Unit “ 10“

CONTROLLING

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ControllingFinal step in the management

process: actions taken to ensure that actual outcomes are consistent with those Planned and anticipated.

Involves setting standard, measuring performance, reporting the results, and taking actions. (this lead to corrective action).

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Management of Change

Change: Change is the process of making something different from what it was

Change Agent: the one who works to bring about change

Change: - The essence of life, it is as long as life

goes on- Necessary for growth.- It often produces anxiety and fear. - The process of making something

different from what it was.

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- There is a sense of loss the familiar the status.

Nurses are seeing change in the field of patient care, new medications, new equipment and new methods treatment

Change can make crises or improvement it depends on how the change is managed

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Change strategies :appropriate strategy depends upon

the power of the change agent and the resistance expected

- Change agent should be able to facilitate and implement change effectively by:

a. Focus on the appropriate change target

b. The willingness and ability to change

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Change strategies:…cont. 1- Rational - empirical strategies:Based on the assumption that people are

rational.Used when there is little anticipated resistance

to the change or the change is reasonable.2- Normative - re - educative strategies:Participative strategy: participate in

identifying the problem, choosing solution and implementing the change.

-Based on the assumption that people act according to their commitment to socio cultural norms

- Does not require the change agent to have a legitimate power base.

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Change strategies:…cont.

The change agent gains power by skills in interpersonal relationships.

Change agent must be accepted, sensitive to person’s perceptions and values and open trust relationship.

3- Power – coercive strategy:- based on the application of power:

(economic sanctionsعقوبات or political clout سياسي (نفوذ

- Based on the assumption that: People with less power comply to the plans, directions and leadership.

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- Individuals will only change when rewarded or forced to change.

- Resistance is handled by authority: the person must accept it or leave.

- Used when high resistance is expected

- The individual will change to avoid threat, peer pressure, or loss of job.

- Used when immediate change is necessary (The quicker strategy)

Should be combined with other strategies to have a permanent change .

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Change Theories: Lewin's theory:- Lewin provides a social -

psychological view of change process.

- He sees behavior as forces working in opposite directions within a field

- The process of change here is affected by two types of forces :

a. Driving forces: facilitate change.b. Restraining forces: keep system

from change

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Lewin's theory:…cont.

The change agent begin by analyzing the entire system in order to identify two forces

Stages needed before the planned change becomes a part of the system:

1.Unfreezing stage 2.Moving stage.3.Refreezing stage

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Lewin's theory:…cont.1- Unfreezing Stage :Gather data: - Problem identification- Decide if change is needed.- Motivate participants to change. - Build a trust .

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According to Lewin: create change occurs

through three mechanisms A. Lack of confirmation: - (Expectations have not been met).B. Guilt and anxiety: - Tension level system (goal is not

met)C. psychological safety: - Providing sufficient security to

minimize the risk. -People will feel comfortable and

attempt the change.

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2- Moving Stage (Implementation)

- The leader put the planned change into effect.

- Move the target system to a new level of equilibrium

Activities in which the leader will be engaged during the changing phase:

- Get participants to agree that current status is not good

- Develop a plan including persons will be affected.

- Sets goals and objectives - Identify areas of support and resistance.- Set target dates. - Introduce any new related information.

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- Encourage the new behavior.- providing support to avoid

resistance to change.- Ventilate the guilt and anxiety

and other feelings .- Provide feedback on progress to

reinforce the change process - Keep communications open.- Act as Energizer to keep interest

high- Over come resistance (tactics of

unfreezing phase)

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3 -Refreezing Stage:The change is stabilized and

becomes a part of the target system

Leader continue to act as Energizer, and delegates responsibility for change behavior to others in the target system

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An Example of change: "The change to new computerized record system" by using lewin's theory of change

The new system has several advantages over the old one:

1. It requires less writing 2. Eliminate repetition 3. Quicker access to stored information 4. Provides total picture of the client’s

progress 5. Different kinds of health care.6. Strongly supported by the

administrators and executives

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However: None of the staff have ever used it

before . They also have not expressed any need to

change the old system A side from staff members seem

concerned about providing high quality care .

The change identified the following:I. Driving Forces:1. Advantages of the new system 2. Administrative support for the system 3. Staff concern about quality care.4. Staff ability to learn the new system

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II. Restraining forces:1. Lack of staff participation in the

selection of the system. 2. Little or no staff knowledge of

the new system. 3. Potential threat to staff feeling

of security (routine).4. Potential threat to various

disciplines because of equal access to information in the new system.

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These opposing forces diagrammed in the following figure :

Lack of staff participation

No knowledge of system

Threat to staff security

threat to various disciplines

Administrative support

Advantages of the new system

quality of care

ability to learn system

Restraining forces

Status quo

Driving forces

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1- Unfreezing stage: The change agent took the following

actions:A. Disconfirmation: (Actions )- Meet with every staff member in small

groups to discuss inadequacies and problems found in the old system.

B. Inducing guilt and anxiety: ( Actions )

- Demonstrate ways in which the old system interferes with quality care

- Tell staff members how strongly administrators support the new system .

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C. Providing psychological safety:( Actions)

- Assure staff members that they will learn the new system.

- Staff will be involved in planning the implementation Phase.

- Point out similarities between old and new systems .

- Express approval of staff concern for the quality of the care given and confidence in their ability to learn the system

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2 -Moving Stage (Changing)a) Introduce new information:Teach the staff how to use the new

system.b) Encourage the new behavior:- Begin with practice using examples

from ready situations - Have the staff begin using the new

system according to the plan.c) Continue the supportive climate:- Allow a adequate time for learning

and practice before implementation. d) Provide opportunities for

ventilation: - Ask staff how they feel about the new

system and listen and respond to what they say about it

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e) Provide feed back and clarification of Goals:

Check computerized records and evaluate progress

Ask staff how well new system is working

f) Present your self as Trustworthy :- Open and direct communication- Make sure that all staff were include

in implementation as promised g) Overcome resistance:h) Act as Energizer:- Take every opportunity to promote

the new system.- Demonstrate interest in staff

progress.

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3- Refreezing Stage (change agent actions)1) Continue acting as Energizer:- Keep the new system visible through

news letters, meetings and so forth.- Continue to show interest in staff progress

and feeling about the new system2) Continue guiding new behavior:- Continue to check computerized records

to see how well the new system is working

- Help staff correct mistakes and provide needed information

3) Delegate increased responsibility to others:

- the outcome of the new system is turned over to the staff member and their supervisors

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Comparison of Chang Models

Lewin Lippitt Havelock Rogers

1 -Unfreezing 1 -Diagnose problem

2-Assess motivation

3-Assess change

agent’s motivations and resources.

1 -Building a

relationship

2 Diagnosing

the problem.

3-Acquiring resources

1- Knowledge

2- Persuasion

3- Decision.

2- Moving 4- Select progressive change

5 -Choose change

agent role .

4- Choose the solution

5- Gaining acceptance

4-implementation

3 -Refreezing 6 -Maintain change.

7 -Terminate helping relationship

6- Stabilization 5 -Confirmation

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Barriers of Change (Resistance)1- Threatened self- Interest. 2- Inaccurate perception: example, staff resist use of computer basing on the

perception that computerization will reduce their freedom in choosing working hours and days off.

3- Objective disagreement: feel the change will benefit the organization.4- Psychological reaction: feel that their freedom has been threatened or

eliminated.5- Low tolerance for change : (low self

confidence)Change agent must understand why people

resist change and be able to deal with resistance.

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Techniques for dealing with resistance:

1. Participation: (persons affected by change)

2. Manipulation: (view change as less costly or more beneficial).

3. Education: (for individuals about the change)

4. External agents: (outside the organization)

5. Incentives: حوافز (the benefits)6. Supportive behavior: (training new skill,

counseling services)7. Gradual introduction: (change gradually)

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Functions &characteristics of change agent:

1. Developing specific, measurable objectives

2. Listing techniques needed to accomplish of activities .

3. Developing a timetable for completion of activities.

4. Assessing resources.5. Preparing a budget.

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Functions &characteristics of change agent…cont.

6. Selecting suitable persons needed for change plan.

7. Designing a method evaluating the outcome of activities

8. Anticipating resistance to change.

9. Developing strategies to manage resistance

10. Designing a plan to stabilize (refreeze) the change.