Transcript The Nurse as Change Agent and Advocate Chapter 8 Origins of Change  Began in the 1990s  Continuing increase in health care costs 

The Nurse as Change Agent
and Advocate
Chapter 8
Origins of Change
 Began in the 1990s
 Continuing increase in health care costs
 Employees expected to become
multiskilled
 Presents challenges for both providers
and consumers
Types of Change
 Developmental change– changes or improvements in currently
used processes and operations
 Transitional change– Moves into a different pattern of
operation and structure
 Transformational change– creates a whole new set of attitudes and
appproaches
Change
 Driving forces for change
– See page 300 for examples of driving and restraining
forces
– External forces
•
•
•
•
Insurance companies
Government
New technology
See page 300 for examples of
– Internal forces
• Strategy for success
• New philosophy
 Planned –deliberate and conscious
 Unplanned- reactive change
Theories of Change
 Bridges’ transformational change
– Focuses on transitions of attitudes and beliefs
– Old must be given up
 Lewin’s force field theory of change
– Moving from one state to a new desired state
– Unfreezing, movement, and refreezing
 Coghlan and McAuliffe
– 5 tasks of change- determining the need,
defining the desired state, assessing,
implementing and managing it, and
consolidating it
Question
 Change in our health care delivery system is an
ongoing process. The view that stability in any
organization or system is achieved through a
balance or equilibrium of forces acting on the
situation is a component of which theory of
change?
A. Coghlan and McAuliffe
B. Bridges
C. Lewin
D. Bennis and Chin
C. Lewin
Answer
Rationale: another theory of change is the
force-field analysis described by Lewin.
Force-field analysis begins with the view
that stability in any organization or system
is achieved through a balance or
equilibrium of forces acting on the situation
(Lewin, 1951).
Strategies for Creating Change
 Environmental and adaptive strategy
 Power-coercive strategy
– Leader orders change
 Empirical-rational strategy– Change will be accepted if seen as desirable
 Normative-reeducative strategy (most
common)
– Change will take place only after attitudes,
values, skills etc. change
Leading and Managing Change
 Role of the change agent
– The person who seeks to lead or create change
– Demonstrate your commitment to change
– Believe in the necessity for planned change
 Managers of change
– Quality patient care continues
– Staff feel supported in doing their jobs
– Adverse effects of the change are mitigated
Facilitating the Change Process
Assessing the situation
– Identifying driving and restraining forces
– Understanding losses associated with change
– Recognizing resistance to change
• Lack of trust can be key
• Fear and loss of control
• Change fatigue- feel overwhelmed by the
expectations and lose enthusiasm
– Self-assessment
Facilitating the Change Process
(cont’d)
 Planning for change
– Developing trust
–Listening is very important
– Planning a response to concerns
– Fostering involvement
– Timing the change
Facilitating the Change Process
 Implementing the change
– Using a pilot project
– Providing resources and supports for change
– Managing the time frame
– Interpersonal processes for change
• Negotiation- find areas both sides can give
• Co-optation- enlist key people from opposition
• Coercion- threat of adverse effects
– Sustaining the change- “refreezing”
– Monitoring and evaluating the change process- story
board
Question
 Is the following statement true or false?
One reason that change fails is
recognizing the losses inherent in change.
False.
Answer
Rationale: as mentioned earlier, Bridges
(2003) suggests that there are many losses
in any change and failure to acknowledge
that loss is present is one reason for the
failure of change.
Effectively Participating in Change
Understanding the change
– Why it should occur
– Who it will benefit
– What is required for success
What is your place in the change?
– Viewed as positive or negative
– Participation is essential
Change Through Advocacy
 Definitions
– Pleading or arguing in favor of something
– Mediation- helping 2 parties work out an agreement
• Broker or responsible model- negotiation,
compromise and persuasion
• Adversarial model or legalistic- focus on rights of the
client without concern for others
– Empowerment of individual- advocate for self
 Background
– Ombudsman program (1978 Nursing Homes)
– American Nurses Association- ethical standard
Change Through Advocacy
(cont’d)
Prerequisite to effective advocacy
– Identify and define your own beliefs and
values
• Avoid paternalism- making decisions for the
person
– Clinical competence
– Believe that you have the right to speak up
Change Through Advocacy
(cont’d)
Assessing the need for advocacy
– Those who lack knowledge
– Those with little power
– Those who need to make decisions
– Those who receive inadequate care
– Those who are unable to communicate for
themselves
Question
 What is a prerequisite to being an effective
advocate?
A. Believe you know what is best for your
client.
B. Define your own beliefs and values.
C. Identify what family members believe
and value.
D. Be supportive of other health care
personnel.
Answer
B. Define your own beliefs and values.
Rationale: before being a client
advocate, you must identify and
define your own beliefs and values.
Advocacy Goals
Advocacy Outcomes
Advocacy Actions
 Preventing the need for advocacy
 Providing information and education
 Assisting and supporting client’s
decision making
Communicating with
Health Care Professionals
 Demonstrate knowledge and tact
 Include information about the client’s
concerns, questions, and expectations
 Call the appropriate physician
 Encourage direct communication between
the client and the appropriate health care
providers
Working for Changes in the
Health Care System
Advocate through understanding
– Organizational structure
– Volunteer for ethics committee
Make sure resources are available
– Clients need to select options that fit their
values and choices
– Community services
Being Involved in
Public Policy Formulation
 Expertise to be an advocate for the health
care needs
 Support legislation that benefits health
care consumers or makes needed services
available
 ANA encourages nurses to step forward as
the experts they are to speak to the media
Question
 One of the ways to be actively involved in the
formulation of public policy is:
A. Networking with other professionals at a
social level
B. Volunteering for planning committees in
professional organizations
C. Knowing who your congressional
representatives are
D. Being actively involved in nursing
organizations that work for programs and
services for clients
Answer
D. Being actively involved in nursing
organizations that work for programs and
services for clients
Rationale: the best ways to be actively
involved in formulation of public policy is
through nursing organizations that work
for programs and services for clients, and
network through professional
organizations, alumni groups, friends, and
coworkers.
Advocating for Other Staff
Members
Managers must address:
– Staff needs
– Staff requests
– Staff problems
– Staff rights
Requires careful judgment relative to the staff
member’s situation and the needs of the
agency
Constraints and Supports
 Constraints
– Conflict with other staff
– Lack of supports
– “Bucking the system”
 Supports
– Legal mandate for client rights
– Personal reward for quality care