University of Phoenix Material

Appendix A: Matrix of Theoretical Models

|Theoretical Model |Description of Theoretical Model |Type of health care change situation |
| | |where model best applies |
|Lewin’s Change Model |In 1947, Kurt Lewin created a model that used |Kurt Lewin’s model can be used in a |
| |Force Field Analysis to describe what happens when|health care change that involves the |
| |an organization experiences change. He explained |implementation of electronic charting and|
| |that there are forces that want change to occur, |electronic medical records. Management |
| |and there also existed forces that wanted to |should accept some resistance from staff |
| |maintain the status quo. For change to be |because it is natural for people to |
| |effective, either the forces that want the change |dislike change. There can be many |
| |to occur had to increase, or the forces that want |reasons for resistance. People become |
| |things to stay the same had to decrease. Once the|very accustomed to and comfortable with |
| |forces are determined and understood, the process |their ways of accomplishing tasks. Also,|
| |of implementing change can occur. Lewin divided |employees may resist because they don’t |
| |the process of change into three phases as |feel they have the adequate skills to |
| |follows: |make the change successful. This may be |
| |Unfreeze: Change agents effectively explain to |one of the biggest reasons why nursing |
| |employees the need for the change, and they |staff may feel apprehensive about the |
| |actively employ the opinions of the staff. |incorporation of electronic charting. |
| |Moving: The staff starts to implement the new |Management should assure that training |
| |procedures and by doing so they have the ability |will be available for all and extra help |
| |to see how necessary the change was. The |will be there for those that feel |
| |employees become less resistant to the change and |technologically challenged. |
| |begin to embrace it. |Management/change agents should also |
| |Refreezing: Changes are monitored and reinforced. |inform the nursing staff of the many |
| |The changes may be slightly altered at this stage |benefits this form of communication will |
| |(Borkowski, 2005). |create. Patients’ information will be a |
| | |few keystrokes away, instead of filed |
| |Lewin felt that change agents had to be take into |away somewhere and making it more |
| |account the negative feelings that employees may |difficult to access information when |
| |feel about the change, and that employees had to |needed; patient’s information will be |
| |be actively involved in the phases of change for |able to accessed wherever you are in the |
| |the change to be successful (Spector, 2010). |hospital. The staff involved in the care|
| | |of patient will be able to see up-to-date|
| | |information and it will increase patient |
| | |safety. Electronic charting will cut |
| | |down on paper work and should free up |
| | |time to attend the patient. A very |
| | |important quality of electronic charting |
| | |is the ability to read what the |
| | |physicians order, because so many nurses |
| | |complain about how illegible their |
| | |writing can be (Manjoney, 2004). |
| | |Management should have those nurses that |
| | |are technologically savvy help those that|
| | |are having a difficult time when the |
| | |moving phase starts. Nurses should be |
| | |encouraged when they see how easily the |
| | |other nurses are able to manage the |
| | |computers. It will take time for some |
| | |nurses to become comfortable with the |
| | |change. All of the nurses should be |
| | |acknowledged for how well they have |
| | |learned the new technology during the |
| | |refreezing process to encourage the |
| | |change to continue and to cement the |
| | |success that has been made and any |
| | |concerns should be addressed at this |
| | |time. |
|Kotter’s Change Model |John P. Kotter devised this change model based on |Kotter’s Change Model is very well suited|
| |his own personal business experience, research and|for a health care situation that will |
| |he also built upon Lewin’s findings. He wrote |greatly improve the care and safety of |
| |about what he found in a book named, Leading |patients. For example, if a hospital has|
| |Change that was written in 1996. The model uses |been experiencing a lot of medication |
| |eight steps to help organizations with the change |administration errors that has caused |
| |process. He developed these steps to fight the |patient harm and some of the medication |
| |“negative” feelings that can accompany change. |administration was potentially fatal, it |
| |“Kotter’s model provides tools for turning these |would cause the hospital to stop and |
| |negative feelings into positive proactive feelings|assess what could be done to greatly |
| |such as faith, trust, optimism, urgency, |decrease the errors. The hospital has |
| |reality-based pride, passion, excitement, hope and|been aware of how electronic medication |
| |enthusiasm” (Campbell, 2008). The steps include |administration has decreased the amount |
| |the following: |of medication errors so they believe that|
| |Build up the belief that there is an urgency for |it is important to implement it in their |
| |change. |hospital. They know that it will cost |
| |Create teams that have the ability to lead change.|the hospital a lot of money because of |
| |Make sure that the strategy for change is clearly |the new technology and the training that |
| |understood. |will have to be given to staff members, |
| |Always let people know why change is needed. |but the overall cost of adding the new |
| |Give people the ability or power to revise actions|technology will be a lot less expensive |
| |to make the plan work. |than the malpractice that happens when |
| |Acknowledge “short-term wins” when the charge is |patients are greatly harmed when given |
| |being implemented because it helps people see that|the wrong medication. Health care workers|
| |the change can be successful (Campbell, 2008). |are empathetic to the needs of patients, |
| |When there has been successful gain, build upon |and they have been a witness to the |
| |that success by enacting more possibilities for |errors or have heard of them. They |
| |change. This will give the change process power |themselves have wondered what could be |
| |and people will see the need to continue with it. |done to decrease the incidents. When the|
| |Make sure the new changes are firmly in place or |administrators introduce the staff to |
| |there will be the possibility that people will |electronic drug administration, the staff|
| |revert back to older policies or procedures. |is initially apprehensive about the new |
| | |technology, but the staff understands how|
| |Kotter put these eight steps into three stages. |important it is to enact new policy and |
| |Steps one to three are the first phase and it is |procedures to protect the patients. They|
| |called “creating a climate for change. Steps |understand the “urgency for change” and |
| |four, five, and six are the second phase which |they are not as resistance to the change.|
| |Kotter calls “engaging and enabling the whole | |
| |organization.” The last phase that encompasses | |
| |steps seven and eight is called, “implementing and| |
| |sustaining change” (Campbell, 2008). | |
| | | |
|Organizational Development Model |This model is different because its focus is on |This model would help a |
| |changing the behaviors the employees and also |hospital that it is suffering because of |
| |changing how the organization as a whole operates.|financial matters due to a culture of |
| |This model operates using the following ten |mediocrity and very low morale. The CEO |
| |perspectives: |may have tried many tactics to keep the |
| |Systems perspective: Success and better |hospital afloat, but to her dismay, |
| |performance is witnessed when all the components |things weren’t getting better. She |
| |of the organization work together. |decides to hire a consultant outside of |
| |Alignment perspective: Organizations operate |the organization that is knowledgeable |
| |better and are more successful when people, |about how to correct low morale issues in|
| |values, environment, etc. are in synchronization. |hospitals. The hospital has had many |
| |Participation perspective: People are more |complaints from patients about the |
| |concerned with seeing growth if they are involved |service they have received from different|
| |in the process of helping correct problems. |departments in the hospital. The |
| |Social capital perspective: Organizational leaders|consultant devises a plan that involves |
| |must development an atmosphere of trust to help |changing the entire system in the |
| |create better production. |organization. It would not just involve |
| |Teamwork perspective: There is a greater chance of|the employees, but it would involve those|
| |success when people work together. |higher up in the organization as well. |
| |Multiple stakeholder perspective: Organizational |The consultant advised the CEO that the |
| |leaders must take into account the needs of |change would take some time but the |
| |everyone; patients, nurses, physicians, managers, |entire culture of the hospital would |
| |the community, etc. |change to one that is focused on the care|
| |Problem-solving perspective: Conflict, when |of the patient. The employees are not |
| |occurring respectively, should not be seen as |happy with the changes that are taking |
| |something negative but as a means to come up with |place, but their attitudes start to shift|
| |better solutions |when they realize that they have a voice |
| |Open communications perspective: There should be |in the change process. They were made to |
| |an atmosphere where those higher in the |feel comfortable whenever they had |
| |organization can feel free to express their |suggestions to offer the leaders. |
| |opinions. |Eventually, the morale increased and the |
| |Evolution/revolution perspective: Organizations |hospital was thriving (Borkowski, 2005). |
| |must be able to successful handle small and large | |
| |changes. | |
| |Process facilitation perspective: People who don’t| |
| |belong to the organization can help those in the | |
| |organization. (Spector, 2010). | |
| | | |
| |Those ten perspectives are the cornerstone of this| |
| |model but its change implementation can be summed | |
| |up using three actions and they are: | |
| |Instead of focusing on one group, the entire | |
| |organizational system is being changed. | |
| |Make sure that there exists an environment where | |
| |communication is welcomed to bring about effective| |
| |change. | |
| |Use knowledgeable people outside of the | |
| |organization to help change. | |