Change Management Using the Model by Lewin - Essay Example

?Introduction Change management has received increasing attention especially in the nursing practice. A notable area to change is the handover systemin order to improved efficiency and save both time and resources. Change is difficult for stakeholders and it takes a dedicated leadership to ensure that it happens successfully. The best model of change for this case is the Three Step Lewin’s Model. Change goes through three basic steps namely: freezing, moving and unfreezing. For change to successfully occur, the leadership should be visionary and motivate its employees towards the required direction. Principles in the practice are based on the stipulations of the NHS and other governing bodies. This paper aims to discuss change management using the Lewin’s model, improvement of the handover system in the given case as well as different types of leadership and policies affecting the practice in the UK. Transforming the bedside handover system has emerged as a means of improving neonatal care in hospitals as explained by Marshall and Coughlin (2010). The current bedside system in the hospital is bedside handover but some modifications can be made to improve efficiency. The new changes are to be based on safety of the infants, patient centred care, value added processes and team vitality. These aspects are the foundation of the change process to be used in the hospital by using the Three Step Lewin’s Model. Literature review According to Anna et al. (2011): Iles and Sutherland (2001); Murray et al (2011) and Boxwell (2010) the handover system should be focussed on the needs of the patients. Haberman and Uys (2006) agree with ANA (2011) on the nursing process and it is used to identify problems in the handover system. MindTools (2011); Cherry (2011) and Change- Management- Coach.com (2011) explain how the 3- Step Lewin’s model can be used to implement change. Cameron and Green (2004) demonstrate the importance of proper leadership in change management. Davies, Nutley and Manion (2000) and Henderson (2002) explain further on the 3- Step model and how it can be used in our case. MindTools (2011) explains the different types of leadership and how they are applied in organizations. Marquis and Huston (2003) concur with Miller (2002) that leadership is more important than management in the contemporary world. Mullins (2002): Higgs and Rowland (2000) assert that leadership varies according to situations and organizations. Burdett Trust for Nursing (2006) stresses on the importance on leadership in nursing, it should be done in accordance to the set rules and regulations in the field. Royal Nursing College (2008); RCN (2003); Department of Health (2011) and Department of Health (2009) state the policies that have been made over the years to introduce change in nursing. Studies done on the bedside handover system One of the studies concerning bedside handover was conducted in Queensland hospital in 2009. This study was done on only ten patients to find out their perspective on bedside handover. The study observed the patients’ approach to the bedside handover system (Murray et al. 2011). The participants were questioned on the advantages and disadvantages. Their current role in the system and the role played by family members and other members of the medical team. The issues arising from this study were: most patients supported the inclusive handover system, others appreciated passive engagement and others viewed it as an opportunity to correct the information being passed. From this study, we can conclude that effective bedside handover provides patients to participate in their care. Another study was conducted in Ipswich hospital where the practice had been in place for over two years. The study was conducted in three wards in a total of thirty days, thirty four nurses were interviewed. The bedside handover had worked efficiently in the hospital. The staff members interviewed had positive feelings about the system since it was introduced. This study demonstrates on the efficiency of bedside handover and it should be adopted in other hospitals and health centres (Murray et al. 2011). Work area and focus Recent studies have shown the importance of neonatal infant care in the growth and development of healthy babies. Neonatal nurses specialize in taking care of infants mainly in the first 28 days as stated by Boxwell (2010). These newborns are the most vulnerable patients and neonatal nurses require specialized skills and knowledge to take care of them. Neonatal nurses support families by focusing on their therapy and psychological needs. They also support neonatal physicians and other medical practitioners who make up the health care team taking care of the newborns. There are three levels of neonatal nurses: The first level is made up of nurses who take care of healthy infants. This form of nursing has decreased as healthy infants mostly stay with their mothers (Boxwell 2010). The second level entails nurses who take care of premature and sick infants who need constant attention. The nurses in the third level have the most responsibilities since they work in the NICU and they monitor premature and seriously ill infants around the clock. They constantly check on the incubators to ensure that the babies are well and show their parents how to take care of them. Problem identification using the nursing process The nursing process is what unifies different types of nurses working in diverse areas. The nursing process is focussed on patient centred care. The nursing process can be used to identify the loopholes in the current bedside handover system. There are five basic steps in the nursing process as stated by Haberman and Uys (2006). The first step is assessment which involves collecting data about the patient. In our case this was done accordingly. The second step is diagnosis and concerns the patient’s response to the actual and potential needs. This should be done in the presence of the patient and not away from them like in this case. The third step is planning that involves setting the goals about the patient. The handover lacks individual care planning where information is recorded in nursing notes, patient files and ward diaries. The fourth step is implementing the plan as stipulated. The last step is evaluation of the effectiveness of the nursing care and the patient’s status (ANA 2011). The handover is an important part in the communication process that takes place once a day with two shifts each taking 12 hours. This study is done on approximately 20 patients and reveals current process is long and ineffective since the information given is a lot and each nurse tends to 2 to 3 patients. This is wastage of time and resources and has financial implications on the employer due to inefficiency. According to Iles and Sutherland (2001) the handover system should place infants and their parents at the heart of all activities. The system should combine the principle of patient-client participation and involvement. In the same context, other members of the medical team should be involved in the process and they share relevant information concerning the needs and recovery progress of the infants. Theories supporting the change process There are two theories that are to be adopted as the framework for managing change. These are: Lewin’s 3- step model and Belbin Team role theory Implementing change using Lewin’s Model The three step model of unfreezing, moving and refreezing provides a useful framework for change management in this case. The three steps are discussed below: i) Unfreezing This involves encouraging nurses to think about the current system and help them acknowledge the need for change as explained by MindTools (2011). For change to take place, a sense of direction and leadership is needed as stipulated by Cameron and Green (2004). The first step involves creating awareness by communicating future changes to all relevant parties (Davies, Nutley and Mannion 2000). These include nurses, parents, the health care team and ward managers so that they have a common vision towards a better handover system. This is communicated to the relevant parties using various channels of communication including staff information (Henderson 2002). This initiates discussion among the nurses creating cognitive agreement and disagreement leading to the search for more information about the new system. The nurses are allowed to discuss different clinical situations and analyse the benefits and shortcoming of the new changes. They are later involved in a discussion to classify and give suggestions on how to deal with the problems experienced. Force field analysis This is carried out to assess the restraining and driving forces to bedside handover. The restraining forces are due to uncertainty and lack of information relating to the change process. The driving force is linked to nurses and management’s determination to ensure its implementation. (Change-Management - Coach.com 2011) ii) Moving stage This is the process of inventing and implementing change (MindTools 2011). There should be a pilot handover session to establish whether the new system works well or not. In the pilot handover sessions, observers should be present to reinforce and monitor the established set of rules step by step. At this stage the nurses are given support and clarification in the event of difficulty. iii) Refreezing stage The result should be evaluated in a staff meeting and the related parties should accept the change (MindTools 2011). At this stage all the nurses having problems with the new system are identified and the support team is given the responsibility of assisting them to understand. After this is successful, the new bedside handover system is fully operational. Implementing change using Belbin Team role theory For the change in the handover system to be successful, nurses need to perform their specific roles in the team where each team member has clear responsibilities assigned to them. In spite of this, the team may fall short of its full potential. This may be because some team members do not complete their tasks and may not be flexible enough to avert weaknesses in the team. Belbin’s theory is based on interpersonal styles and observed behaviour. He noted that people in a team are inclined to take different roles. He expressed team roles as the tendency to interrelate and behave with other people in a specific manner (MindTools 2011). This theory is used to identify the different roles played by team members in implementing the changes to improve the current system. He states the nine team roles that bring about team success as explained below: Action Oriented Roles Shapers These are people who challenge the team to improve. They are extroverts who enjoy stimulating others. They often question norms and come up with the best approaches for problem solving (MindTools 2011). Their main problem is that they are argumentative and they may hurt other people’s feelings. These are the people who encourage the other team members to embrace the change. Implementers These are the people that get things done. They take the role of turning concepts into practical actions (MindTools 2011). They are naturally conservative and disciplined and they work efficiently in the team. Their major weakness is that they tend to be inflexible and resistant to change. These people embrace the change and work in accordance to the new way of doing things and are very important in our case. Completer/Finisher These are the people who ensure that activities are completed thoroughly. They pay attention to details and ensure that there are minimum errors (MindTools 2011). They are conscious about deadlines and see to it that the job is completed on time. They are best described as perfectionists as they are quite systematic. Their major weakness is that they find it hard to delegate tasks and worry without reason. These will ensure the handover is done thoroughly and is in compliance with the stipulations of the improved system. People Oriented Roles Coordinators These are the people that take the leadership role and are referred to as the chair. They guide the team to achieve set objectives. They are good in delegation of tasks and are good listeners. Their major flaw is that they are manipulative and may delegate too much personal responsibility. The leaders should lead by example by ensuring that they act in accordance to the changes in the handover system. Team worker These are the people who ensure that the team members work coherently. They act as negotiators as they are perceptive, tactful and flexible (MindTools 2011). Their weakness is that they tend to be irresolute thus maintain uncommitted positions during decision-making and discussions. These are the people who encourage team spirit making it easy to implement change in the handover. Resource investigator These explore available options, develop contacts and negotiate for resources. They are curious, innovative and enthusiastic individuals who work with external stakeholders to help the team to achieve set objectives (MindTools 2011). On the downside, they are often too optimistic and lose enthusiasm fast. The role played by resource investigators in our case is limited. Thought oriented roles Plant These are described as creative innovators who come up with new perspectives and ideas. They are encouraged through praise and find it hard to deal with criticism (MindTools 2011). They prefer to work alone as their ideas tend to be impractical in some instances. They have poor communication and ignore rather obvious limitations. These people come up with new ideas on how to improve the current system. Specialists These are the people who have specialized skills and knowledge required to do a particular job. They take pride in theirs abilities and skills and work hard to uphold their professionalism. Their main flaw is that they may have limited contribution to the team and result to a preoccupation with technicalities at the expense of the bigger picture (MindTools 2011). The role of specialists is limited and they come in to help incase of difficulties in the implementation process. Monitor- Evaluators These are best at assessing the ideas that other team members come up with (MindTools 2011). They are objective and are good in analysing the pros and cons of the available alternatives before developing a decision. These determine whether the changes to be put into practice in the handover system are appropriate. These are the main roles in a team as explained by Belbin. In this case, the most important roles for change management include monitor-evaluators to analyze the changes in to be made in the handover system. Team workers are important as they ensure team work is maintained as the new system is put in place. Coordinators lead the change management process and ensure delegation of tasks among the team members. The completers/finishers make sure that the project is completed successfully. The implementers are the ones who actually do the job by turning the new handover system into practical actions. Management and leadership In the past, there have been debates about the difference between management and leadership. It has also been argued that a competent management runs an effective organization. Taking into account the current state of the world, organizations have come to realize that leadership is more important than management as suggested by Marquis and Huston (2003). In order for the implementation of bedside handover to succeed, a leader will motivate and encourage the nurses through team work while a manager will delegate what is to be done without participating (Miller 2002). From this it is clear that leadership is more important in the neonatal service for there is need for team work and motivation to achieve the set objectives. The various types of leadership that can be used to implement change management are explained below. Leadership styles Leadership styles are the characteristics that define leaders in organizations as asserted by Mullins (2002). It is less about the needs of the leader and more about employees. Leadership styles are not something to be changed aimlessly rather they should be changed to suit specific situations and challenges in an organization as explained by Higgs and Rowland (2000). There is no one ideal leadership style and the management should choose the effective approach that suits their organization and different situations (Cherry 2011). Popular leadership styles that can be used are explained below: i) Autocratic leadership In this form of leadership, leaders have absolute power over their employees. They delegate what should be done and how it should be accomplished without taking any input from the employees (MindTools 2011). This style is unpopular among employees and results to high levels of staff turn over and absenteeism. This style is efficient for unskilled and routine jobs. This form of leadership would be inappropriate for executing change in the bedside handover. ii) Bureaucratic leadership These leaders follow regulations rigorously and see to it that employees follow rules correctly (MindTools 2011). This leadership is appropriate for jobs involving high risks including handling cash, working with machinery and toxic substances. This form of leadership is inappropriate in such an environment that requires team work. iii) Charismatic leadership This can be described as a transformational form of leadership as leaders are energetic in their teams and are enthusiastic in driving their employees forward (MindTools 2011). The downside is that charismatic leaders tend to be the driving force and the organization may collapse if they leave. The leaderships should steer the team towards the right direction in putting the change into practise and it is suitable to implement change in the system. iv) Participative leadership or democratic leadership Here employees participate in the decision making process (MindTools 2011). However, the leadership retains the responsibility of making the final decision. This increases job satisfaction and improves people’s skills. Although this takes a longer time to get things done, the results are better in the end. This is appropriate for teamwork and when quality is important and can work well in our case. v) Laissez-faire leadership (Delegative) This is the type of leadership whereby the team members are left to work own their own (MindTools 2011). This is effective where the team members are self-motivated and highly skilled. This form of leadership is not suitable as neonatal nurses constantly need supervision. vi) People-oriented leadership This type of leadership is focussed on supporting, organizing and developing people in their teams. It is makes all stakeholders to participate and be creative. This form of leadership is applicable in our case that is centred on team spirit. vii) Servant leadership This is where any individual in the organization can lead simply by meeting the requirements of a team (MindTools 2011). This leadership can be described as democratic since the team is involved in the decision making. This is suitable for this case as to as team work is required to successfully implement change. viii) Task-Oriented leadership This is the type of leadership that focuses on getting the job done and is described as autocratic (MindTools 2011). Roles are defined and there are structures put in place to monitor and organize. However, this leadership does not support team work and suffers similar flaws as the autocratic leadership. This form of leadership is suitable in our case since tasks are allocated to specific nurses and they are held responsible if they fail to carry out their roles. ix) Transactional leadership In this form of leadership, team members obey their leaders and they accept the tasks delegated to them (MindTools 2011). The team members are paid according to their compliance and effort. The leader can practice management by exception where measures can be taken where the set targets are not achieved. This form of leadership is not practical in implementing change in the handover system. x) Transformational leadership These leaders analyse the projects that add value to the organization (MindTools 2011). This is highly effective for organizations in the contemporary world. This is the most appropriate form leadership that can be used to effect the change in the handover system. Some of the measures undertaken to improve neonatal nursing are explained below: Liberating the NHS (DOH 2008) Quality clinical leadership is acknowledged as an important factor in the provision of excellent health care and creating a culture of support and innovation in health care organizations. The current economic situation and the Liberating NHS (DOH) mean that there is need to develop leaders who can make the provision of quality health care the major objective in their organization’s strategy (Burdett Trust for Nursing 2006). This has led to changes in the NHS framework in different areas. The most significant change is to place the patients at the centre of decision making (Department of Health 2009). NHS should improve its standards, deliver value for money and improve professional accountability eventually creating a healthier nation. Quality for all (Lord Darzi) National protection agency NHS Next Stage Review by Lord Darzi was an important articulation of the past government’s plan for change in the NHS. This was published in 2008 and started the government’s plan to reform the NHS. The primary goal was to improve the quality of health care by putting nurses and other medical practitioners at the core of the change. The study is founded on reports from clinical groups and health authorities that share the same vision for change in their localities (Department of Health 2011). The main reasons for the improvement were a variety of quality indicators such as patient perceptions and measuring survival, mortality and complication rates. A percentage of trusts’ incomes were to become provisional on quality indicators. Trusts were obliged to make annual quality accounts. A formal constitution was proposed in 2001 and entailed the principles of NHS and the rights and responsibilities of the staff, patients and the staff (RCN 2003). The most important patients’ right is treatment or drug that is recommended by NICE (National Institute for Health and Clinical Excellence). Darzi’s report was widely accepted although cultural change which is an important factor in the change process is lengthy and difficulty to measure. The authority given to clinicians could be against the commitment on patient control and choice. NICE is an independent organization that is responsible for providing guidance on prevention and treatment of ill health and promotion of good health. It strengthens decision making in NHS in relation to the new interventions (Royal Nursing College 2008). Conclusion and recommendations Change management is important in transforming some aspects in organisational operations. Lewin’s model is the appropriate way of introducing change in the bedside handover system. The leadership should be involved in the change and ensure team work among employees to ensure successful implementation. The incoming nurse should conduct patients with the outgoing nurse such that near misses can be handled in time. The outgoing sister or ward manager should be the one to allocate patients to the incoming nurses since she knows the ward situation and the patients’ condition. The management should identify staffing problems and deal with them in advance. The shift coordinators should undertake their handover according to the current practice since they are responsible for all patients. Other nurses can join them once a week in their handover with the intention that all the nurses have an update on the progress of the newborns. Bottom of Form References ANA 2011, The nursing process: A common thread amongst all nurses, viewed 30 May 2011, . 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