Deck 9: People and the Process of Change

Question 1

A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new director of nursing was brought in to replace the former one, who had retired after 30 years. The new director addressed the staff members at the reception held to welcome him. "My philosophy is that you cannot manage anything that you haven't measured. Everyone tells me that you have all been doing an excellent job here. With my measurement approach, we will be able to analyze everything you do and become more efficient than ever." The nursing staff members soon found out what the new director meant by his measurement approach. Every bath, medication, dressing change, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for. Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the "interruption" in his or her work. No one complained openly about the change, but absenteeism rates increased. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the sole staff member with their requests to "tell me how soon I can retire with full benefits." The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities.
What evidence of resistance to change can you find in this case study?

Answer 1

Situation:
A large health care corporation recently purchased a small 50-bed rural nursing home. A new director was appointed. He addresses the staff members and conveyed a new measurement approach through which every staff member would be analyzed for their performance.
Nurse Manager needs to review these data with staff members and question them any time for their mistakes. No one complained openly about the change, but absenteeism rate increased.
The director found that shortage of staff was becoming a serious problem and offered few good jobs opportunities in that rural area.
Resistance to change:
Resistance to change is the action taken by individuals and groups when they recognize that a change is occurring as a threat to them.
"Evidence of resistance to change":
A new director was appointed. He addresses the staff members and conveyed a new measurement approach through which every staff member would be analyzed for their performance.
The nursing staff members started to record time taken by each and every activity, medication for patients, dressing for patients, feeding of a resident, trip of unit had to be counted and episode of incontinence care.
Therefore, these all are the evidences of resistance to change in given situation.

Question 2

Describe the process of change.

Answer 2

Change process:
Change process is the process which changes from one state of nature to another.
The process change:
The basic stages of change process are given below:
1. Unfreezing
2. Change
3. Refreezing
Unfreezing:
It involves finding a method to change from an old pattern that was not productive to a productive new pattern. These stages state about the movement from one zone to another zone. The more the change is needed, the more motivation of change occurs.
Change:
This stage occurs when we make changes which are required. It involves change in feelings, behavior and thoughts that is more productive. This phase is hard for people as they are not sure whether the change will be successful.
Refreezing:
It establishes the changes as new practice so that it becomes permanent procedure in management. Without this last stage it is very easy to flip off to back old ways. People make new relationships and become comfortable with new pattern in routine.

Question 3

Why is change inevitable? What would happen if no change at all occurred in health care?

Answer 3

Change is inevitable:
Change is an inevitable part of living and working. How people react to change, the amount of stress it causes, and the resistance it produces can be influenced by good leadership.
To keep staff up-to-date, the leaders have to adapt to outside changes and lead others in an organization. Successful leader has failure documents, which are followed by success.
Transforming of the health care organization will be required to move from current state to another. Most changes can become opportunities for professional growth and development with which nurses and their clients have to cope.
The following are the reasons for no-change in health-care organizations:
• In case, the organization does not adapt to change, then it will be placed in the last when compared to competitors.
• If change does not happen, then there will be no professional growth and development.
• If change does not happen then everything will be the same, using old practices for patient's treatment.
• This can lose many opportunities to be the best in the market place.

Question 4

A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new director of nursing was brought in to replace the former one, who had retired after 30 years. The new director addressed the staff members at the reception held to welcome him. "My philosophy is that you cannot manage anything that you haven't measured. Everyone tells me that you have all been doing an excellent job here. With my measurement approach, we will be able to analyze everything you do and become more efficient than ever." The nursing staff members soon found out what the new director meant by his measurement approach. Every bath, medication, dressing change, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for. Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the "interruption" in his or her work. No one complained openly about the change, but absenteeism rates increased. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the sole staff member with their requests to "tell me how soon I can retire with full benefits." The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities.
What kind of resistance to change did the staff members exhibit?

Question 5

Recognize resistance to change and identify its sources.

Question 6

Why do people resist change? Why do nursing staff seem particularly resistant to change?

Question 7

A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new director of nursing was brought in to replace the former one, who had retired after 30 years. The new director addressed the staff members at the reception held to welcome him. "My philosophy is that you cannot manage anything that you haven't measured. Everyone tells me that you have all been doing an excellent job here. With my measurement approach, we will be able to analyze everything you do and become more efficient than ever." The nursing staff members soon found out what the new director meant by his measurement approach. Every bath, medication, dressing change, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for. Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the "interruption" in his or her work. No one complained openly about the change, but absenteeism rates increased. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the sole staff member with their requests to "tell me how soon I can retire with full benefits." The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities.
Why did staff members resist this change?

Question 8

Suggest strategies to reduce resistance to change.

Question 9

How can leaders overcome resistance to change?

Question 10

A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new director of nursing was brought in to replace the former one, who had retired after 30 years. The new director addressed the staff members at the reception held to welcome him. "My philosophy is that you cannot manage anything that you haven't measured. Everyone tells me that you have all been doing an excellent job here. With my measurement approach, we will be able to analyze everything you do and become more efficient than ever." The nursing staff members soon found out what the new director meant by his measurement approach. Every bath, medication, dressing change, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for. Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the "interruption" in his or her work. No one complained openly about the change, but absenteeism rates increased. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the sole staff member with their requests to "tell me how soon I can retire with full benefits." The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities.
If you were a staff nurse at this facility, how do you think you would have reacted to this change in administration?

Question 11

Assume a leadership role in implementing change.

Question 12

Describe the process of implementing a change from beginning to end. Use an example from your clinical experience to illustrate this process.

Question 13

A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new director of nursing was brought in to replace the former one, who had retired after 30 years. The new director addressed the staff members at the reception held to welcome him. "My philosophy is that you cannot manage anything that you haven't measured. Everyone tells me that you have all been doing an excellent job here. With my measurement approach, we will be able to analyze everything you do and become more efficient than ever." The nursing staff members soon found out what the new director meant by his measurement approach. Every bath, medication, dressing change, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for. Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the "interruption" in his or her work. No one complained openly about the change, but absenteeism rates increased. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the sole staff member with their requests to "tell me how soon I can retire with full benefits." The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities.
How do you think the director of nursing handled this change? What could the nurse managers and staff nurses do to improve the situation?

Question 14

A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new director of nursing was brought in to replace the former one, who had retired after 30 years. The new director addressed the staff members at the reception held to welcome him. "My philosophy is that you cannot manage anything that you haven't measured. Everyone tells me that you have all been doing an excellent job here. With my measurement approach, we will be able to analyze everything you do and become more efficient than ever." The nursing staff members soon found out what the new director meant by his measurement approach. Every bath, medication, dressing change, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for. Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the "interruption" in his or her work. No one complained openly about the change, but absenteeism rates increased. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the sole staff member with their requests to "tell me how soon I can retire with full benefits." The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities.
How could the new administrator have made this change more acceptable to the staff ?