Change Theories in Nursing - Case Study Example

Change Theories in Nursing: A Case Study Introduction The contemporary healthcare environment is undergoing tremendous changes especially in view of the fact that technological advancements are being gradually integrated into medical practice with special emphasis to nursing. Nurses are constantly required to acclimatize to new approaches, which variously challenge them as they incorporate the new technologies into their jobs. The Implementation of change sometimes creates a form of anxiety. Nurses may be required to use equipment with which they are unfamiliar bringing about tension and disquiet or fear of making a fatal mistake. The corollary is that, several of the technologies have been met with resistance, as many nurses are often unwilling to accept such radial changes especially when they are not involved in making the key decisions. This paper examines a case study scenario where change management was unsuccessful by considering the implementation in view of some of the existing theories of change management and proposing how they could have been affected more effectively. Case Study In the past, the hospital where I work used analogue paper-based data recording and storage systems; however, a new director proposed that the entire system should be overhauled run on an electronic platform. For the implementation of the project, a committee was formed comprising of 4 doctors, the IT chairperson and 3 hospital administrators among whom was a former nurse who represented the interests of the nurses. The after discussing the various challenged the hospital underwent as a result of inefficient record keeping, they agreed that Electronic Medical Technology was the best way forward and passed that it should be implemented at once. This later came to be viewed in negative light by most of the nurses since they felt they had not been properly represented or even consulted. The change when it came excluded them in decision-making and they only served to take orders and instructions from people who had no real inkling of what their (Nurses) jobs entailed. While many of the officers were happy with the new development, some serious setbacks emerged from the very start. Some of the PDAs ran out of power in the middle of shifts and as a result, some of the nurses ended up wasting time trying to charge them. In some cases, the reverted to paper records, which they then had to transfer to the PDAs therefore duplicating their work. After a week with about five cases of near misses and one non-lethal overdosing, the hospital administrator called for a crisis meeting. In this meeting, some of the nurse’s representative expressed dissatisfaction with the way the whole change management process was carried out without their being consulted. They argued that they had been sidestepped in the process solving a problem affected and it was concluded that the matter should be put off until a middle ground could be arrived at. Case Study Analysis Change is described as to be inexorable; nonetheless, this does not guarantee that it will be accepted or even appreciated. Many people, even when they are aware of its inevitability of the change about to come into their lives are still uncomfortable and resistant (Burns & Scapens, 2000). The objective of this is to demonstrate why and how the change managers in the institution failed to convert what was a good idea into a practical reality. This was despite the fact that they had at their disposal all the factors that were needed for this endeavor. Loosely put, change management is a systematic approach to dealing with change both from an individual and personal level; it typically follows three generic steps, which are adapting, controlling and effecting. In the above case study while change was indeed introduced, it was dealt with in an unsystematic way. The managers did not facilitate the process of helping the staff adapt nor did they control it before trying to effect it, which explains why it fell through. One of the foremost change management theories is Lewin’s model, which has three metaphorically depicted stages of unfreeze change and refreeze (Burnes, 2004). Typically, it requires that the change managers follow three key steps, which can metaphorically be compared to a block of ice that one needs to turn into a cone. The first step is to melt the ice, then shape it and finally refreeze it into the preferred form. In the case study, it is apparent that the managers did not go through any of the steps of Lewin’s model, the change was implemented forcefully and abruptly without sufficient consultation with the nurses. Metaphorically speaking, the system failed to take off since they attempted to “hack” the block into shape and the consequences bespeak the ineffectiveness of the technique. The attitude of the nurses towards the change was never queried and therefore the managers could not have reasonably expected to change it. As aforementioned, many of the nurses may have feel anxiety and fear because they were now expected to do a very specific job in which a small error could be fatal using tools they were not familiar with. In this respect, their negative attitude can be summarized as a result of management failure. The change managers did not take to account the possible effect it may have on the working experiences of the nurses which is why they skipped the motivation stage. According to Kathryn Bartol, management is fundamentally about people (Bartol et al., 2004); conversely, in the context of the above case study, the leaders focused too much on the bigger institutional picture and ignored the key implementers who were the nurses. The primary difference between change management and leadership is that change management involves a set of basic structures and tools that are meant to keep any form of change under control. Change leadership on the other hand is concerned about mobilizing driving forces to change motivation of employees and generally the process that initiates and leads large-scale transformation. The change managers knew that shifting from analogue to digital medical systems was inevitable and in any case, it has been proven more effective and safer in many other instances. Why then did they not manage to instill this knowledge into the nurses? According to Rogers (1983), change can be implemented in five main stages, which are innovation, diffusions, knowledge persuasion, decision implementation and confirmation (Preston & Badrick, 2004). In the context of Roger’s theory, it is apparent that the hospital change managers skipped diffusion and implementation, which ultimately derailed the confirmation. The management failed to motivate the staff who felt they had been made part of an idea they neither understood nor approved of. Instead of popularizing the change and motivating the staff as one would expect of leaders, the managers simple let it run its own course which resulted in disaffection. The management never took the time to popularize or sell their idea to the nurses although they were the very people would be supposed to implement the change. They were not persuaded of the importance of what was they were doing and the upper management assumed that the nurses would automatically accept the new terms. Through persuasion, change leaders can change the perception of their followers towards the change, which then creates a positive attitude. In the context of the above case study, had the leadership paid more attention to changing the nurse’s outlook, they may have successfully implemented the change without adjusting the technical aspects of the implementation. John Kotter on the other hand proposes an 8-stage model that is typically organized into 3 phases with the first being to create a climate for change. This requires that the managers of change establish as sense of urgency about the change process (Preston & Badrick, 2004. The second stage is the engaging and enabling of the organization, this involves communication of the vision and objectives of the change; in addition; the change managers underline the short-term goals and facilitate empowering action (Kotter, 1996). The nurses were not allowed the benefit of any of these; naturally, many studies were carried out prior to the implementation. However, the results of these were not sufficiently communicated or explained to the nurses. In the end, it can be said that the main cause of the problem was a breakdown in communication; had the managers invited the nurses to talk about the changes they wanted to implement they would have been more optimistic (Shortell & Kaluzny, 2006). However, it may be argued that given the inevitability of change in the industry, it sometimes falls upon managers to ensure that change is enhanced even if it causes friction and teething pain. In addition, an autocratic system of leadership can be applied when managers want to institute change quickly and effectively (Pomerleau, 2008). Proponents of the bringing about organizational changes abruptly on a need to know basis may argue that when people are simply provided with information of what to do instead of engaging in lengthy dialogue, change may take place more expediently. However, in the nursing setting, people have to share information constantly and engage each other with vertical and horizontal flow of information being equally important. In addition, nurses are often required to provide feedback and opinion to doctors although the latter are deemed more qualified and have greater responsibility. Given that the structure of communication in the field of nursing is loosely structured and nurses generally have unlimited access to information pertaining to their jobs, cutting them out of the decision making process was a serious error of judgment for the change managers. When it comes to the management of change, managers should be prepared to deal with resistance to change, which is always expected whenever change is to be implemented (Bartol et al., 2004). This requires that the change managers to create a process of preparing for change. In spite of the initial challenges. Change can either be revolutionally or evolutionally (Allen, 2010). In this case, the change was implemented in a revolutionary way, abruptly upsetting traditional beliefs and practices and causing widespread disaffection In this case. The change managers should have helped the staff understand why the current system was not as effective as it could be. The theory of change efficacy proposes that shared beliefs of organization members are highly influential to their capacity and ability to execute the action that is involved in the process of change (McCarthy & Eastman, 2010). By failing to create a shared point of interest among the nurses and members of staff, the institution failed to motivate them to appreciate the need for change, which would have promoted their agenda and made it easier for them to implement the change. Ultimately, considering the various change theories, it is obvious that the process of change implementation despite being driven by a noble idea was not effectively executed which was why the projected change did not materialize. In Conclusion, the hospital failed in implementing an idea that is both theoretically good and warranted by the global technological advancement. This was because despite the soundness of the idea, the method of implementing was poor. Furthermore, the organization had not set up advance mechanism to handle resistance to change or even motivate them to see the change as a positive thing. Ultimately, the underlying lesson to be learnt here is that change, must be carried out in a structured and consultative way. Ad hock and manager centered methodologies of implementing change often result in high levels of change resistance and resentment for the new ideas, which jeopardizes the objectives Recommendations The hospital should pursue more consultative methods of implementing change so that all the stakeholders more so the nurses can be consulted. The hospital management should pursue transformational leadership so they can be involve the nurses and ask their opinion on matters affecting them. Change managers should pursue transformational leadership techniques that involve the motivation and inspiration of employees towards a given goal rather than “ordering” them to it (Mcnulty & Ferlie, 2004). In the case study, a transformational leadership should have tried to motivate the nurses by changing their attitudes about the current record keeping practices. This way the demand for change can be intrinsic rather than extrinsic resulting in a self-motivated staff. Before change is attempted, various change models should be examined, this way the change managers can determine which specific methods or combination is best applied in the process. In the case study, there is no evidence that any model was used, furthermore, the steps taken to implement the change did not take to context the attitude of the nurse therefore no attempt was made to change them. In future attempts, the first stage should be creating a positive attitude towards the change in question so the nurses themselves can see the need for its advocacy. Finally, change should be originated from the bottom up, the nurses should give their feedback and before after the digitalization is attempted, it should first be piloted among them so they can respond and present their opinions with the benefit of hands on experience. In the case study, the best option would be to issue some of the nurses in a specific wing with the technology for a given period. This should then be followed by a critical evaluation, by members of a committee in which nurses are represented. Afterwards, based on the results of the evaluation, a decision can be made on whether to introduce the changes. References Allen, S. (2010). The revolution of nursing pedagogy: a transformational process. Teaching and Learning in Nursing, 5(1), 33-38. Bartol, K., Tein, M., Matthews, G., Sharma, B., & Scott-Ladd, B. (2011). Management: A Pacific Rim focus (6th ed.). Sydney: McGraw- Hill. Burnes, B. 2004. Kurt Lewin and the planned approach to change: A Re‐appraisal. Journal of Management studies, 41(6), 977-1002. Burns, J., & Scapens, R. W. 2000. Conceptualizing management accounting change: an institutional framework. Management accounting research, 11(1), 3-25. Kotter, J.P. (1996). Leading change. Boston, MA: Harvard Business School Press. McCarthy, C., & Eastman, D. (2010).  Change management Strategies for an Effective EMR Implementation.  Chicago, IL: HIMSS. Mcnulty, T & Ferlie, E (2004) Process transformation: Limitations to radical organisational change within public service organisations. Organisation Studies 25(8):1389-1412. Pomerleau, M. (2008). Electronic health record: Are you ready for the next step? Nursing for Women’s Health, 12(2), 151-156. Preston ER, T., & Bad rick, A. (2004). Organisational influences on the management of health care organisations. In M. Clinton, (Ed.), Management and the Australian health care industry (3rd ed., pp. 157-159). Prentice Hall. Rogers, E. (1983).  Diffusion of Innovations. New York; Free Press. Shortell E.R & Kaluzny, A. (2006). Health care management: Organizational design and behavior (5th ed., pp. 384-414). Clifton Park, NY: Thomson. Read More