Lewin’s Three-Step Change Theory in Nursing

Introduction

Change processes are inevitable in every sphere of life because change is crucial for development. Changes frequently become a problem due to the resistance of stakeholders and other obstacles. Change theories are supposed to empower the process of change and make it less painful for the parties involved. Thus, this paper will provide an analysis of Lewin’s Three-Step Change Theory in the context of nursing, review stakeholders and their considerations concerning the change project, predict possible obstacles, and provide strategies for their overcoming. The applied theory is going to manage a project dedicated to the comparison of the effectiveness of increased patient education and participation with regular exercise/physical therapy to current hospital fall prevention programs with limited exercise/physical therapy.

Change Theory and its Impact on the Change Project Implementation

Change theories can be applied to organizations or separate projects in various spheres, including nursing. The American Organization of Nurse Executives singles out five nurse executive competencies such as “communication, knowledge, leadership, professionalism, and business skills” (Shirley, 2013, p. 69). The demand within the category of leadership is the demonstration of change management skilfulness by nurse executives. It is important to choose an appropriate change theory to facilitate the stages of project implementation, management, and evaluation.

One of the theories that are frequently used in nursing is the one developed by Kurt Lewin, the pioneer of change theories (Shirley, 2013). Lewin was the first to identify three stages that have to be passed to implement a change (Mitchel, 2013). Thus, he singled out unfreezing, moving, and refreezing as significant phases of change. Unfreezing presupposes preparation for change. During this stage, a change agent or a nurse leader is supposed to realize the existing problem, establish the need for change, and inform other stakeholders about the need for change. The moving or transitioning stage requires treating change as a process. In fact, transitioning includes the inner movement of a person who realized the necessity of change. This stage “necessitates creating a detailed plan of action and engaging people to try out the proposed change” (Shirley, 2013, p. 70). During this stage, it is important to reveal and overcome fears and manage communication between the involved parties to avoid misunderstanding that can become an obstacle on the way to the final goal. Finally, refreezing comprises “stabilizing the change so that it becomes embedded into existing systems such as culture, policies, and practices” (Shirley, 2013, p. 70). The third stage is crucial for institutionalizing change. Also, it contributes to a change in sustainability in the future.

In the case of managing change in patient education, it is possible to apply Lewin’s theory. For this project, the unfreezing stage includes an analysis of the current situation. The existing hospital fall prevention program with limited exercise/physical therapy is not efficient. Awareness of the problem leads to the demand for change. Thus, it is supposed that interventions of patient education and regular exercises can be effective for senior hospitalized patients. The second stage of the theory will contribute to the development of a detailed plan of patient education interventions. Moreover, this stage defines the responsible parties and outlines the expected outcomes. Also, it is important to assess the possible risks of the planned interventions. Finally, the third stage of the theory is used to manage the assessment of the planned interventions. In case they are efficient, it is possible to use them on a regular basis. On the whole, Lewin’s Three-Step Change Theory is useful for managing the process of change in nursing because it helps to follow all-important stages and make the change project more efficient.

Stakeholders Involved with Change Proposal and Stakeholder Considerations I

Since the change project is implemented in a hospital, it involves different groups of stakeholders. Major stakeholders are patients, nurses, and administration of the healthcare facility. Patients’ relatives are minor stakeholders. A primary concern of all stakeholders is patients’ safety. For patients, who are elderly people in this project, safety is important because falls in hospitals can negatively influence their health. However, they can be suspicious concerning a new project since senior patients do not accept changes eagerly. Nurses will be managing the project implementation. Thus, they are supposed to be positive about the project and consider it an opportunity to improve patient outcomes. Hospital’s administration is a controlling party in the change process. They will benefit from the successful project implementation, but also should control the adherence to nursing standards. Patients’ relatives, although being minor stakeholders, are concerned about the health and safety of their family members and can oppose changes in case they consider the project dangerous or not effective. It is important to learn the considerations of all stakeholders to predict if they can create obstacles for the change in project implementation.

Strategies to Overcome Stakeholder Resistance to Change

Resistance to change is a common aspect of a change process. Resistance to change in this project can be managed with the help of Lewin’s theory. During its unfreezing stage project manager should predict the possible reasons for resistance and address them during the moving stage. Thus, an informative strategy can be applied. Stakeholders should be informed about the details of the change project concerning increased patient education and participation with regular exercise/physical therapy. Another strategy applicable to this project is that of a positive example. The presentation of the successful implementation of similar projects in other healthcare facilities is likely to reduce stakeholder’s resistance to change.

Potential Obstacles and Strategies for Overcoming Obstacles

The implementation process of a change project is frequently interrupted by some obstacles. They can be of structural, financial, or organizational character (Grol, Wensing, Eccles, & Davis, 2013). For the change project in patient education, the potential obstacles can include the lack of finance and organizational problems. The financial component is decisive for the project. Lack of finance can interfere with the successful project implementation. Thus, the authors of the project should find sponsors to avoid this obstacle. As for organizational issues, they can comprise such obstacles as patients’ or staff resistance to change. Also, over-controlling leadership can create a barrier to change (Gbadamosi, 2015). The strategy to overcome these obstacles is emotional intelligence (Foltin & Keller, 2012). Emotional intelligence has a positive impact on motivation, communication, and teamwork that are significant for the change in project implementation. In the terms of Lewin’s theory, this strategy can be used during the moving stage. Another possible strategy applied during this stage is the presentation of project benefits. It will provide a picture of the possible positive results and productively influence the perception of the need for changes in patient education.

Conclusions

Summarizing, it should be mentioned that changes in nursing are the demand of time. Technology development and contemporary research provide opportunities for improvements in patient care and suggest new approaches that can be more efficient than the existing ones. The role of a nurse in such conditions is to be attentive to the spheres which need change, discuss these problems, develop change projects, and implement them. However, apart from change project creation, it is crucial to predict the possible problems and provide strategies to manage them. Moreover, the definition of all stakeholders is necessary because it helps to distribute roles in the process of change project implementation.

References

Foltin, A., & Keller, R. (2012). Leading change with emotional intelligence. Nursing Management, 43(11), 20-25. Web.

Gbadamosi, N. (2015). What are the barriers to implementing change in the NHS? Nursing Times. Web.

Grol, R., Wensing, M., Eccles, M., & Davis, D. (Eds.). (2013). Improving patient care. The implementation of change in health care. Oxford, UK: John Willey & Sons.

Mitchel, G. (2013). Selecting the best theory to implement planned change. Nursing Management, 20(1), 32-37.

Shirley, M.R. (2013). Lewin’s theory of planned change as a strategic resource. Journal of Nursing Administration, 43(2), 69-72. Web.