Change Theory

Running head: Change Theory

Change Theory
Heather Russell
Western Governors University

Change Theory

Change Theory

Change theory was developed by Lewin who wrote Force Theory in Social Science in 1951.
Lewin suggests a three-step approach to implementing structured changes in the workplace.
Adopting this enabled the whole team to psychologically identify with and sustain the change
(Bowers, 2011). He proposes
Bringing about meaningful structured change meant supporting employees in
psychologically unfreezing from a point of comfort with the current state of affairs.
Moving can then occur, as team members are encouraged to alter their values and
ideally gain ownership of the change, exploring the alternatives and defining and
implementing solutions. Refreezing occurs once the change has become integral and
established.
In a medical environment, professionals tend to cling to their current practices and can resistant
to change. Changing procedures or standards of care can initially slow workflow and make
practitioners feel unsure of themselves. The scenario that led to Mr. B.s demise, demonstrated a
clear need to both develop a new protocol and reinforce an existing protocol. Clearly the ER
needs to have a protocol to ensure adequate staffing to accommodate critical patients and be
prepared for unexpected traumas.
Unfreezing in this scenario can be facilitated by debriefing with the ER staff, supervisory
staff, and those with a stake in the ER staffing and outcomes. The sentinel event of Mr. B.s
death showed the danger of inadequate staffing. Because only one RN, one LPN, and one MD
were available at the time, it was impossible to safely care for a sedated patient, the incoming
trauma, as well as the more stable patients. The event itself likely had a deep psychological
impact on the people involved. They likely feel guilt over the unnecessary loss of a patient.
They are likely defensive as well though, feeling that they gave the best care they could, given

Change Theory

the situation. When proposing change, it will be important to explain the need for change
without laying blame.
In the next stage, moving, the change is actually implemented. To ensure compliance
with the change, a clear protocol is written. In the case of ensuring adequate staffing, an
algorithm based on patient numbers and acuity provides clear suggested staffing levels. Ideally
there should be an extra RN at all times open to receive a critical or trauma patient. Since this
change benefits the staff directly, it should be a positive change in their mind, though some may
feel that they are inadequate and thats why they need more staff. When developing the new
protocol, it is important to get direct input from the staff members, since they are the biggest
stakeholders. While implementing the change, frequently ask the staff members for their input
on any needed changes or whether it is working well for them. Consider changing the protocol if
needed and/or trialing multiple protocols.
In the refreezing stage, the protocol has become clearly established and accepted.
Reinforcement of the protocol and continuous evaluation ensure that complacency doesnt lead
to errors or slips. Senior staff members should be available to answer questions as they arise and
train new staff members.

Change Theory

References

Bowers, B. (2011, August 16). Managing change by empowering staff. Retrieved December 26,
2014, from
http://www.nursingtimes.net/Journals/2011/08/12/i/x/x/160811_Innovation_Bowers.pdf