Matrix of Theoretical Models
HCS/587

Theoretical Model | Description of Theoretical Model | Type of Health Care Change Situation Where Model Best Applies | 1. Kurt Lewin’s field theory model 2. Lippitt’s change theory model | Kurt Lewin’s field theory model has three stages of change: * Unfreezing * Change or Moving * Refreezing The unfreezing stage requires altering the patterns of employee behavior. The employee adaptive behavior must align with the organizational goals and vision. The lack of alteration in behavior changes can result in employees’ resistance during the implementation process. The management should communicate effectively with the staff explaining the need for change. The management should encourage the staff to submit their ideas and be a part of the change process. The change stage refers to the introduction of new organizational policies and procedures. The management should ensure that the affected staff fully understands the reasoning behind the changes and offer support for adapting the new organizational business culture. It is imperative that management includes the staff in the development of new policies and designing the new procedures. The refreezing stage requires reevaluation of the implemented procedures in which the management evaluates the efficacy of the implemented changes and makes adjustments to meet organizational goals (Borkowski, 2005). The management should seek feedback from the staff and fine tune the procedures to eradicate wastage in the implemented processes. The refreezing phase is the most important phase for maintaining the first two stages. Without this stage, the employees may revert to pre-change policies and procedures.Lippitt’s change theory model extend Lewin’s three-step change theory model. According to Kritsonis (2005), “Lippitt’s change theory model focus more on the role and responsibility of the change agent than on the evolution of change itself.” The seven step of Lippitt’s change theory include: 1. Diagnosing the problem 2. Assess the motivation and capacity for change 3. Assess the resources and motivation of the change agent 4. Choose progressive change objects, including planning and development of change strategies 5. Understanding each change agent’s role, such as cheerleader, facilitator, and expert. 6. Maintain the change by communicating, feedback, and group coordination efforts. 7. Termination of the help relationship when the change becomes part of the organization culture.Lippitt believed that an outside agent of change may be helpful in an organization with a culture of strong resistance to any major change. The outside agent could become the voice of the change and empower the employees to become part of the change process. An outside change agent is perceived as a non-partisan person and reduces the chances for blaming someone within the organization for bringing the change. | Kurt Lewin’s model is suitable when an organization is planning for a planned change. The change in employees’ behavior, empowering employees to be a part of the change and evaluation of the process can be costly and time-consuming. The advantage of this model is that it can be applied at a departmental or the organizational levels. At MedStar Montgomery General Hospital, the management is planning to introduce Computerized Physician Order Entry (CPOE) system. The CPOE is an integral part of the electronic health records systems that every health care provider must implement by 2014. The management at the hospital appears to be following the Kurt Lewin’s change theory model by incorporating the major stakeholders in the systems development and implementation process. The physicians were little reluctant to embrace the CPOE. The physicians’ fears were alleviated by including them as part of the systems development. The physicians and other health care workers understand that benefits of the CPOE outweigh the cons of this system. Each health care worker will go through an intense system training and practice sessions to ensure they understand the system features and able to navigate through the different menus. The hospital is not at the refreezing stage yet but should do well in the third stage considering how well they followed the Kurt Lewin’s change model in the first two stages.“Change is a very complex phenomenon involving the multiplicity of man’s motivationsin both micro and macro systems and that a man gets satisfied with his equilibrium and is resistant to changing his status quo” (Borkowski, 2005, p. 380). The staff at the MedStar Montgomery General Hospital was very resistant to the idea of implementing computerized charting. Like aforementioned CPOE system, computerized or electronic charting is imperative part of the electronic medical records. The management held open discussion forums to explain the advantages of electronic medical records system. The directors meeting revealed silos of resistance among various departments despite multiple open discussion forums. The management decided to invite a representative from the 3M software company that was responsible for implementation of the application. The 3M representative happened to be a motivational speaker. He invited all the major stakeholders for the discussion sessions and based on the feedback assisted in forming the implementation team. The employees previously focused on blaming other departments for the change became productive members of the implementation team. The implementation of the application was delayed for a month because of the interoperability issues. The implementation team was enough motivated to iron out the kinks and proceed with the implementation process. The computerized documentation system has been in place for over six months. The 3M representative is in the process of terminating the help relationship. The management at the MedStar Montgomery hospital successfully implemented the required computerized documentation application by following the Lippitt’s change model. | 3. Havelock’s theory of change model | Havelock’s model is another example of linear change models and resembles the Lewin’s field theory model. Havelock’s model emphasis on planning and understanding that people may be resistant to change (Tyson, 2010). Havelock’s model suggests six steps to implement change through planning and monitoring: * Building relationship * Diagnosis * Acquiring relevant resources for change * Pathway selection * Establishing change * Maintenance and SeparationHavelock states that the agent of change must understand the current system by building relationship with the current system. The change of agent should evaluate the need of change and the awareness that a change is desired. The first step in developing solution is to gather relevant information to the change that requires change (Tyson, 2010). The next step is pathway selection that requires exploring all the available options to implement the change. It is imperative to ensure that organization and the individuals has accepted the change and any resistance to change has been resolved. In the last stage the change agent should monitor the affected system. The change agent should separate from the organization once the change becomes part of the organizational culture. | Havelock’s theory of change stresses the importance of planning of an orderly process to recognize, implement, and maintain the change. Change often embodies a desire to improve the system but organizations often fail to estimate the amount of effort and required resources to implement and maintain the change. The Havelock’s theory of change model can help identifying the desired change and an orderly planning of steps for successful implementation of the change. At MedStar Montgomery hospital, a newly hired unit manager identified the issue of contaminated urine samples. As the nursing team leader, she started diagnosing the issue by observation and asking questions to the floor nurses and nursing technicians. She found many inconsistencies among the unit staff about collecting the clean catch urine samples. Some nurses were ordering the technicians to collect the urine samples, and others were asking patients to collect the samples. The unit manager discussed the issue with other unit managers facing the similar issue of higher rates of contaminated urine samples. The unit manager formed an action committee consisting of nurses, unit managers, nurses, and technicians. The committee proposed five different solutions but at the end, the committee decided that nurses should collect the urine samples and the entire nursing staff should receive a shot refresher course on obtaining the urine samples. There was some resistance from a small number of unit nurses about the change. This group of experienced nurses was unwilling to learn the correct way of obtaining the urine sample. The committee invited the laboratory manager to speak with the entire staff about the importance of cleaning catch sample and how the urine sample results could change the course of treatment. After the change was implemented, the contamination rate was reduced to 1% from previously 10% contamination rate. The unit manager provides feedback to the staff in the form of quarterly quality reports as a way of positive reinforcement. |

References
Borkowski, N. (2005). Organizational Behavior in Health Care. Sudbury, MA: Jones and Bartlett Publishers.
Kritsonis, A. (2005). Comparison of Change Theories. Retrieved from http://nationalforum.com/Electronic%20Journal%20Volumes/Kritsonis,%20Alicia%20Comparison%20of%20Change%20Theories.pdf
Spector, B. (2010). Implementing Organizational Change: Theory into Practice (2nd ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Tyson, B. (2010). Havelock's Theory of Change. Retrieved from http://www.brighthubpm.com/change-management/86803-havelocks-theory-of-change/