108 unit 2 | Working Within the Organization
Providing Psychological Safety
As indicated earlier, a proposed change can threaten
people’s basic needs. Resistance can be lowered by
reducing that threat, leaving people feeling more
comfortable with the change. Each situation poses
different kinds of threats and, therefore, requires
different actions to reduce the levels of threat; the
following is a list of useful strategies to increase
psychological safety:
■Express approval of people’s interest in
providing the best care possible.
■Recognize the competence and skill of the
people involved.
■Provide assurance (if possible) that no one will
lose his or her position because of the change.
■Suggest ways in which the change can provide
new opportunities and challenges (new ways to
increase self-esteem and self-actualization).
■Involve as many people as possible in the design
or plan to implement change.
■Provide opportunities for people to express their
feelings and ask questions about the proposed
change.
■Allow time for practice and learning of any new
procedures before a change is implemented.
Dictating Change
This is an entirely different approach to change.
People in authority in an organization can simply
require people to make a change in what they are
doing or can reassign people to new positions
(Porter-O’Grady, 1996). This may not work well if
there are ways for people to resist; for example:
■When passive resistance can undermine the change
■When high motivational levels are necessary to
make the change successful
■When people can refuse to obey the order with-
out negative consequences
The following is an example of an unsuccessful
attempt to dictate change:
A new and insecure nurse manager believed that her
staff members were taking advantage of her inexperi-
ence by taking more than the two 15-minute coffee
breaks allowed during an 8-hour shift. She decided
that staff members would have to sign in and out for
their coffee breaks and their 30-minute meal break.
Staff members were outraged. Most had been taking
fewer than 15 minutes for coffee breaks or 30 minutes
for lunch because of the heavy care demands of theunit. They refused to sign the coffee break sheet. When
asked why they had not signed it, they replied “I for-
got,” “I couldn’t f ind it,” or “I was called away before
I had a chance.” This organized passive resistance was
suff icient to overcome the nurse manager’s authority.
The nurse manager decided that the coffee break sheet
had been a mistake, removed it from the bulletin
board, and never mentioned it again.For people in authority, dictating a change often
seems to be the easiest way to institute change: just
tell people what to do, and do not listen to any
arguments. There is risk in this approach, however.
Even when staff members do not resist authority-
based change, overuse of dictates can lead to a pas-
sive, dependent, unmotivated, and unempowered
staff. Providing high-quality patient care requires
staff members who are active, motivated, and highly
committed to their work.Leading the Implementation
of ChangeNew graduates may find themselves given respon-
sibility for bringing about change. Following are
examples of the kinds of changes they might be
asked to help implement:
■Introduce a new technical procedure
■Implement evidence-based practice guidelines
■Develop new policies for staff evaluation and
promotion
■Participate in quality-improvement and patient-
safety projects
■Prepare for accreditation reviews and safety
inspectionsNow that you understand how change can affect
people and have learned some ways to lower their
resistance to change, taking a leadership role in suc-
cessful implementation of change is presented.
The entire process of bringing about change can
be divided into four phases: designing the change,
deciding how to implement the change, carrying
out the actual implementation, and following
through to ensure the change has been integrated
into the regular operation of the facility (Fig. 8.3).Designing the Change
This is the starting point. The first step in bringing
about change is to craft the change carefully. Not
every change is for the better: some changes fail