Analysis of Changes in Healthcare in Britain - Essay Example

IMPLEMENTING CHANGE IN HEALTHCARE (UK) All change involves some kind of loss. Even if one approves of a change and recognise that it is beneficial, there are often aspects of a current situation that most regret having to give up. For a start, there is the familiarity of a known location, colleagues or work practices. There may be aspects of a job or environment that were particularly satisfying. In comparison to proposed change. Change involves learning new skills, new ways of doing things, new attitudes. It means acknowledging that current skills and expertise, behaviours and attitudes are no longer adequate or appropriate. How easy is it for people to give up their belief in their own competence Sometimes the need for learning new skills is recognised formally by an organisation when it builds training events into the change programme. Change affects people in different ways, but management experts tend to agree that people go through similar stages in order to come to terms with change. From this transition from resistance to acceptance of change to move into the desired future situation would depend mainly on tow factors, available resources and the willingness to change. Some theories cane be of help to assess this. Lewin's (1951) model of change is one of the most frequently used and easily understood approaches to planning and implementing change in organizations. Many people have added their own elaborations to this model, but its basic ideas remain the same. The basic elements of Lewin's change model are unfreezing, change, and refreezing. Assuming that a work situation is basically stable before change is introduced, although some changes occur naturally, people tend to stay in the "comfort zone" meaning they are generally accustomed to each other, have a routine for doing their work, and are pretty confident that they know what to expect and how to deal with whatever problems may arise in the course of a day (Lewin, 1951, 1-23). A change of any magnitude is likely to move people out of this comfort zone into discomfort. Lewin calls this movement unfreezing. People resist change for a variety of reasons, which vary from person to person and situation to situation. Some are ready to risk change, and others seem to prefer maintaining the status quo. One change in routine provokes a storm of protest, whereas another change is hardly noticed. Resistance to change comes from three major sources: technical concerns, psychosocial needs, and threats to a person's position and power (Lewin, 1951, 35-41). Lewin suggested a way of looking at the overall process of making changes. He proposed that organizational changes have three steps. The first step involves unfreezing the current state of affairs. This means defining the current state, surfacing the driving and resisting forces and picturing a desired end-state. The second is about moving to a new state through participation and involvement (Lewin, 1951, 45-53). The third focuses on refreezing and stabilizing the new state of affairs by setting policy, rewarding success and establishing new standards. Lewin's three-step model uses the organism metaphor of organizations, which includes the notion of homeostasis. This is the tendency of an organization to maintain its equilibrium in response to disrupting changes. This means that any organization has a natural tendency to adjust itself back to its original steady state (Lewin, 1951, 57-78). Lewin argued that a new state of equilibrium has to be intentionally moved towards, and then strongly established, so that a change will persist. Lewin's model was designed to enable a process consultant to take a group of people through the unfreeze, move, and refreeze stages. For example, if a team of people began to see the need to radically alter their recruitment process, the consultant would work with the team to surface the issues, move to the desired new state and reinforce that new state (Lewin, 1951, 85-99). Lewin's ideas provide a useful tool for those considering organizational change. The force field analysis is an excellent way of enabling for instance a management team to discuss and agree on the driving and resisting forces that currently exist in any change situation. When this analysis is used in combination with a collaborative definition of the current state versus the desired end state, a team can quickly move to defining the next steps in the change process. These next steps are usually combinations of: communicating the gap between the current state and the end state to the key players in the change process; working to minimize the resisting forces; working to maximize or make the most of driving forces; and agreeing a change plan and a timeline for achieving the end state (Lewin, 1951, 101-143). This model is sometimes used by managers as a planning tool, rather than as an organizational development process. The unfreeze becomes a planning session. The move translates to implementation. The refreeze is a post-implementation review. This approach ignores the fundamental assumption of the organism metaphor that groups of people will change only if there is a felt need to do so. The change process can then turn into an ill-thought-out plan that does not tackle resistance and fails to harness the energy of the key players. Considering the needs for change in practice in nursing to live up to the demands of standards, this could be a model worthwhile considering implementation of changes in the healthcare scenario (Lewin, 1951, 112-119). In this model for change or change management, the first step involves unfreezing the current state of affairs. This means defining the current state, surfacing the driving and resisting forces, and picturing the desirable end state. The second step is about moving to a new state through participation and involvement. The third step focuses on refreezing and stabilizing the new state of affairs by setting policy, rewarding success, and establishing new standards. Clearly an organizational restructuring process could follow this model. There is a current state that needs unfreezing and a perceived end state that is required (Lewin, 1951, 112-119). The main focus, therefore, is the need to ensure that movement between the former to the latter state is as smooth and quick as necessary. The theory of forcefield analysis, the change manager examines the forces in the current situation that can hinder or obstruct change, and those that can support or drive the change forward. The forces for change may include goals and strategies for change, the people who are actively supporting it, resulting benefits to customers and to working practices, and problems with the current situation. The forces for change may include goals and strategies for change, the people who are actively supporting it, resulting benefits to customers and to working practices, and problems with the current situation (Lewin, 1951, 112-119). To manage a change, the strength of each force is assessed. If those for change are equal to those against, the result is equilibrium and nothing will change. Conversely, the forces for change may be strong where there is senior management commitment and compelling external pressures, such as the need to conform to new customer requirements. If the forces for change outweigh those against then the change can be driven forward. But if the forces against are greater than those for change, then it may not be possible to carry out the change successfully, unless you can significantly influence the forces at work (Lewin, 1951, 112-119). As a change manager, influencing these forces is part of the manager's role as a leader who should want to build up the forces for change and decrease or minimise those against change. Forcefield analysis helps the manager to see where he or she can most usefully focus his/her efforts (Lewin, 1951, 112-119). People are considered among the forces considered in a forcefield analysis. One needs to have people on your side so it is worth considering their position and perspective in more detail. Some resistance to change is based on concerns about whether the proposed change itself is a good idea. In some cases, these concerns are justified. According to Maslow (1970), human beings have a hierarchy of needs, from basic physiological needs for oxygen, fluids, and nutrients to the higher-order needs for belonging, self-esteem, and self-actualization. Maslow observed that the more basic needs must be at least partially met before a person is motivated to seek fulfillment of the higher-order needs (Maslow, 1970, 35-49). Change can make it more difficult for a person to meet any or all of these physiological and psychosocial needs. For example, if a massive downsizing occurs and a person's job is eliminated, fulfillment of virtually all of these levels of needs may be threatened, from having enough money to pay for food and shelter to opportunities to fulfill one's career. In other cases, the threat is more subtle and may be harder for the leader or manager to anticipate. For example, an institution-wide evaluation of the effectiveness of the advanced practice role would be a great threat to a staff nurse who is working toward accomplishment of a lifelong dream of becoming an advanced practice nurse in gerontology. Status, power, and influence, once gained within an organization, are hard to give up (Parker & Gadbois, 2000, 466-473). This applies to people anywhere in the organization, not just those at the top. In organizations, empowerment is a source of motivation and satisfaction for most people. Although change can empower people, it can also threaten their sense of empowerment, especially when they feel that the change was imposed on them and that they had no choice in the matter. Resistance may be active or passive. Active resistance can take the form of attacks or outright refusals to comply (Kotter, 1990, 101-111). Passive approaches use avoidance: canceling appointments to discuss implementation of the change, being "too busy'' to make the change, refusing to commit to changing or agreeing to it but doing nothing to change, and simply ignoring the entire process as much as possible. Once resistance has been recognized, action can be taken to lower or even eliminate it. A great deal can be done to lower people's resistance to change. Strategies fall into four categories: information dissemination, disconfirmation of currently held beliefs, provision of psychological safety, and by command (Heifetz and Laurie, 1997, 124-134). To analyse the resistance from people in an organisation, stakeholder analysis is an accepted procedure, and this is a technique for examining the relative power and influence of each stakeholder group, the impact of change on them, their likely response and expectations from the change. An analysis of stakeholders will help you build an understanding of the people affected by a change (Guilfoyle, 2005, 101-124). An organisation's stakeholders are all the people and groups that have a stake or interest in the organisation. The leader is to choose a perspective from which to analyse stakeholders, depending on the type of change the manager is seeking to lead. The first step in stakeholder analysis is to identify the stakeholders. These are the people and groups who have an interest in or are affected by the work the manager is on to. Force field analysis would analyse the stake holders by identifying the key stakeholders, recognising how each of the stakeholders would be affected by the stated change, pinpointing their interest in the change (Goleman, 2000, 78-90), predicting their expectations from the change and the extent of their loss or gain by the change, and assessment of power they possess over the purpose and goals of the change and over the way the change is planned and implemented. Such an analysis will show the leader who is likely to support the change, who is likely to resist it and why. It highlights the range of interests that may be concerned with the change and who has most power to affect its formulation and outcome (Kanter, 2002, 47-59). However the analysis of the manger happens to be based on his own judgment and experience. This is valuable bit not entirely reliable. It is better to review the assumptions and conclusions by talking to people and finding out what they say about their concerns. With gain of more information, it is better to modify the analysis and make necessary adjustments (Hailey, V H and Balogun, 2002, 153-179). The leader's assessment about what different people expect from the change process and the resultant changed situation would help the leader to plan how to satisfy different and sometimes competing interests. Obviously, such an analysis would facilitate planning of the approach to overcome resistance and build on support. As a starting point, it is important to make sure to address the stakeholders' particular interests in the way the leader communicates with them. Appealing to the interests and viewpoints of others is key to any form of negotiation or persuasion (Curtis and White, 2002, 15-20). Much resistance is simply the result of misunderstandings about a proposed change. Sharing information about the proposed change can be done on a one-to-one basis, in group meetings, or through written materials distributed to everyone involved using print or electronic means. Leaders often can take action that provides a catalyst for change (Carney, 2002, 206-211). Simply providing information is often persuasive enough to lower resistance to change when people are reluctant to give up their current beliefs, opinions, or comfortable routines. When this happens, providing evidence that what people are doing or believing is inadequate, incorrect, or inefficient can increase their willingness to change. When a proposed change threatens the basic human needs of individuals or groups of individuals in some way, resistance can be lowered by reducing that threat, leaving people feeling more comfortable about the proposed change. Each situation poses different kinds of threats and requires different actions to reduce these threats. This can be achieved through many strategies. The leader needs to point out the similarities between the old and the new procedures (Bullock and Batten, 1985, 383-412). The change manager would need to express approval of people's concern for providing the best possible care, and following recognition of the competence and the skill of the people involved, if possible the manger needs to provide assurance that no one would lose his or her position because of the change. The leader has also the responsibility to suggest ways in which the change can provide new opportunities and challenges and means to increase self-esteem and self-actualization. To effect a change, the change manager would express his valuing of each individual's and group's contributions in general and to the proposed change. This would ensure involvement of as many people as possible in both the design of the change and implementation. Perhaps the most important acumen of the leader is to provide opportunities for people to express their feelings and ask questions about the proposed change and based on these to Allow time for practice and learning of any new procedures, if possible, before a change is implemented. This would provide a climate of acceptance in which some mistakes can be made without negative consequences for individuals. When all these preceding are done within a climate of trust and acceptance of each other's differences, much of resistance can be overcome, and changes are far easier to implement (Bridges and Mitchell, 2002, 47-59). Analysing the possible reactions to change provides clues about how best to support people who are facing change, and how to manage the change so that they are able to adapt and accept it. For example, those who are angry, are unlikely to be ready to listen to any plans for the change, and such an approach only deepens a person's negative reaction. By responding sensitively to people the leader or the agent can help them to tackle their concerns about change and move through these stages (Lipman-Blumen, 2002, 89-101). In the stage of anger and denial, the essential leadership skills will tend to deal with high emotions and will deploy a strategy to make them listen. The leader would need classically to listen to individual concerns of the team members and would acknowledge and understand feelings. With patience, the leader needs to explain why change is needed in order to dissipate the pressures for change and to explain what the change is designed to achieve. In the stage of defiance and defense, people put forward objections and reject the change, may be due to some flawed thinking. The leader needs to listen carefully and counter objections. The successful leader would confront false assumptions and irrational fears in a sensitive manner and at the same time would provide information about the change and be honest and open about what it will mean. It is important to start to talk about planning to show that the change is going to happen (Rafael, 2000, 336-344). To achieve cooperation in this stage, the leader must listen to individuals with due acknowledgement of losses and difficulties that concern individuals. The change agent would challenge unfounded fears and misconceptions of the team members with rumours put down. This can be effectively done by explanation of the purpose and reasons for the change. The leader would better explore the benefits of the change for the individuals with an attempt to show what the future will look like for the organisations and for individuals and then involve the team members in mapping the process of making the change. In the next stage, people would start to explore what the changes mean for them, and the change agent and change leader would need to provide information and support, and encourage people to become involved in thinking through the implications of the change. This is possible only by giving people control over the change in this area. To deal with such reactions, the leader need to ensure understanding, provide information, be looking into the future rather than dwelling on the past, encourage participation, support the team members, encourage problem solving, and seek views and feedbacks (Weiner, Amick, and Lee, 2008, 379-436). Conclusion: Leading a change when a change is indicated and judicious is a matter of management skills. Any change leads to opposition due to many reasons, and these reasons are valid. Applying the principles of change management and with a change plan in place, the leader or the change agent can encounter these resistances in a manner that can be conducive to the change where all the team members would be eventually acting as partners in the change process (Tappen, 2001, 35-51). The strategies involved in such process depend on the reactions of the individuals undergoing the change, and the effective application of such changes can only be made when the agent is aware of the factors involved in the process of reactions and resistance to changes. Reference List Bridges, W and Mitchell, S (2002) Leading transition: a new model for change, in On Leading Change, ed F Hesselbein and R Johnston, pp 47-59 , Jossey-Bass, New York Bullock, R J and Batten, D (1985) It's just a phase we're going through, Group and Organization Studies, 10 (Dec), pp 383-412 Carney, M., (2002). The management of change: using a model to evaluate the change process. 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