in order to improve results, deliver better services at a lower cost, and boost the retention of healthcare workers. Individuals and/or organizations must examine a variety of aspects in order to implement successful change, including culture, population knowledge, if there is a genuine need for change, whether the timing is acceptable, and which change theory should be employed to get the best results.

The change agent’s abilities, expertise, and leadership will have a significant impact on the result of change implementation. The foundation for change theories was laid by Lewin’s Models of Change Theory in Nursing and Theory of Driving and Restraining Forces, which paved the way for Bennis, Benne, and Chinn’s Contemporary Adaptation, Complexity Science, CAS, and the Chaos Theory. Understanding the need for change, the theories used to execute change, the role of the change agent, and why this is essential in the healthcare context is critical for healthcare practitioners.

Frequently Asked Questions (FAQs)

1. What is the meaning of planned change?

Change through drift and planned change are two forms of change that may be seen in companies and even in a person’s life. Prior to the mid-nineteenth century, individuals often debated whether they should interfere in a problem or allow nature to take its course (Tiffany & Johnson-Lutjens, 1998). Prior to this period, the thought was more in accordance with the change by drift technique, in which there is no control over change or effort put into it. It’s referred to as unintentional change, as opposed to planned or deliberate change.

2. What is the role of the change agent?

Change Theories and Relevance in Health Care
Change Agents

A change agent is a person who is knowledgeable about the theory and execution of planned change, and their abilities may have a significant impact on whether the change is successful or not (Marquis & Huston, 2017). The change agent ensures that all parts of the organization that will be impacted by the change are balanced. The management or an internal source is often the change agent, however, external sources are employed in certain cases.

3. What are Lewin’s 3 stages of change?

  • Unfreezing
  • Movement
  • Refreezing

4. What is chaos theory in simple terms?

Edward Lorenz, a meteorologist in the 1960s, set out to enhance weather forecasting methods, which subsequently created the foundation for the chaos theory. What he concluded was that even modest adjustments in settings may have extremely significant consequences. Along with that, he emphasized that these changes frequently look chaotic and uncontrolled, although they are not.

References

  • Balogun, J. & Hailey, H.V. (2008). Exploring Strategic Change (3rd ed.) United Kingdom: Prentice-Hall.
  • Burrowes, N. & Needs, A. (2009). Time to contemplate change? A framework for assessing readiness to change with offenders. Aggression and Violent Behavior, 14 (1), 39-49. https://doi-org.lynx.lib.usm.edu/10.1016/j.avb.2008.08.003
  • Bussolari, C. J., & Goodell, J. A. (2009). Chaos theory as a model for life transitions counseling: nonlinear dynamics and lifes changes. Journal of Counseling & Development,87(1), 98-107. doi:10.1002/j.1556-6678.2009.tb00555.x
  • Cornforth, A. (2013). COPD self-management supportive care: Chaos and complexity theory. British Journal of Nursing, 22(19), 1101-1104. Retrieved from web.b.ebscohost.com.lynx.lib.usm.edu/ehost/pdfviewer/pdfviewer?vid=0&sid=6f6bda63-746e-4cb3-ad45-e6f208a58fdf@sessionmgr101.
  • Davis, C. (2017). Change agents wanted. Nursing Made Incredibly Easy, 15 (1), 4. Retrieved from https://journals.lww.com/nursingmadeincrediblyeasy/fulltext/2017/01000/Change_agents_wanted.1.aspx.
  • Educational Business Articles (EBA). (2017). Kotter’s 8 step process to successful change. Retrieved from https://www.educational-business-articles.com/8-step-process/
  • Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin’s change model: a critical review of the role of leadership and employee involvement in organizational change. Journal of Innovation & Knowledge,3(3), 123-127. doi:10.1016/j.jik.2016.07.002
  • Lewin, K. (1947). Field theory in social science. New York: Harper & Row.
  • Kaminski, J. (Winter, 2011). Theory applied to informatics – Lewin’s Change Theory. CJNI: Canadian Journal of Nursing Informatics, 6 (1). Retrieved from http://cjni.net/journal/?p=1210
  • Mangundjaya, W. L., Utoyo, D. B., & Wulandari, P. (2015). The role of leadership and employee’s condition on reaction to organizational change. Procedia – Social and Behavioral Sciences,172, 471-478. doi:10.1016/j.sbspro.2015.01.385
  • Marquis, B. & Huston, C. (2017). Organizational structure. Leadership roles and management functions in nursing (9th ed.). 308-310. Philadelphia, PA: Wolters Kluwer.
  • Prochaska, J.O. & DiClemente, C.C. (1982). Transtheoretical therapy: toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 19(3), 276-288. Retrieved from http://web.b.ebscohost.com.lynx.lib.usm.edu/ehost/pdfviewer/pdfviewer?vid=2&sid=02e202f0-6f60-4c57-8418-591a37f4ce1c%40sessionmgr120
  • Rockwell, D. (2015). 10 principles of the thorn. Retrieved from http://leadershipfreak.wordpress.com/2015/10/07/10-principle-of-the-thorn/
  • Tiffany, C. R., & Johnson-Lutjens, L. R. (1998). Planned change theories for nursing: Review, analysis, and implications (1st ed.). Thousand Oaks, CA: Sage Publications. Retrieved from http://dx.doi.org/10.4135/9781452232935
  • Walker, H.J., Armenakis, A.A. & Bernerth, J.B (2007). Factors influencing organizational change efforts: An integrative investigation of change content, context, process, and individual differences. Journal of Organizational Change, 20(6), 761-773.
  • Wheeler, T. R., & Holmes, K. L. (2017). Rapid transformation of two libraries using Kotter’s eight steps of change. Journal of the Medical Library Association,105(3), 276-281. doi:dx.doi.org/10.5195/jmla.2019.97
  • Zenger, J., and Folkman, J. (2015) 7 things leaders do to help people change. Harvard Business Review. Retrieved from https://hbr.org/2015/07/7-things-leaders-do-to-help-people-change

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