Kurt Lewin's Change Theory Analysis

Patients have the right to self-determination and individuals should have control over their own lives. With respect for human autonomy comes respect for patient rights. Apart of the nurses job is to promote, advocate and protect the rights, health, and safety of our patients. Patients have the right to determine their health needs, make informed decisions, and the right to information regarding their treatment and also the refusal of treatment. Nurses are obligated to know the rights of a patient and to make sure the patient understands their treatment plan. Supporting patient autonomy includes making decisions in the best interest of the patient, considering their values and recognizing differences between cultures. In the treatment

Duke University Children's Hospital was facing a financial crisis in 1996 that required turnaround and transformation in order for the hospital to survive (Spector, 2013). On top of the financial crisis, caused by decreased Medicaid allowances and an increase in capitated reimbursement patients, patient and staff satisfaction had reached an all-time low (Spector, 2013). The hospital's chief medical director, Jon Meliones, understood that the hospital could only do so much to control their financial outcomes and a united front would be needed to bring about effective and impactful change (Spector, 2013).

Kurt Lewin's Change Theory consists of three distinct and vital stages, "Unfreezing", "Moving to a new level or Change" and "Refreezing" (1995,Schein). The three step process provides a high level approach to change, as it help us implement a change effort with a framework. Unfreezing will involve finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. If a structure that is not secure has been in place for a long time, habits, and routines naturally settle in. It has been observed that St.Michael's Hospital nursing staff in M3 have a standard process that has strayed off course when it comes to hand off report. The SBAR sheet and verbal report as stated in the hospital protocol for shift report, is not being applied as stated. Nurses have shown to leave out important information from outgoing nurse to oncoming nurse and have been observed throughout the hallway and nurses station having discussions for hand off report, and a few have not used the SBAR sheet at all. The whole process of hand off report is unorganized and lacks in communication. Unfreezing will get nurses to gain a new perspective on

Implementing a change in practice within these environments can produce anxiety or fear of failure in nurses, leading to a resistance to change. Several studies (Bozak, 2003; Lehman, 2008; Spetz, Burgess & Phibbs, 2012) expounded the need for a concise plan and clear communication between nurses and management when implementing a change of this nature. The use of Lewin’s Change Management theory can support nurses through the transitions and identify areas of strengths and resistances prior to implementing change. Without a framework for guidance, it can be difficult to keep on track.

“The purpose of public policy is to direct problems to government and secure government’s response, while politics is the use of influence to direct the responses toward goals” (Milstead, 2013, p. 12). Policies are used as guidelines to reach a common goal. In healthcare, policies can affect and have an impact on how we provide care for our patients’. For this reason, it is important for nurses to be knowledgeable and involved in important healthcare decisions. “Knowledgeable nurses in advanced practice must demonstrate their commitment to action by being a part of relevant decisions that will ensure the delivery of quality health care by appropriate providers in a cost-effective manner” (Milstead, 2013, p. 1).

Throughout nursing, there are many theories that nurses may come across and use. Calista Roy’s and Betty Neuman are two theorists that use two different types of models to encompasses the health, person, and the environment. Callista Roy uses a theory that promotes adaptation to the stimuli a person may encounter. Betty Neuman uses a theory that promotes equilibrium in a time where a person will encounter stress. These theories allow the nurse to bring a knowledge to learn more about the person and the factors that influence their health. Although with any theory there are different approaches in how the nursing plan is done, but with the patient in mind, it makes the difference in care that is given and allows for better outcomes for the patient.

Shirey (2013) wrote about Lewin’s theory of change in which three stages individuals move through before change is

The Change Theory was developed by Kurt Lewin. He identified three stages in change: unfreezing, changing, and freezing. According to Lewin, in order to be successful in implementing a change, people must go through all three steps. The first step is understanding that a change is necessary. In the scenario, the staff may have been comfortable with their routine and disregarded the moderate sedation policy because no sentinel events had occurred previously. To unfreeze this behavior the staff must acknowledge their behavior and realize a change is needed. A thorough review of the findings that lead to the death of Mr. B will may assist the staff in recognizing the need for change. The second step is the “change”. In this stage the staff would update the moderate sedation policy and implement the recommended changes. Such as, one on one nursing monitoring, vital sign monitoring, and completing or updating required education. The third is “Freezing”. In this step the staff has implemented and performed the desired changes until they have become the standard practice. This will reduce the likelihood

Ludwick, R., Zalon, M. L., Patton, R. M., & American Nurses, A. (2014). Nurses Making Policy

Implementing change can evoke stress, and nurses are not immune to this stress brought on by change, or this stress might be amplified due to the fact that nurses are usually at the forefront of change. Any change that is initiated in the healthcare industry will impact how nurse perform their duty, and can negatively can affect their workflow if extra precaution is not taken. Thus, nurses are a major force in resistance to

Nurses are constantly challenged by changes which occur in their practice environment and are under the influence of internal or external factors. Due to the increased complexity of the health system, nowadays nurses are faced with ethical and legal decisions and often come across dilemmas regarding patient care. From this perspective a good question to be raised would be whether or not nurses have the necessary background, knowledge and skills to make appropriate legal and ethical decisions. Even though most nursing programs cover the ethical and moral issues in health care, it is questionable if new nurses have the depth of knowledge and understanding of these issues and apply them in their practice

Lippitt’s Phases of Change Theory Lippitt, Watson, and Westley (1958) extend Lewin’s Three-Step Change Theory. Lippitt, Watson, and Westley created a seven-step theory that focuses more on the role and responsibility of the change agent than on the evolution of the change itself. Information is continuously exchanged throughout the process. The seven steps are:

The second step in the change theory is the transition stage. Once people are unfrozen, the problem now shifts to how to keep them going. This is now the actual change process a stage that is characterized by confusion as people try to change from the old to new ways. This stage is further characterized by fear because people tend to be unsure and is the hardest step in the whole process (Schein, 1995). During transition, new behaviors are developed, values and attitudes. It is achieved through development techniques and change in existing organizational structures. People undergoing this stage need to be given ample time to adapt to new ways. Of uttermost importance during this stage is support. Support is offered in terms of coaching and training as well as acceptance that mistakes will be part of the transition process (Smith, 2001).

Unfreezing stage clear communication must be provided which is still valid today. The communication must include a sense of urgency and help employees understand why the change is needed. In order for change to occur, employees must be prepared for the change. They must also feel that their position is secure and that they will receive support from all levels through the implementation of the change. Additionally, employees should be a part of the change process to ensure they still feel empowered within the organization.

After the uncertainty created in the unfreeze stage, the change stage is where people begin to resolve their uncertainty and look for new ways to do things. People start to believe and act in ways that support the new direction.