Change theory models in healthcare management

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Change is inevitable, yet slow to accomplish. While change theories can help provide best practices for change leadership and implementation, their use cannot guarantee success. The process of change is vulnerable to many internal and external influences. Using change champions from all shifts, force field analyses, and regular supportive communication can help increase the chances of success [5]. Knowing how each departmental staff member will likely respond to change based on the diffusion of innovation phases can also indicate the types of conversations leaders should have with staff to shift departmental processes.

You are not required to obtain permission to distribute this article, provided that you credit the author and journal. Turn recording back on. Help Accessibility Careers. StatPearls [Internet]. Search term. Change Management Jennifer M. Affiliations 1 McNeese State University.

Confirmation staff recognize the value and benefits of the change and continue to use changed processes. Issues of Concern All change initiatives, no matter how big or small, unfold in three major stages: pre-change, change, and post-change. He further qualified those change acceptance categories with the following descriptions: Innovator: passionate about change and technology; frequently suggest new ideas for departmental change.

Early majority: Prefer the status quo; willing to follow early adopters when notified of upcoming changes.

Late majority: Skeptical of change but will eventually accept the change once the majority has accepted; susceptible to increased departmental social pressure. Laggard: High levels of skepticism; openly resist change [4].

Clinical Significance Change is inevitable, yet slow to accomplish. Review Questions Access free multiple choice questions on this topic. Comment on this article. References 1. Leading change: a concept analysis. J Adv Nurs. Shirey MR. Lewin's Theory of Planned Change as a strategic resource.

J Nurs Adm. Mitchell G. Selecting the best theory to implement planned change. Nurs Manag Harrow. Using Diffusion of Innovations Theory to implement the confusion assessment method for the intensive care unit.

J Nurs Care Qual. Burden M. Using a change model to reduce the risk of surgical site infection. Br J Nurs. Change Management. In: StatPearls [Internet]. In this Page. Bulk Download. Related information. PubMed Links to PubMed.

Similar articles in PubMed. Ann Clin Lab Sci. The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol. Newell S, Jordan Z. Build a guiding coalition, including all the right staff to plan, coordinate and carry out the change. Establish a clear vision and each accompanying change initiative.

Break goals into bite-size chunks and communicate successes little and often. Maintain momentum, and push harder after every successful implementation. The sense of urgency for short-term wins could lead to high rates of staff burnout. Something healthcare staff are already at risk of before the change leader implements a change plan.

Over a few months, short-period change management strategies in health care work well with this model. One example could be a move to paperless patient onboarding in an ER unit, which is a high-pressure, task-oriented environment. Although burnout due to this change could potentially be high, staff may be more pragmatic and see improvements quickly, reducing staff stress and increasing patient care quality over the time taken to implement the change.

Paperless onboarding would primarily involve getting used to new technology and simple employee training , and the sense of urgency, the first step of the model, is innate in ER staff due to the nature of the work.

ADKAR Awareness, Desire, Knowledge, Ability, Reinforcement analysis is vastly different from the first two models as it focuses on understanding the emotions and thoughts of the people affected by the change.

In healthcare, many stakeholders are affected by changes with different ways of gaining or losing. There are five steps to achieving an ADKAR analysis; the first is creating awareness for healthcare staff. Show healthcare staff what changes are necessary and why. Detail is needed when explaining changes, and change leaders should define training schedules.

Face-to-face announcements and training are preferred so staff can ask questions to enable them to participate early in the process. Create a desire to be supportive of the change to create an environment in which employee engagement increases so much that attitudes toward change become positive organically.

Ensure adequate support is available for employees. Training, coaching, and checklists provided by the business are some types of support. Ensure employees, relatives, and patients can give feedback about their change journey. Leaders of change, such as project leaders or healthcare managers, record and action this to provide the best opportunity for learning and development. At this point, the change leader can make further adjustments to the plan based on the feedback.

Use rewards and cash or holiday incentives to employees and other means such as championing staff who embody shared values. Also, HR could implement an internal advertising campaign to remind everyone that the change leader adjusted the plan based on their feedback.

These actions ensure the new status quo is maintained for ongoing performance improvement. Of all the change management tools in this list, the ADKAR model is the model most focused on human experience and supporting staff to engage with new ways of fulfilling their role naturally. For this reason, the ADKAR model can be effective for long-term change strategies within large or small teams. It can be beneficial in healthcare environments due to the many stakeholders of different professions with competing goals.

The ADKAR model is great for many healthcare contexts but particularly for departments caring for high vulnerability patients needing sensitive communication with patients and relatives, like an intensive care unit. Staff in such care environments can hold more specialized skills than in other departments. The ADKAR change management model can support the change with constant feedback and communication to ensure that changes do not negatively impact care.

Developed by William Bridges over thirty years ago, the Bridges transition model focuses on the human experience of processing and acting on change. This model is softer, more philosophical, and more human-oriented than some of the other models and is formed of three basic principles Although it sounds somewhat philosophical, every ending is also a beginning.

This point forms the first phase of the Bridges transition model. This phase represents the human act of accepting and managing loss. Within this stage, staff lose some things to a change management strategy and keep others. Managers strengthen professional relationships and increase communication by outwardly acknowledging this. Once the loss is accepted comes the next phase: the neutral zone. This zone is when the strategy has ensured the old culture is out, but the new culture is not in force.

This stage is the most critical stage of the transition period when staff is changing their deeply embedded beliefs and routines for completing tasks and what values they hold. Significant concepts such as identity and sense of reality are confronted in this stage and re-aligned. New ways of understanding things, new values, and new attitudes all contribute to forming a sense of the new status quo, cementing changes as part of a transformation strategy. When change is well managed, staff members feel liberated and empowered as they begin to understand and act on their new role within a new system.

For some companies, change models such as the bridges transition model will help them to understand the employee experience of processing change. Understanding the employee experience of change is powerful in healthcare to reduce resistance to change because there are many different levels of staff with different specialisms who are empowered to complete tasks a certain way.

Engaging with this hierarchy of specialisms is easier with the Bridges transition model as it encourages understanding staff mentalities. However, using the Bridges transition model with a more task-oriented model can help establish leadership in health care environments and the need to reach specific change goals. A change leader is a senior staff member, often a healthcare manager, who becomes a change agent. A change agent is a staff member who begins the change process and often goes on to coordinate changes as a change leader.

The essential attributes of a change leader are that they have a deep understanding of their current healthcare organization culture and communicate with staff effectively to implement change using the appropriate change model.

The leadership style of the change leader is an essential means of ensuring the best communication is possible and that the communication style fits with the change management model. The five leadership styles can be used for various reasons by a change leader in healthcare in many other applications. The five leadership styles are below. I give a task; you do it. This premise is behind the authoritarian leadership style, with no dialogue between the change leader and the team.

In this style, change leaders take on the role of a visible authority figure. This style is excellent when the change leader has superior knowledge on a topic compared to the rest of the team, and there are strict time constraints for change projects. This combination can lead to impressive results when an organization needs change to occur over a short period. In contrast to the authoritarian style, the participative leadership style involves much more collaboration and dialogue.

Participative leadership is far more democratic and makes a more engaging experience for team members, motivating them to contribute ideas and solutions. On the other hand, the discussion takes time and can lead to unclear answers, making this leadership style inappropriate in a time-constrained environment. The participative leadership style fits well with the ADKAR change management model due to the promotion of understanding and dialogue between change leaders and team members. However, within the context of change, the change leader would benefit from experience in change management to coordinate team members toward the best outcome in a democratic but focused manner.

The delegating leadership style involves assigning initiatives to other staff within a team. This style works best when the unit is experienced and proficient in the task, naturally taking responsibility and enjoying working alone.

Change leaders using this style must be aware of conflict when the team cannot reach an agreement, resulting in team divisions and lowering morale and motivation. Everything is evident in the transactional leadership style; the leader, goals, and what will happen if the team achieves or fail objectives.

Transactional leadership is oriented toward the structure to complete tasks rather than organizational change. Change leaders give rewards or punishments in response to goals being hit or missed. This type of environment can lead to healthcare staff seeing their colleagues benefit or be disadvantaged by hitting or missing goals, creating motivation to succeed in allocated tasks to promote change.

Using the Bridges transition model with a more task-oriented model can be helpful for organizational change management within larger healthcare organizations. A transformational change leader uses a strategic vision speech to inspire their team to set off as empowered and motivated individuals to achieve their goals. The transformational change leader is also the role model for the shared values of an organizational change.

Transformational leadership can create a more exciting environment for healthcare staff. But the question is, is it safe and appropriate for hospital teams to be excited by inspirational speeches instead of being motivated by the delivery of safe, consistent care practice?

The answer comes in the form of balance. If implemented correctly, a change leader can give a speech to promote change safely and consistently in an inspirational manner. The other advantage of transformational leadership in healthcare change management is that it fits well with change. This point makes it ideal for use with any change management models mentioned above.

Leadership styles and change management models can support change leaders to achieve institutional change management in healthcare. But what about the theory of change management in the healthcare industry?

Many theories help make sense of the reasons for resistance to change in healthcare and support understanding why these reasons occur to influence human behavior toward accepting change. One theory that can help change leaders understand the fundamentals of change is the complexity science theory. Prigogine developed complexity science as we know it today and apply it to leadership and organizational theory, and at its core is the concept of complex adaptive systems CAS.

Complex — A system has lots of diversity, and the differences are significant in number. The system includes a variety of parts working bother together and separately. Complexity theory, with CAS at its core, can be used to consider specific individuals or groups within health care organizations when leading change.

Once the change leader accomplishes this, the appropriate leadership style and change management models can be applied to help support the individual or group to embrace change and allow the CAS to function correctly.

CAS theory is separate from the practical side of implementing a change management model, and some change leaders are not theory-minded. That said, taking a step back can be useful and considering a different perspective on change management.

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