Exam 3 content: Planned Change (Ch. 8)

Question 1

what forces are driving change in HCS?

Answer 1

Rising health care costs
Declining reimbursements
Workforce shortages
Increasing technology
Dynamic nature of knowledge
Growing elderly populations

Question 2

why do HCO change?

Answer 2

Upgrade their structure
Promote greater quality
Keep their workers

Question 3

what is the continual change in health care?

Answer 3

Organizational Restructuring
Quality Improvement
Employee Retention

Question 4

what is the definition of planned change?

Answer 4

• Deliberate application of knowledge & skills by a leader to bring about change
• Well thought out effort to make something occur.

Question 5

what is a “change agent”?

Answer 5

Person skilled in theory and implementation of planned change

Question 6

what are change agent challenges?

Answer 6

Organizations tend to reject outside change agents.
~ Perceived as lacking information.
~ Motives are not trusted

Inside agents are influenced by personal bias.

Change agents must have sensitivity to needs of the organization

Question 7

what are L&M functions in planned change?

Answer 7

• Well developed organizational skills
• Vision & expert planning skills
• Ongoing evaluation of organization goals
• Changes implemented based on evaluation organization needs
• Appropriate use fiscal & human resources
• Be visionary & flexible in adapting to change

Question 8

what is change theory?

Answer 8

• Classic Change Theory by Kurt Lewin (1951)
• He stated change should be implemented for good reason
• It should be gradual
• Should be planned, and not sporadic or sudden
• All individuals who would be affected by the change, should be involved in the planning.
• Lewin identified three phases
• Change agent must be involved in the entire process
• Unfreezing, Movement, and Refreezing

Question 9

what is “unfreezing stage”?

Answer 9

Unfreeze the forces that maintain the status quo

People become discontented and aware of a need for change. People may feel anger.

Convince members of the group to change when guilt, anxiety, or concern can be elicited and most importantly anger!

Make a through and accurate assessment of the extent and interest of the change

Implement change for good reason

Coerce members of the group to change, or when guilt, anxiety, or concern can be elicited

Question 10

what is movement?

Answer 10

Identify, plans, and implements appropriate strategies

Ensures that driving forces exceeds restraining forces

Implement gradually and for good reason

Allow time change to be fully assimilated

Question 11

what is refreezing?

Answer 11

Assist in stabilizing the system so that it becomes integrated into the status quo

Be supportive

Reinforce

Takes 3 – 6 months to be accepted

Make a commitment to be available until the change is complete

Refreezing does not eliminate the possibility of further improvements to the change

Question 12

what are Lewin’s Driving and Restraining Forces?

Answer 12

Driving forces (facilitate) - The forces that push the system towards change
	- desire to please your boss, eliminate a problem, pay raises, and receiving recognition, healthcare (private health insurance program premiums are above what consumers can afford)

Restraining forces (barriers)-The forces that pull the system away from change
	- resistance, bad timing, lack of power

Question 13

what is necessary for practice changes to occur?

Answer 13

Must feel a need for change (unfreezing)

A helping relationship between the change agent and his patient (Movement)

Problem is identified and clarified

Alternatives for change are examined

Resources are assessed

Active modification occurs

Movement is complete

Refreezing occurs; change is stabilized

The helping relationship ends

Question 14

what should you know about resistance?

Answer 14

Expected Response to Change

Level of resistance is based on type of change
~ Technological changes involve less resistance
Changing IV pump

~ Perceived social changes that are contrary to customs or norms involve more resistance.
` Change in who is able to administer certain types of IV therapy.

It is easier to change knowledge levels than attitudes

Values, education, culture, experiences & social background affect level of resistance to change

Question 15

what should you know about resistance to change?

Answer 15

Because change disrupts the homeostasis or balance of the group, resistance should always be expected

It’s a natural and expected response to change

Encourage subordinates to speak openly so that options can be identified to overcome objections

Change should be planned and implemented GRADUALLY!

Question 16

what are some strategies to minimize resistance to change?

Answer 16

Established trust & rapport with workers

Encourage subordinates to speak openly

Encourage workers to share their perceptions of the forces driving changes

Then, assess the need for support & resources

See & share the vision of what the future state will be after the change is implemented

Experienced change agent & project champion

Question 17

what is the needed change to impact 21st century organization dynamics?

Answer 17

21st Century organizations are contemporary

- Change is unforeseeable & ever present
- HCS’s long term outcomes are unpredictable
- This unpredictability can not be managed with traditional linear theories (Lewin)

Nonlinear theories are needed to managed change in this unpredictable society

Question 18

what is Complex Adaptive Systems (CAS)?

Answer 18

a Nonlinear Change Theory

The relationship btwn elements & agents within a system is nonlinear & are constantly in motion for change

Change agents must examine the focus of the relationships & interactions involved in change

Question 19

what is Chaos Theory (Butterfly Effect)?

Answer 19

Nonlinear Change Theory

Determine the underlying order in the random information in a changing system

Hidden variables must be explored before change is considered

This chaos makes it difficult to determine the future

Question 20

what should you know about organization aging? what is it?

Answer 20

Organizational Aging: Change as a Means of Renewal

Organizations progress through developmental phases.

As organizations age, they become more stable

Young organizations: High energy & fluid

Aged organizations: Established turf, control & change is limited.

Organizations must have balance

Without change; organizations stagnate/die

Question 21

how should you integrate leadership and management in planned change?

Answer 21

Understand plan of action & implement.

Be aware of restraining/driving forces.

Provide tools/resources needed for change.

Be productive in a chaotic changing system.

Know the trends & changes facing your system.
Big picture focus.

Integrate vision, adapt to change & know when change is needed.

Model professional skills.