Lewin’s Change Theory, Essay Example

Today’s NHS is rapidly changing, placing more emphasis on the managerial responsibilities of ward managers. Managing change is seen as being skilled at creating, acquiring and transferring knowledge to reflect new knowledge and insights. Defining core concepts is often difficult and requires the drawing on models/theories of change for guidance. Guidance from Kurt Lewin force field analysis demonstrates the complexities of the change process and how driving and resisting forces were incorporated within the planning and implementation phases. In our work I would like to view Lewin’s change theory and demonstrate how it can be applied to particular cases.

The psychologist Kurt Lewin offered a three-stage model of change, which enables a patient to get aware of the necessity to change his or her life and start making logical steps in the direction of a new chosen goal. This model is also known as unfreezing-change-refreeze one. So, the first stage includes understanding that changes are inevitable and, therefore, requires new forces for removal of the existing factors that influence the patient’s destructive behavior. As the person is apt to rejecting new things and ideas, the specialist should provide him or her with as much reliable information as possible. Moreover, encouragement is of high importance here, as it is the only means of reducing learning anxiety. The second stage is the act of changing itself. To be more exact, one should comprehend the gap between the present state and that desired and decide what needs to be changed. Activities which contribute to making the change include imitation of role models and looking for solutions through trial-and-error learning. Again here constant encouragement and guidance are required from a specialist. In addition, a patient should be provided with sufficient information on the problem and its possible consequences. The last stage consists in making the change permanent, which is making acquired concepts of behavior habitual, as well as establishing and development new interpersonal relationships. The specialist’s performance on this stage includes monitoring and evaluating new behavior, establishing proper conditions for changes to happen, and rewarding for satisfactory results. As the psychologist Leininger described this theory, “the basic idea is to “unfreeze” current methods, so that new ideas and implemented changes can be fixated and put into place and then to “freeze” these new procedures so that they will stick, and those affected by them can learn and become accustomed to the new process involving their work” (1991).

For Kurt Lewin behavior was determined by totality of an individual’s situation. In his field theory, a “field” is defined as ‘the totality of coexisting facts which are conceived of as mutually interdependent” (Bushe & Pitman, 1991). Individuals were seen to behave differently according to the way in which tensions between perceptions of the self and of the environment were worked through. The whole psychological field, or “life space”, within which people acted, had to be viewed, in order to understand behavior. Within this individuals and groups could be seen in topological terms (using map-like representations). Individuals participate in a series of life spaces (such as the family, work, school and church), and these were constructed under the influence of various force vectors (Bushe & Pitman, 1991).

According to the research (Bushe & Pitman, 1991), this model appears extremely adventurous, because, first, it involves previous planning and fact gathering and, second, focuses on the personal communication, which is a necessity in nursing. It should be also emphasized that a change process is considered here as a chain, which means that learning moves from one person to another, then on to the group and so on. In such a way an insignificant change may influence a group of people or even the whole organization. Moreover, according to Argyris, the notion “unfreeze” has been chosen by the author of the theory to emphasize that it takes individuals much effort to get read of old patterns of behavior, which means that to be successful the change process should be supported by “large force field of driving and restraining forces” (1990). Consequently, changing has to be carried out under complex psychological conditions because, as Argyris noted, just adding a driving force toward change often produced an immediate counterforce to maintain the balance. It means that restraining forces are extremely hard to fight, because they are, as a rule, personal psychological defenses. The peculiarities of these defenses depend strongly upon the individual’s type, which determines the necessity of a specialist to be a keen observer of a human nature.

However, some researches (Bushe & Pitman, 1991) state that one theory is not enough to provide an appropriate nursing process, which means that one should be aware of some other methods which may complement the main one. That is why I decided to view some more popular nursing theory which appeared helpful in terms of the problem faced – teenage pregnancy. Moreover, I will demonstrate them in regard to concrete situations and evaluate accordingly.

The problem we are going to view concerns change in staffing. It is evident that any change in any organization inevitably results in various kinds of crisis, both psychological and financial.

Patient safety and quality improvement efforts have grown impressively in recent years. Despite these gains, though, questions remain about the value of improving quality from both societal and hospital perspectives. From the societal perspective, the question is whether gains from improving quality reduce costs to patients, hospitals, and payers or, if they increase costs, whether the value of the quality improvement to patients justifies spending more on care. From the hospital perspective, the question is whether cost savings or revenue gains from improving quality offset the costs of quality initiatives—that is, whether there is a business case for quality. There is a compelling need to understand better the economic implications for all stakeholders of implementing quality improvement.

Moreover, the work environment of nurses, the largest segment of the nation’s health care work force, needs to be substantially transformed to better protect patients from health care errors, says a new report from the Institute of Medicine of the National Academies. The report calls for changes in how nurse staffing levels are established and mandatory limits on nurses’ work hours as part of a comprehensive plan to reduce problems that threaten patient safety by strengthening the work environment in four areas: management, work-force deployment, work design, and organizational culture.

The growing body of evidence linking hospital workforces to patient outcomes suggests that one way to improve quality is to increase nurse staffing. Because nurses are a large portion of hospital labor costs, the cost of increasing staffing would not be insignificant. The additional costs of having more nurses, however, should be offset to some extent by the monetary and nonmonetary benefits of reducing adverse outcomes.

There seem to be three ways to increase nurse staffing: raise the proportion of hours provided by registered nurses to the seventy-fifth percentile for hospitals below this level; raise the number of licensed nursing hours per day to the seventy-fifth percentile; and rise staffing to each of these levels in hospitals where each is below the seventy-fifth percentile. This percentile was chosen based on our judgment that attaining this level of staffing is feasible for most hospitals.

Along with changes in staff levels and hours, hospital restructuring initiatives include substantial changes in how nurses work. As hospitals try to respond to the financial pressures resulting from modifications to public and private insurance payment systems, their efforts altered the ways in which nurses are organized to provide care and, in many cases, undermined trust between nurses and management. As a key step toward improving nurses’ work environments and restoring trust, the report urges health care organizations to involve nurse leaders in all levels of management and to solicit input from nursing staff on decisions about work design and implementation. Nurses are in prime positions to help pinpoint inefficient work processes that could contribute to errors, identify causes of nursing staff turnover, and determine appropriate staff levels for each unit.

Speaking of Lewin’s Change theory in terms of the problem, it appears that the personnel should be given proper information on the issue and, consequently, convinced that drastic changes in the hospital should be made to normalize the situation or raise the effectiveness of work. It goes without saying that before giving her any kind of information the manager has to get acquainted with the peculiarities of relationships within an existing staff, as well as the financial situation in the hospital and patients’ attitudes to its work. Then, one should set about to planning and organizing the process of staff changing. To convince people that changes are essential one can apply Martha Rogers’ theory, which, as we have already said, viewed openness and pattern as the basis of successful nursing. According to her, openness and pattern are the most important in this kind of intervention (Alligood, 2006). Managers themselves should demonstrate confidence of their statements, as well as convince patients that they are not alone in their troubles.  Furthermore, they are to be ready to discuss sensitive issues in such a manner that no one feels ashamed or abased. As a consequent, stuff, as well as patients will begin to admire the decision to change something in hospital management and will surely take this behavior as a role model. It is the way Rogers’ concepts of nursing (openness and pattern) are working (Alligood, 2006).

The most difficult part of this stage is also to persuade the collective that there are no grounds for fears, in case she would take appropriate measures. So, the point is that the person should be knowledgeable about what should be done to avoid troubles and, therefore, feel confident in overcoming current obstacles.

Then, the particular actions had to be taken to recover the situation. First of all, people have to develop a positive outlook on the situation and behave accordingly. Second, one has to get on the right side of the existing personnel in order to meet with their support.  To add, on this stage, the staff has to comprehend that it is not a mistake, which caused the necessity of changes, but a good opportunity to improve working conditions. It is the very state of mind that can enable her to cope with difficulties they are in for.

The last stage included “refreezing”, that was new behavior was being actively developed and, therefore, substituted the old one. In our case, the staff, as well as patients, was really convinced that they had to accept the situation and make all that was in her power to get accustomed to a new situation and make it a pleasure to work in the hospital. Moreover, they got emotionally involved in the change process and did their best to recover from the shock and return to a normal working routine. To add, the way they behaved convinced us that they are ready to take active part in changing process and are able to cope with the problem and fully support the manager. Thus, in this case there was no need to control the process or give specific recommendations, as they felt responsible and aware of what was to be done in future. However, some guidance was given, as it was extremely important to ensure a complete change. Moreover, knowledge of the relationship of nurse staffing to patient outcomes is crucial to managing professional nursing resources and to optimizing patient care. It is important that the decisions influencing nursing staff deployment in delivering patient care be data driven. The outcomes to consider in any formal evaluation must be chosen by the sensitivity of those outcomes to nursing care. Researchers warn that it is difficult to selectively determine that patient care outcomes are the direct result of an isolated nursing or medical activity (Hegyvary, 1991).

Lewin’s Change theory seems to be very effective, as it calls for careful planning and individual work with people. Moreover, it enables an individual to get rid of destructive concepts, which conditioned the troubles, and create new ones, which are sure to contribute into developing new outlook on life. Constant guidance ensures also positive results. In our case the last stage was almost unnecessary, as the staff members understood what was to be done next themselves. It should be also emphasized that the application of additional theories enabled to make as effective as possible.

To conclude, we do not state that it is possible to get rid of this problem completely, as the analysis of our today’s community shows that there is still much to be done until we will be able to say for sure that there is nothing to be concerned about. However, there exist several theories of nursing which make it possible to ensure decent care for those who require it. So, in the first part of our work we considered Lewin’s Change theory, which is extremely helpful in our case of s. We made a conclusion that people should, first, be well informed about the current situation concerning said problem, that is know how to behave in it and, second, be aware the ways of avoiding it. In the second part of the work, we paid particular attention to coping with problem when it already occurred. In this case particular nursing practices are of major importance. Among them we pointed out Martha Rogers’ theory of openness and pattern. The main theory we considered is Lewin’s Change theory, as the most effective one.  In our opinion, it is these theories that can ensure an appropriate nursing (in our case it is preparation for changes in staff). Findings outline the benefits of a small scale change for staff, patients and the organization when successfully used to introduce a change of shift pattern within a progressively busy hematology day unit, in order to meet service demands without additional funding. Conclusions have been drawn in relation to the process and recommendations for practice made to further enhance care delivery within the unit.

References

Alligood, M. (2006). Nursing theory: Utilization & Application. Elsevier Health Sciences.

Argyris, C. (1990). Overcoming Organizational Defenses. Boston: Allyn & Bacon.

Bushe, G. & Pitman, T. (1991). Appreciative Process: A Method for Transformational Change. OD Practitioner. September, 1-4.

Gregg, A. (2002). Performance Management Data Systems for Nursing Service Organizations. Lippincott Williams & Wilkins, Inc.

Hegyvary, S. (1991). Issues in outcomes research. Journal of Nursing Quality Assurance, 5(2), 1-6.

Leininger, M. (1991). Culture care diversity and universality: A theory of nursing. New York: National League for Nursing.

Mercer, R. T. (1995). Becoming a mother. New York: Springer.

Parse, R. (1993). Theory of Health as Human Becoming. Sheila Bunting. Sage.