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Section 3  Change Process

To embrace or not to embrace change shouldn’t be the question! As the challenge of building teams is upon us, change is not an option and certainly here to stay. Change in health care will continue to accelerate and increase.

 For many in nursing for a long time, the amount of change encountered in the next two years will be equivalent to the amount of change during the past twenty-five years. Because of technology and communication capabilities, any change in the future will come at a faster, more explosive rate.

                 Change is a unique, and not so unique, process that will continue to invade the health care horizon for the rest of your career. Without it, nothing could exist, and life as present generations know it, could not exist. Therefore change is inevitable.  If change were not present, there would be little opportunity for growth or improvement, especially in patient care circles.

                 Few managers or staff members enthusiastically jump in and wallow in change. The norm is to avoid it. For most, change and shifting gears is scary business. Fear factors rise and denial can match the fear level. It’s even easy to become paralyzed.

                 Change in health care is usually messy! It can also be destructive. Things get broken along the way, possibly the old beliefs, habits and traditions. Nay-sayers will issue warnings and no one really wants to be hurt in the process.

                  If organizations are unwilling to break a few things along the way of the change path, heavy baggage can accumulate. Bad habits stay intact. By being careful and protecting the sacred cows, the future may be in danger.

Stages of Change 

                  When nurses are faced with the change process, there are multiple stages to be experienced. Judith Briles describes them as the following:  

·     Resistance. Being stubborn and denying the benefits and need of a process or concept. Fear is the underlying ingredient when resistance is in play, fear of the unknown, fear of failure, and sometimes, fear of success.

·     Skepticism. Described as willing to try, but still doubting the benefit and use of the process. Clinging to the past, wishing it could be different or worshipping sacred cows.  

·     Adaptation. This step requires moving past reluctance and fully accepting that the process or concept can be integrated into the work situation or setting.

·     Shifting. This occurs when the team or individuals open up to “what if” scenarios; the transition is beginning to take shape and may even be almost complete.

·     Cohesiveness. There is realization that the ways of the past are the past and a new attitude emerges. There may even be the thought, “why didn’t I do this sooner?” “What took my team or organization so long to change?”  

[Judith Briles, “To Embrace or not to Embrace Change,” Revolution-The  Journal of Nurse Empowerment 1998; 8 (1) 43].  

Overcoming Resistance and Avoiding Change 

                  Some staff members may want to desperately cling to the past. They hang on to what’s familiar, sinking deeper into their comfortable routines to avoid the chilling thought that they might have to change! Change always means giving up something and the greater the personal sacrifice the more you may feel like dragging your feet.

                   Another reason why staff members defend the old way of doing things is to maintain personal stability or feel more in control. They battle against change out of fear of the future, not because of love of the past. The more there is a dislike for unpredictability, the more likely there is to protect the status quo.

                  Some staff members may resist change as a way to “get even.” They play “punish” the organization in retaliation for changes they don’t like. This may even be considered plain old revenge! In this scenario, staff members may damage themselves just to get back at the organization.

                  Some change resistors are well-intentioned staff members who think that the organization is about to make a mistake! They fight change because they have the organization’s best interest at heart and have enough nerve to take a stand. Often, these staff members with good intentions often happen to be wrong. In order to try and save the organization they may shoot it in the foot.

              When the winds of change hit your organization the bottom line is that resisting often does more harm than good. Resisting change takes a lot of effort and there are often more productive ways to spend your energy. Instead of trying to hang onto the past the effort should be in trying to grab hold of the future.

                   A key issue with respect to the change process concerns how much energy is sometimes put into avoiding a certain situation, problem or the change concept itself. By trying not to focus on something, which is the same as avoiding focusing on it, it is possible to actually focus all attention in its direction! Thus, avoiding something doesn’t work. The only way we can change our focus from what we want to avoid is to replace it with something else that we want to focus on!

    For example, when we are focusing on mistakes we are likely to make more of them. We must focus on what we do want rather than what we do not want. What we want is a smooth functioning, effective team in our organizations.

    Ed Oakley and Doug Krug have suggested some change friendly highlights for organizations that may be avoiding change:  

Change Friendly Highlights  

·    Self- esteem is a major factor in team member’s attitudes. Staff members with low self-esteem may resist change because they interpret it as an indicator of their worth.

·    The 80/20 rule of thumb suggests that 20% of staff members will be open to change while 80% will resist the change to varying degrees.

·     How and where staff members and organizations focus their attention can dramatically impact the results they are able to achieve.

·     A team has a great deal of choice about where they focus their attention.

·     How and where the focus is directed determines what is possible to attract more of.  

·     The amount of energy focused on problems reduces the energy available to create the desired solution.

·     The attention and energy put into trying to avoid something frequently draws us closer to what we are trying to avoid.

·     The distinction between focusing on what’s wrong with where the team is and how long it will take to get there can be astounding on its impact and the ability to achieve an objective.

·     The ability of an organization to move forward depends upon how much productive energy that the team members are expending while moving toward the organization’s mission and vision.

·     A primary role of management in team building is to mange where the team member’s energy and attention is focused.

[Ed Oakley, and Doug Krug. Enlightened Leadership: Getting to the Heart of Change (New York: Simon and Schuster, 1991), 93].  

Change Agent Role

                    What makes an effective change agent? According to David Sheff, a change agent needs courage, flexibility, balance, and humor. Balance is probably the most important. Another skill is the ability to communicate verbally with different types of audiences.

     It’s a rare skill and important in any nursing clinical areas since there are often several levels and types of staff members to deal with. Change agents have to be able to reach people, and they can’t use the same style, language and message with everyone.

                     Another attribute and skill to consider is a better understanding of what it takes to work in teams. Often, the staff members involved and even the change agents themselves didn’t know nearly as much about teamwork and team building as they thought they did. It can be a long learning process with lots of challenges.

                     The flip side of change is resistance. There are several ways to deal with it. First, expect it. Human beings inevitably exaggerate the joys of the past, the pain of the present, and the risks of the future. It’s perfectly normal.

      Second, don’t take it personally. And third, understand that staff members are afraid and scared. It’s something they’ve never done! before and a journey they’ve never been on  

       [David Sheff, “Levi’s Changes Everything,” Fast Company: New Rules of Business 1998; 1 (1): 28].

                       Emily Morgan also suggests several lessons about making changes as a change agent, regardless of the workplace or situation:  

·     Context is king.  

Staff members can learn to deal with ambiguity; they may even learn to prefer it. But they need a clear picture of the end goals. You’ve got to be able to explain the past, in order for staff to understand the future. And most importantly, take the fear out of change.

·     Check in early and often.  

Implementing change is a dynamic process. You always have to worry about how far and how staff members can move. It becomes intuitive, how they are feeling, but you have to listen carefully.

·     Be a catalyst, not a controller.

Let the staff who is going to do the work fill in the blanks between the big concepts and what’s really happening. As soon as possible, turn over the next phase of change to the staff members who have to make it happen. True commitment is generated that way.

·     Learning is your only chance to keep up with change.  

Success requires growth and knowledge. Failure if often the fault of the system or organization, not the people in it.

·     Consider the following questions:  

What is already working?  

What makes it work?  

What is the objective?  

What are the benefits of achieving the objective?  

What can we do to move closer to the objective?  

[Emily Morgan, “Confessions of a Change Agent,” Fast Company: New Rules of Business 1998; 1 (1): 29].