1 and half pages 3 references 2 from walden university library due Friday September 22,2017 at 1800 EST The following is the essay that a response is needed for
Implementing and maintaining change in an organization is difficult, Szabla (2007) “estimates that two thirds of [organizational] change projects fail” (as cited by Mitchell, 2013, p. 32). Many theories have been developed to guide change; managers and leaders benefit from applying theory framework to guide organizational changes and “increase likelihood of success” (Mitchell, 2013, p. 32). Lewin’s Theory of Planned Change is simple and straight-forward, involving three steps: unfreezing, or “getting ready for change”; moving or transitioning; and refreezing, or “stabilizing the change” (Shirey, 2013, pp. 69-70). This approach is useful for a top-down approach but is not a good choice for unplanned or nonlinear change (Shirey, 2013, p. 70).
In the last year at UW Health there was a quality initiative to improve staff response time to patient call lights, a reactive planning process (Marquis & Huston, 2015, p. 142). A top-down change to the nurse and nursing assistant (NA) paging system was planned and implemented that involved escalating pages going to secondary staff members who could answer the call light if the primary nurse was unable to respond. The page would first go to the NA, then escalate to the nurse if unanswered in a few minutes. If the call light was still unanswered, a page would then be sent to a secondary NA, and finally to a secondary assigned nurse if still unanswered.
UW Health roughly followed Lewin’s Theory of Planned Change. The unfreezing process involved staff education via computer-based training modules, unit managers answering questions at staff meetings, and simple reminder signs posted near paging stations. The moving or transition phase involved the new process being implemented, staff being assigned a paging buddy and encouraged to answer the escalation pages. However, refreezing occurred before equilibrium was achieved and the change slowly faded from practice (Mitchell, 2013, p. 32; Shirey, 2013, p. 70).
A few small barriers made the transition difficult, but without coherence, the small barriers brought down the planned change. McAlearney et al. (2014) explained that “if there is coherence within the organization, or a shared understanding of the logic and value of a particular QI effort, staff may be more likely to be engaged positively with the goals and strategies of the organization striving to achieve that improvement” (p. 258). The practice change at UW Health came as a top-down order without front line staff involvement or input, so there was little coherence to the plan. The change went well as planned for a few weeks, with nurses and NAs answering overtime call lights. When a new unit clerk was hired, however, the new practice dwindled away. The new employee had difficulty multitasking and was having too much trouble assigning staff to the paging system and creating paging buddies; she was overwhelmed so the manager asked staff to start assigning themselves to paging, an additional step that was not planned for. The change started fading from practice as staff felt they could spare the 5 minutes at the beginning of the shift to sign in their pager because they had to start answering call lights and administering medications or sometimes they simply forgot to do it. Now, instead of call lights being answered in a timely manner, some nurses do not even get a page for the call light. The new unit clerk has since found a different job within the organization but the practice has not returned.
Planned change fails more often than it succeeds (Mitchell, 2013, p. 32). But “careful consideration of change theory can simplify the process for change agents and help those affected by change to be more receptive to it” (Mitchell, 2013, p. 37). Thus, it is important for managers and change agents to select the appropriate change theory to increase the likelihood of success during implementation (Mitchell, 2013, p. 32). Staff should be involved in practice changes and continual feedback and improvements are necessary during the transition phase to solidify the new practice before refreezing, otherwise the change will fail as it did at UW Health.
Marquis, B. L., & Huston, C. J. (2015). Leadership roles and management functions in nursing: Theory and application (8th ed.). Philadelphia, PA: Lippincott, Williams & Wilkins.
McAlearney, A., Terris, D., Hardacre, J., Spurgeon, P. Brown, C., Baumgart, A., Nyström, M. (2014). Organizational coherence in health care organizations: Conceptual guidance to facilitate quality improvement and organizational change. Quality Management in Health Care, 23(4), 254-267 doi: 10.1097/QMH.0b013e31828bc37d
Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing Management – UK, 20(1), 32-37. doi: 10.7748/nm2013.04.20.1.32.e1013
Shirey, M. R. (2013). Lewin’s Theory of Planned Change as a strategic resource. The Journal of Nursing Administration, 43(2), 69-72. doi:10.1097/NNA.0b013e31827f20a9