Change Theories

Because change occurs within the context of human behavior, understanding how change occurs (or doesnt) is helpful to learn how to initiate or manage change. Four theorists, Lewin, Lippitt, Havelock and Rogers, explain the change process from a social-psychological viewpoint. Table 5-1 compares the four. Lewin (1951) proposed a force-field model, shown in Figure 5-1. He sees behavior as a dynamic balance of forces working in opposing directions within a field (such as an organization). Driving Forces facilitates change because they push participants in the desired direction. Restraining Forces impede change because they push participants in the opposite direction. To plan change, one must analyze hese forces and shift the balance in the direction of change through a three-step process: unfreezing, moving and freezing. Change occurs by adding a new force, changing the direction of a force or changing the magnitude of anyone force. Basically, strategies for change are aimed at increasing driving forces, decreasing restraining forces or both. Lewins model has been used successfully in health care settings (Baulcomb, 2003). The image of peoples attitudes thawing and then refreezing is conceptually useful. This symbol helps to keep theory and reality in mind simultaneously. Lippit and colleagues (1958) extended Lewin theory to a seven-step process and focused more in what the change agent must do than on the evolution of change itself. (See Table 5-1 for a comparison of four change theories). They emphasized participation of key members of the target system throughout the change process, particularly during planning. Communication skills, rapport building and problemsolving strategies underlie their phases. Havelock (1973) described a six-step process, also a modification of Lewins model. Havelock describes an active change agent as one who uses a participative approach. Rogers (1983) takes a broader approach than Lewin, Lippit or Havelock (see table 5-1). His fivestep innovation-decision process details how an individual or decision-making unit passes from first knowledge of an innovation to confirmation of the decision to adopt or reject new idea. His framework emphasizes the reversible nature of change: Participants may initially adopt a proposal but later discontinue it or the reversethey may initially reject it but adopt it at a later in time. This is a useful distinction. If the change agent is unsuccessful in achieving full implementation of a proposal, it should not be assumed the issue is dead. It can be resurrected, perhaps in an altered form or at a more opportune time. Rogers stresses two important aspects of successful planned change: key people and policy makers must be interested in the innovation and committed to making it happen. Table 5-1 Comparison of Change Models Lewin 1. Unfreezing 2. Moving 3. Refreshing Lippit 1. Diagnosing problem 2. Assess motivation 3. Assess change Havelock 1. Building a relationship 2. Diagnosing the Rogers 1. Knowledge 2. Persuasion 3. Decision

4. 5. 6. 7.

agents motivations and resources Select progressive change objects Choose change agent role Maintain change Terminate helping relationships

problem 3. Acquiring resources 4. Choosing the solution 5. Gaining acceptance 6. Stabilization and self-renewal

4. Implementation 5. confirmation

Figure 5-1 : Lewins force-field model of change. Adapted from resolving social conflicts and filed theory in
social science by K. Lewin.

Restraining forces Moving Present equilibrium (Status quo) Dividing forces Example: Restraining forces Some long-term employees resist change Present (Status quo) Interested vice-president Almost complete turnover of staff (many new nurses) Administration mandates the change Entrenched director of nurses Nurse manager lacks change agent skills (unfreezing) New equilibrium

Restraining forces (Refreezing)

Dividing forces

Fear of job loss

Force will be toward change Need new solution (old one doesnt work) Budget in red (financial incentive to change)

Change Strategies
Regardless of the setting or proposed change, the four-step change process should be followed. However, specific strategies can be used, depending on the amount of resistance anticipated and the degree of power the change agent possesses.

POWER-COERCIVE STRATEGIES
Power-coercive strategies are based on the application of power by legitimate authority, economic sanctions, or political clout. Changes are made through law, policy or financial appropriations. Those in control enforce changes by restricting budgets or creating policies. Those who are not in power may not even be aware of what is happening. Even if they are aware they have little power to stop it. The prospective permanent system for Medicare (DRGs) was a similarly managed care has changed economic incentives in health care. The change process continues through the seven steps, but there is little, if any, participation by the target system members. Resistance is handled by authority measures: accept it, or leave. Power-coercive strategies are useful when a consensus is unlikely despite efforts to stimulate participation by those involved. When much resistance is anticipated, time is short, and the change is critical for organizational survival, power-coercive strategies may be necessary.

EMPIRICAL-RATIONAL MODEL
In the empirical-rational model of change sstrategies, the power ingredient is knowledge. The assumption is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. It is also assumed that the change agent who has knowledge has the expert power to persuade people to accept a rationally justified change that will benefit them. The flow of influences moves from those who know to those who do not know. New ideas are invented and communicated or diffused to all participants. Once enlightened, rational people will either accept or reject the idea based on its merits and consequences. Empiricalrational strategies are often effective and the change is perceived as reasonable. Introduction of new technology that is easy to use, cuts nursing time and improves quality of care would be accepted readily after in-service education and perhaps a trial use. The change agent can direct the change. There is little need for staff participation in the early steps of the change process, although input is useful for the evaluation and stabilization stages. The benefits of change for the staff and perhaps research findings regarding patient outcomes are the major driving forces. Well-researched, cost-effective technology can be implemented using these strategies.

NORMATIVE-REEDUCATIVE STRATEGIES
In contrast to the rational-empirical model, normative-reeducative strategies of change rest on the assumption that people act in accordance with social norms and values. Information and rational arguments are insufficient strategies to change peoples patterns of actions; the change agent must focus on non-cognitive determinants of behavior as well. Peoples roles and relationships, perceptual orientations, attitudes and feelings will influence their acceptance of change. In this mode, the power ingredient is not authority or knowledge, but skill in interpersonal relationships. The change agent does not use coercion or nonreciprocal influence, but collaboration. Members of the target system are involved throughout the change process. Value conflicts from all parts of the system are brought into the open and worked through so change can progress. Normative-reeducative strategies are well situated to the creative problem solving needed in nursing and health care today. With their firm grasp of the behavioral sciences and communication skills, nurses are comfortable with this model. Changing from a traditional nursing system to self-governance or initiating a home follow-up service for hospitalized patients are examples of changes amenable to the normative-reeducative approach. In most cases, normative-reeducative approach to change will be effective in reducing resistance approach to change will be effective in reducing resistance and stimulating personal and organizational creativity. The obvious drawback is the time required for group participation and conflict resolution throughout the change process. When there is adequate time or when group consensus is fundamental to successful adoption of the change, the manager is well advised to adopt this framework.