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Unit “ 10 “
CONTROLLING
Controlling
Final step in the management process:
actions taken to ensure that actual
outcomes are consistent with those
Planned and anticipated.
 Involves setting standard, measuring
performance, reporting the results, and
taking actions. (this lead to corrective
action).

Management of Change
Change: Change is the process of making
something different from what it was
Change Agent: the one who works to bring
about change
Change:
- The essence of life, it is as long as life goes on
- Necessary for growth.
- It often produces anxiety and fear.
- The process of making something different from
what it was.
There is a sense of loss the familiar the
status.
 Nurses are seeing change in the field of
patient care, new medications, new
equipment and new methods treatment
 Change can make crises or improvement
it depends on how the change is managed
-
Change strategies:
appropriate strategy depends upon the
power of the change agent and the
resistance expected
- Change agent should be able to facilitate
and implement change effectively by:
a. Focus on the appropriate change target
b.The willingness and ability to change
Change strategies:…cont.
1- Rational - empirical strategies:
 Based on the assumption that people are rational.
 Used when there is little anticipated resistance to
the change or the change is reasonable.
2- Normative - re - educative strategies:
 Participative strategy: participate in identifying the
problem, choosing solution and implementing the
change.
-Based on the assumption that people act according
to their commitment to socio cultural norms
- Does not require the change agent to have a
legitimate power base.
Change strategies:…cont.
The change agent gains power by skills in
interpersonal relationships.
 Change agent must be accepted, sensitive to
person’s perceptions and values and open trust
relationship.
3- Power – coercive strategy:
- based on the application of power: (economic
sanctions‫ عقوبات‬or political clout‫)نفوذ سياسي‬
- Based on the assumption that: People with less
power comply to the plans, directions and
leadership.

-
-
-
Individuals will only change when
rewarded or forced to change.
Resistance is handled by authority: the
person must accept it or leave.
Used when high resistance is expected
The individual will change to avoid threat,
peer pressure, or loss of job.
Used when immediate change is
necessary (The quicker strategy)
Should be combined with other strategies to have a
permanent change .
Change Theories:

Lewin's theory:
-
Lewin provides a social - psychological
view of change process.
He sees behavior as forces working in
opposite directions within a field
The process of change here is affected
by two types of forces :
Driving forces: facilitate change.
Restraining forces: keep system from
change
-
a.
b.
Lewin's theory:…cont.
The change agent begin by analyzing the
entire system in order to identify two
forces
 Stages needed before the planned change
becomes a part of the system:
1. Unfreezing stage
2. Moving stage.
3. Refreezing stage

.
Lewin's theory:…cont
1- Unfreezing Stage :
 Gather data:
- Problem identification
- Decide if change is needed.
- Motivate participants to change.
- Build a trust .
According to Lewin: create change occurs through
three mechanisms
A. Lack of confirmation:
- (Expectations have not been met).
B. Guilt and anxiety:
- Tension level system (goal is not met)
C. psychological safety:
- Providing sufficient security to minimize
the risk.
-People will feel comfortable and attempt
the change.
2- Moving Stage (Implementation)

-
The leader put the planned change into effect.
Move the target system to a new level of
equilibrium
Activities in which the leader will be engaged during
the changing phase:
Get participants to agree that current status is not
good
Develop a plan including persons will be
affected.
Sets goals and objectives
Identify areas of support and resistance.
Set target dates.
Introduce any new related information.
-
-
Encourage the new behavior.
providing support to avoid resistance to
change.
Ventilate the guilt and anxiety and other
feelings .
Provide feedback on progress to reinforce
the change process
Keep communications open.
Act as Energizer to keep interest high
Over come resistance (tactics of unfreezing
phase)
3- Refreezing Stage:
The change is stabilized and becomes a
part of the target system
 Leader continue to act as Energizer, and
delegates responsibility for change
behavior to others in the target system

An Example of change:
"The change to new computerized record
system" by using lewin's theory of change
The new system has several advantages
over the old one:
1. It requires less writing
2. Eliminate repetition
3. Quicker access to stored information
4. Provides total picture of the client’s progress
5. Different kinds of health care.
6. Strongly supported by the administrators and
executives
However:

None of the staff have ever used it before .

They also have not expressed any need to
change the old system

A side from staff members seem concerned
about providing high quality care .
The change identified the following:
I. Driving Forces:
1. Advantages of the new system
2. Administrative support for the system
3. Staff concern about quality care.
4. Staff ability to learn the new system
II. Restraining forces:
1. Lack of staff participation in the
selection of the system.
2. Little or no staff knowledge of the new
system.
3. Potential threat to staff feeling of
security (routine).
4. Potential threat to various disciplines
because of equal access to information
in the new system.
These opposing forces diagrammed in
the following figure :
Restraining
forces
Lack of staff
participation
No knowledge
of system
Threat to staff
security
threat to various
disciplines
Status quo
Driving forces Administrative
support
Advantages of the
new system
quality of care
ability to learn system
1- Unfreezing stage:
The change agent took the following actions:
A. Disconfirmation: (Actions )
- Meet with every staff member in small groups
to discuss inadequacies and problems found in
the old system.
B. Inducing guilt and anxiety: ( Actions )
- Demonstrate ways in which the old system
interferes with quality care
- Tell staff members how strongly administrators
support the new system .

C. Providing psychological safety:( Actions)
- Assure staff members that they will learn
the new system.
- Staff will be involved in planning the
implementation Phase.
- Point out similarities between old and
new systems .
- Express approval of staff concern for the
quality of the care given and confidence in
their ability to learn the system
2- Moving Stage (Changing)
a) Introduce new information:
Teach the staff how to use the new system.
b) Encourage the new behavior:
Begin with practice using examples from
ready situations
Have the staff begin using the new system
according to the plan.
c) Continue the supportive climate:
Allow a adequate time for learning and
practice before implementation.
d) Provide opportunities for ventilation:
Ask staff how they feel about the new system
and listen and respond to what they say
about it
e) Provide feed back and clarification of
Goals:
Check computerized records and evaluate
progress
Ask staff how well new system is working
f) Present your self as Trustworthy :
Open and direct communication
Make sure that all staff were include in
implementation as promised
g) Overcome resistance:
h) Act as Energizer:
Take every opportunity to promote the new
system.
Demonstrate interest in staff progress.
3- Refreezing Stage (change agent actions)
1) Continue acting as Energizer:
- Keep the new system visible through news
letters, meetings and so forth.
- Continue to show interest in staff progress and
feeling about the new system
2) Continue guiding new behavior:
- Continue to check computerized records to
see how well the new system is working
- Help staff correct mistakes and provide needed
information
3) Delegate increased responsibility to
others:
- the outcome of the new system is turned over
to the staff member and their supervisors
Comparison of Chang Models
Lewin
1- Unfreezing
2- Moving
Lippitt
Rogers
1- Diagnose problem
1- Building a
1- Knowledge
2-Assess motivation
relationship
2- Persuasion
3-Assess change
2 Diagnosing
3- Decision.
agent’s motivations
and resources.
the problem.
4- Select progressive
change
5- Choose change
3- Refreezing
Havelock
3-Acquiring resources
4- Choose the
solution
agent role.
5- Gaining
acceptance
6- Maintain change.
6- Stabilization
7- Terminate helping
relationship
4-implementation
5- Confirmation
Barriers of Change (Resistance)
1- Threatened self- Interest.
2- Inaccurate perception:
example, staff resist use of computer basing on the perception that computerization
will reduce their freedom in choosing working hours and days off.
3- Objective disagreement:
feel the change will benefit the organization.
4- Psychological reaction:
feel that their freedom has been threatened or
eliminated.
5- Low tolerance for change : (low self confidence)
 Change agent must understand why people resist
change and be able to deal with resistance.
Techniques for dealing with resistance:
1.
2.
3.
4.
5.
6.
7.
Participation: (persons affected by change)
Manipulation: (view change as less costly or more
beneficial).
Education: (for individuals about the change)
External agents: (outside the organization)
Incentives: ‫( حوافز‬the benefits)
Supportive behavior: (training new skill,
counseling services)
Gradual introduction: (change gradually)
Functions &characteristics of change agent:
1.
Developing specific, measurable objectives
2.
Listing techniques needed to
accomplish of activities .
Developing a timetable for completion
of activities.
Assessing resources.
Preparing a budget.
3.
4.
5.
Functions &characteristics of change agent…cont.
6. Selecting suitable persons needed for
change plan.
7. Designing a method evaluating the
outcome of activities
8. Anticipating resistance to change.
9. Developing strategies to manage
resistance
10. Designing a plan to stabilize (refreeze)
the change.