104 unit 2 | Working Within the Organization
When asked the theme of a nursing management
conference, a top nursing executive replied,
“Change, change, and more change.” Whether it is
called innovation, turbulence, or change, this theme
seems to be a constant in the workplace today.
Mismanaging change is common. In fact, as many
as three out of four major change efforts fail
(Cameron & Quinn, 2006; Hempel, 2005). This
chapter discusses how people respond to change,
how you can influence change, and how you can
help people cope with it when it becomes difficult.
Change
A Natural Phenomenon
Change is a part of everyone’s lives. Every day, peo-
ple have new experiences, meet new people, and
learn something new. People grow up, leave home,
graduate from college, begin a career, and perhaps
start a family. Some of these changes are mile-
stones, ones for which people have prepared and
have anticipated for some time. Many are exciting,
leading to new opportunities and challenges. Some
are entirely unexpected, sometimes welcome and
sometimes not. When change occurs too rapidly or
demands too much, it can make people uncomfort-
able (Bilchik, 2002), even anxious or stressed.
Macro and Micro Change
The “ever-whirling wheel of change” (Dent, 1995,
p. 287) in health care seems to spin faster every
year. By itself, managed care profoundly changed
the way health care is provided in the United States
(Trinh & O’Connor, 2002). Medicare and
Medicaid cuts, increasing numbers of people who
are uninsured or underinsured, restructuring,
downsizing, and staff shortages are major concerns.
Such changes sweep through the health-care sys-
tem, affecting patients and caregivers alike. They
are the macro-level(large-scale) changes that affect
virtually every health-care facility.
Change anywhere in a system creates “ripples
throughout the system” (Parker & Gadbois, 2000,
p. 472). Every change that occurs at this macro
level filters down to the micro level(small-scale
change), to teams and to individuals. Nurses, col-
leagues in other disciplines, and patients are parti-
cipants in these changes. This micro level of change
is the primary focus of this chapter.Change and the Comfort Zone
The basic stages of the change process described by
Kurt Lewin in 1951 are unfreezing, change,and
refreezing(Lewin, 1951; Schein, 2004). Imagine a
work situation that is basically stable. People are
generally accustomed to each other, have a routine
for doing their work, and believe they know what
to expect and how to deal with whatever problems
come up. They are operating within their “comfort
zone” (Farrell & Broude, 1987; Lapp, 2002).
A change of any magnitude is likely to move peo-
ple out of this comfort zone into discomfort. This
move out of the comfort zone is called unfreezing
(Fig. 8.1). For example:
Many health-care institutions offer nurses the
choice of weekday or weekend work. Given these
choices, nurses with school-age children are likely to
f ind their comfort zone on weekday shifts. Imagine
the discomfort they would experience if they were
transferred to weekends. Such a change would rap-
idly unfreeze their usual routine and move them
into the discomfort zone. They might have to f ind
a new babysitter or begin a search for a new child-
care center that is open on weekends. Another alter-
native would be to establish a child-care center
where they work. Yet another alternative would be
to f ind a position that offers better working hours.Unfreezing Change RefreezingComfort
ZoneNew Comfort
ZoneDiscomfort
ZoneFigure 8.1The change process. (Based on Farrell, K., & Broude, C. [1987].Winning the Change Game: How to Implement
Information Systems With Fewer Headaches and Bigger Paybacks.Los Angeles: Breakthrough Enterprises; and Lewin, K.
[1951].Field Theory in Social Science: Selected Theoretical Papers.N.Y.: Harper & Row.)