Essentials of Nursing Leadership and Management, 5th Edition

chapter 8 | People and the Process of Change 109

because they are poorly conceived in the first place.
Ask yourself:

■What are we trying to accomplish?
■Is the change necessary?
■Is the change technically correct?
■Will it work?
■Is this change a better way to do things?

This is a good time to use creativity and innovation
(Handy, 2002). Encourage people to talk about the
changes planned, to express their doubts, and to
provide their input (Fullan, 2001). Those who do
are usually enthusiastic supporters later in the
process.

Planning

Now is the time to build a “road map” to guide you
on the journey from status quo to completed
change (McCarthy, 2005). All the information pre-
sented previously about sources of resistance and
ways to overcome that resistance should be taken
into consideration when deciding how to imple-
ment a change.
Remember that some research has found nurs-
ing staff to be resistant to change. You are likely to
find supporters, “fence-sitters,” and resisters within
your group (McCarthy, 2005). The supporters will
help you lead people on the path to change, but be
sure to include those who are neutral (the fence-
sitters) and opposed (the resisters) in the process
and to analyze why they might be resistant. Ask
yourself:

■Why might people resist this change?
■Is their resistance justified?

■What can be done to prevent or overcome this

resistance?

The context in which the change will take place is

another factor to consider when assessing resist-

ance to change (Lichiello & Madden, 1996). This

includes the amount of change occurring at the

same time, the organizational climate, the environ-

ment surrounding the organization, and past histo-

ry of change in the organization. Is there goodwill

toward change because it has gone well in the past?

Or have the changes gone badly, generating ill will

and resistance to additional change (Maurer,

2008)? There may be external pressure to change

because of the competitive nature of the health-

care market in the community. In other situations,

government regulations may make it difficult to

bring about a desired change.

Almost everything you have learned about

effective leadership is useful in planning the imple-

mentation of change: communicating the vision,

motivating people, involving people in decisions

that affect them, dealing with conflict, eliciting

cooperation, providing coordination, and fostering

teamwork. People have to be moved out of their

comfort zone to unfreeze the situation and get

them ready to change (Flower & Guillaume, 2002).

Consider all these things when formulating a plan

to implement a proposed change, then act on them

in the next step: implementing the change.

Implementing the Change

You are finally ready to embark on the journey that

has been carefully planned. Consider the following

factors:

■Magnitude:Is it a major change that affects

almost everything people do, or is it a minor one?

■Complexity:Is this a difficult change to make?

Does it require much new knowledge and skill?

How much time will it take to acquire them?

■Pace:How urgent is this change? Can it be done

gradually, or must it be implemented all at once?

■Stress:Is this the only change that is taking

place, or is it just one of many taking place?

How stressful are these changes? How can you

help people keep their stress at tolerable levels?

A simple change, such as introducing a new

thermometer, may be planned, implemented, and

integrated easily into everyone’s work routine. A

complex change, such as introducing a medication

Design the Change

Plan the Implementation

Implement the Change

Integrate the Change

Figure 8.3Four phases of planned change.