This multi-staged model describes how a human system might experience, react to, and then adjust to change over time (Smith, 2010). The components of this Model of change consist of six stages: the first stage: old status quo is the current norm, the second stage: foreign element is something happens that interrupts the familiarity of the status quo, the third stage: chaos is the reaction to a foreign element that throws you into chaos, the fourth stage: transforming ideas gives you a new understanding of what to do, you begin to see a way out of the chaos, the fifth stage: practice and integration: you start to try your new idea or new behavior. The last stage new status quo: the new norm. According to Emery, (2012) “it is the nature of individuals to resist change and cling to familiar ways of doing things”. The Old Status Quo the group is at a familiar place.
The performance pattern is consistent. Stable relationships give members a sense of belonging and identity. Members know what to expect, how to react, and how to behavior (Smith, 2012).Foreign Elements in this sage something happens that shatters the familiarity of the old status quo. A significant event that is internal or external seeking change that threatens the stability of familiar powers. Chaos the foreign elements throw you into chaos. In this stage, you are suddenly in unfamiliar waters where your things are unpredictable, and your usual pattern behaviors do not work. Your performance is affected and people around you may not act in unusual ways (Emery, 2012). Transforming ideas eventually the group transforms. You create lots of new ideas when you are in Chaos. Transforming ideas gives the group a new understanding of why’s, what and how’s. They began to see a way out of the chaos (Emery, 2012).
Integration and Practice is the period of assimilation, you are transforming ideas into your operation, and a new status quo begins. You learn quickly and make progress. You make lots of mistakes, and every now and then your progress slips back to old status quo. You learn what works and what doesn’t. You have become more skilled and your performance is back up. You sense you are moving towards a new status quo (Emery, 2012). The New Status Quo your performance began to level off as you master your new skill. You start to feel good about your rapid learning. With time, the newness fades, and the “new status quo” become the “old status quo” (Emery, 2012).| Satir’s change model can be applied to any organization large or small.
Hospital information is changing rapidly affecting clinicians both in ambulatory and primary care practice settings who are struggling to keep up with the pace of emerging technology. The demand for improvement in hospital safety, quality and performance reporting has made it necessary for this clinical transformation of its care practice process. Switching from paper to electronic medical record is one technological demand driven by Medicare and Medicaid coverage and reimbursement policies Transition from paper to computer documentation is still a challenge in health care (Straube, 2005). The process for documenting patient care was formalized during the years of Florence Nightingale’s practice the old status quo. Older nurses are having difficulty adapting to this change because their generation was driven by paper so they didn’t have to use the computer whereas the younger nurses have been exposed to technology must of their lives.
A foreign element has been implemented into the care environment this has disturbed the status quo Satir second stage of the change model. A primary care setting feed ac keas given by receptionist stating “no one has time to scan charts for a physician who brought 1,000 patients with him to the practice”. The arrival of the “foreign element” electronic medical record precipitates a period of “chaos” According to Kiel (2011). “This is both the most liberating and terrifying aspect of the Satir Model”. The old way is out paper charting and the new way is in electronic medical record computer charting. Satir is optimistic in the fourth stage of the change model transforming idea people are calm, listening, being optimistic at that point they are ready to engage in problem solving.
Not all transforming ideas are good you may have to try several times for chaos to achieve a renewed sense of direction (Kiel, 2011).Nurses that where apprehensive with the change from using paper charts to a computerized charting system where offered computer training classes, also some of the younger nurses offered to volunteer with in-house tutorial assistance. Chart software was purchase to help with staff development Rothenberg (2005). With integration and practice this stage of Satir’s change model the implementation of computerized charting nurses found themselves becoming more proficient in knowing more about computer technology and computer systems. According to Kiel (2011) “It is impossible to have too much support after implementation phase”.
The last stage of Satir change model “new status quo” the older nurses now believe using a computer is like turning pages in a book. You access different screens and follow assigned task, like pain management vital signs, and a third for I&O (Rose, 2011). | Kotter model| Kotter identified eight steps within the model after building on Lewin’s change model. Borkowski, 2005 identifies the following eight steps; (1) Establish a sense of urgency; This deals with the need for change and examines theOrganization’s crises, opportunity and competition.(2) Create a powerful guiding coalition; This should include all members not part of upper management. (3) Develop a vision; Create a vision for the change & strategies to achieve it.
(4) Communicate the vision; Using strategies and ways in which to communicate the vision, including new behaviors. (5) Empower others to act on the vision; Eliminate barriers to change & creative problem solving. (6) Plan for and create short-term wins; plans for vision improvement & recognize and reward staff involved.(7) Consolidate improvement & produce more change; using hiring, promoting and developing employees to create more change.(8) Institutionalize new approaches; Reinforce changes by highlighting connection between new behavior & Organizational success, ensure leadership succession (Borkowski, 2005). Utilizing Kotter’s model can be a guideline for all Organizations, when trying to implement a change process.
According Du Plessis 2011, the biggest mistake people can make during a change intervention is tostart the process before a high enough sense of urgency has been established. Complacency is the biggest resistance factor to overcome in a change intervention, especially if there is no major or visible crisis.| Kotter eight step model can be applied in both small and large Organizations. For a change process to take place it is important to communicate with the staff members what is going to be implemented. Member’s involvement is also a significant factor. Being involved allows the individual to feel valued which makes the transition much easier. According to Spector 2010, people will become more committed to implementing solution, if they have been involved in the problem-solving process. For change to stick, it has to be integrated into the total psychic framework or personality and has to be supported by others whose opinions and perceptions the person cares about. (Winter, 2002).
Many Organizations feel that there is a need for change to improve the effective and quality of services offered to their customers. Examining Kotter model has key aspects in a change process. Important aspects such as; need for change, member inclusion, strategies & problem solving, communication, rewards and recognition are all significant for small as well as large Organization to be successful. These key approaches will have less resistance and balance between the new structure and positive behavior among all staffs. Example of Organizations are health care settings; hospitals, nursing homes, and rehab facilities. | Complexity Theory| The complexity theory has emerged from the natural sciences in the 20ths century. It allows understanding of unexpected phenomena. The complexity theory (CT) has two applications.
The metaphorical application is used by social science and a mathematical application is implemented by the physical sciences. The complexity theory addresses the dynamic, nonlinear, and complex nature of systems or organizations. Complex systems have multiple subsystems interacting at the same time with one another by nonlinear intertwined feedback loops which can produce unexpected results (Sanger & Giddings, 2012). The complexity theory provides the following observations; first, small changes can generate massive or unpredictable changes. Second, changes applied under similar conditions are not guarantee to have the same outcomes. The results are unpredictable. Third, cause and effect are not continuous or directly proportional functions. Fourth, culture generates diversity so a standardization of processes cannot be implemented (Hoffman, 2012).
The butterfly effect is exhibited in complex systems. This idea makes it easy to understand and remember the essence of the complexity theory. The butterfly effect explains that “small changes in a complex system may lead to large, unpredictable changes over time” (Sanger& Giddings, 2012). This theory provides information on how the organization adapts to the environment and variable conditions.| The complexity model seems appropriate to deal with the constantly changing environment of the health care system. Managers and employees have to embrace the uniqueness of this system since they are forced to lead others particularly in the critical care environment. The Intensive Care Unit (ICU) involves medical, social, psychological, and intertwined interactions.
In addition, state and federal policies affecting the organization are considered as macro factors (Sanger & Giddings, 2012). Federal and state issues focus on reducing the high cost of medical care and improving patient quality of care. One way that most hospitals are meeting these requirements is by keeping current with scientific advances in the medical field. Continuing education and updated knowledge have been essential in order to incorporate change and provide optimal patient care. This is not enough to improve overall performance of a complex system. Principles of complexity theory need to be applied in order to achieve optimal goals (Hoffman, 2012).
The intensive care unit is a dynamic system affected by multiple factors interacting nonlinearly that can lead to unpredictable results. Complexity theory application can provide information on unexpected outcomes. Sedation administration, Rapid Response Teams (RRTs), and infection control are some of practices that will benefit from complexity theory application. Sedation administration in the ICU is done based on standard protocol in order to prevent failed spontaneous breathing, coma, and delirium. Unfortunately, more than 30% of patients still reported some of these symptoms. These unexpected results need to be evaluated using the complexity model (Hoffman, 2012).. |
Borkowski, N. (2005). Organizational Behavior in health care. Sudbury, MA: Jones and Bartlett. Du Plessis, M. (2011). Re-implementing an Individual Performance Management System as Change Intervention at Higher Education
Institutions – Overcoming Staff Resistance. Proceedings Of The European Conference On Management, Leadership & Governance, 105-115. Emery, D. H. (2011). Managing yourself through change. Retrieved from www.http:// dhemery.com/articles/managing_yourself_through_change.html Hoffman, L. (2012). High-Value health care: Implication from Complexity Theory. Critical Care Alert, 20(7), 49-21. Kiel, D. (2011). Leading People Through Change. Retrieved from: www. http://cfe.unc.edu/pdfs/leading_people.html Rose, J.F. (2011). Charting challenges. Retrieved from: www. http://news.nurse.com/article.html Rothenberg, B. (2005). Medical technology as a driver of healthcare cost. Retrieved www.bcbs.com Sanger, M., & Giddings, M. (2012). Teaching note a simple approach to complexity theory. Journal of Social Work Education, 48(2), 369-375. Schein, E. H. (2002, Winter). Models and tools for stability and change in human systems. Reflections, 4(2), 34-46. Retrieved from week 3 electronic reading. Smith, S, M. (2012). The Satir Change Model. Retrieved from www.http://stevensmith.com/ar-satir-change-model.html
Spector, B. (2010). Implementing organizational change: Theory into practice (2nd ed). Upper Saddle River, NJ: Pearson Prentice Hall.