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Matrix of Theoretical Models

Matrix of Theoretical Models
November 19, 2011
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Appendix A: Matrix of Theoretical Models

Theoretical Model | Description of Theoretical Model | Type of health care change situation in which model best applies | Kurt Lewin’s Change Theory and Force Field Analysis | Kurt Lewin’s theory model has three stages of change including: freezing, change or moving, and refreezing. The first stage of freezing involves finding methods to help people relinquish learned habits that were inefficient. Recognizing the need for change occurs in this stage. According to Schein (2002), the moving stage “allows members of the group to change from one set of behavior to another, such as new job responsibilities, new roles, and new job skills” (p. 37). The third stage of refreezing makes the change the standard operating procedure, the change becomes permanent. Without this last stage, individuals can revert back to the pre-change policies and procedures. Lewin’s theory believes that behavior is “a dynamic balance of forces working in opposing directions” (Lewin, 1951). He acknowledged that there are driving forces that cause change to occur, pushing individuals in the desired direction. Restraining forces counter driving forces, pushing an individual in the opposite direction. Examples of restraining forces include personal defense mechanisms or group “norms.” The goal within a force field of driving and restraining forces is to move to gain equilibrium. Equilibrium is a state of being where driving and restraining forces are equal. In this state no change is occurring. | “This theory is a time-tested, easily applied field theory that is often considered the epitome of change models, suitable for personal, group, and organizational change” (Kaminski, 2011, para. 2). This model can be applied when there is planned change. Lewin’s theory focuses on behavior within groups rather than on organizations, but it is the organization’s responsibility to educate and provide resources for the change. Strategic planning is important when change is taking place in a group environment. Feedback and interaction in the planning process for change is important to reduce resistance to change. The theory recognizes and accommodates resistance, helping nurses to understand the situation. “Driving and restraining forces need to be analyzed before implementing a planned change” (Kritsonis, 2004, p. 4).Nursing uses this theory with the introduction of new technologies, evidence-based practice, and service-centered care. Lewin also believes in joint ownership of change with the client. Stage one-the unfreezing stage-assesses the problem (an example from Boone County Hospital includes collaboration to improve employee and patient satisfaction scores), build a multi-disciplinary partnership, and come up with interventions (educational or teaching material, in-service sessions, and reinforce standards). Stage two-the moving stage-focuses on tools to accomplish change (at BCH it is computerized reports and data review), and continued assessing of satisfaction. Stage three-the refreezing stage-is applying the new knowledge from data analysis and implementation to improving employee and patient satisfaction.This theory can be applied to higher education with changing policies, procedures, and knowledge needs. | Lippitt’s Change Theory | Lippitt’s change theory involves bringing in an external change agent to help formulate a plan to effect change. Lippitt’s theory is an extended version based-off of Lewin’s theory. Lippitt’s theory involves a seven-step process that “focuses more on the role and responsibility of the change agent than on the evolution of the change itself.” The seven-steps include: diagnosing the problem; assessing the motivation for change; assessing resources, motivation, and commitment of the change agent; choosing progressive change objects-developing action plans and strategies; selecting the roles of the change agents-should understood by everyone involved with clear expectations; maintaining the change-communication, feedback, and coordination are important; gradually terminate from the helping relationship-this occurs when the change becomes part of the organization culture (Lippitt, Watson, & Westley, 1958-1959). This process of the change agent leaving after the change can be more stabilizing to the organization-there is no-one to blame and often-times behavior is more acceptable in the presence of people outside the organization. The right person leading, as the voice of change, empowering the process is essential to change. Bringing in an outside change agent is useful in an organization in which the change situation is volatile because of resistance. The change agent is an individual with skills in the theory of planned change who initiates and accomplishes the change using a process of confrontation. | “According to Lippitt, planned change is defined as a conscious, planned effort which moves a system, an organization, or an individual in a new direction” (Zeigler, 2005, p. 204). Lippitt’s theory can be used with individuals, groups, or organizations. Planned change is goal-oriented. Lippitt’s theory involves a helping relationship, so it is appropriate for a client of one-to-one relationship (Ziegler, 2005, p. 204). Boone County Hospital is currently using this theory with changing from paper charting to computerized charting. A year’s notice was given to employees and departments with information on when this change is to take place and how it will affect everyone involved. Each individual department discussed the change openly; any resistance among staff was analyzed. Technical support from the company for the new health care system is present to aid in learning and answer questions to individuals. Departments can individualize the system to meet the employee and patient needs. The technical staff will continue to support employees at BCH until the change is complete, and the system is a part of the status quo, they will leave. This is a prime example of the seven-steps. | The Satir Change Model, Satir Chaos Model | This system helps people improve their lives by transforming the way they see and express themselves (Smith, 2010). The Chaos Model of change has five stages: the old status quo, resistance, chaos, integration, and new status quo. In stage one, the group is at a familiar place where the performance pattern is consistent, and relationships give a sense of belonging and identity (Smith, 2010). “Members know what to expect, how to react and how to behave” (Smith, 2010). Poor communication can lead to dysfunction, which can include feelings of anger, guilt and can have physical symptoms. People may not be aware of the dysfunction until external forces from outside the group points it out. In stage two, resistance, the group faces a foreign element that requires a response. This foreign element threatens the status quo, and people can react by denying, avoiding, or placing blame on someone for the cause. The psychological blocking factors can be combined with physiological symptoms. Groups or people in this stage need help opening up and becoming aware of the situation. In stage three-chaos-the group or individuals enter the unknown. Old expectations or reactions may not be possible, and can trigger feelings of the loss of belonging and identity. Group performance and productivity will decrease rapidly during this stage. Relationships will become strained. Integration, or stage four, is where the group or individuals “discover a transforming idea that shows how the foreign element can benefit them” (Smith, 2010). With implementation and practice of new policies and procedures, performance improves rapidly. New relationships are formed. In this stage support is needed to encourage staff to continue with the new way of doing things. In stage five, or the new status quo, the change is permanent and a part of the culture of the group. People have a sense of accomplishment; performance stabilizes at a higher level than the old status quo. | This model or system can also be used for the change from paper to computerized charting. To keep up with the changing times, Boone County Hospital is moving from paper to computerized charting. The staff involved fear that the computer system will be difficult to use, will be complicated, will change the “old way” of doing things will take away from patient care, and will lose wording and meaning in charting. After seeking information from external sources, staff members realize that the computerized change will lead to increased privacy of patients’ medical records, will cut down on time spent charting, and will increase the hospital’s competition with other facilities in implementing new technologies. The computer systems are an integrated part of the staff’s job, satisfaction in employees and patients increase. In the first stage, information needs to be sought by the group or individuals from an outside source. Managers and leaders need to help people express themselves and become aware in the second stage. During chaos (the third stage) a safe environment with open communication needs to be established to express feelings. Support systems need to be in place (in the example of paper to computerized charting, the support systems included specially trained “super-users” made up of peers, and technical support from the system being used). New methods of coping, rules, regulations, and reassurance are all important to the success of the fourth stage-integration. The new status quo (the fifth stage) is a part of the practice. |

References
Kaminski, J. (Winter, 2011). Theory applied to informatics – Lewin’s Change Theory. CJNI: Canadian Journal of Nursing Informatics, 6 (1), Editorial. http://cjni.net/journal/?p=1210
Kritsonis A. (2004). Comparison of Change Theories. International Journal of Scholarly Academic Intellectual Diversity; 8(1), p. 1-7.
Lewin, K. (1951) Field theory in social science; selected theoretical papers. D. Cartwright (ed.). New York: Harper & Row.
Satir, Virginia, John Banmen, Jane Gerber and Maria Gomori. (1991). The Satir Model. Palo Alto, CA: Science and Behavior Books.
Schein, E. H. (2002). Models and tools for stability and change in human systems. Reflections, 4(2), 34-46.
Smith, S.M. (2010). The Satir Change Model. Retrieved from http://stevenmsmith.com/ar-satir-change-model/
Ziegler, S.M. (2005). Theory-directed nursing practice (2nd ed.). New York, NY: Springer Publishing Company, Inc.

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