Introducing a new system means changing the way staff work. Kurt Lewin’s Field Theory in Social Science (1951) introduced the three-step change model. He views behaviour as a dynamic balance of forces working in opposing directions. Driving forces facilitate change because they push employees in the desired direction. Restraining forces hinder change because they push employees in the opposite direction. Therefore, these forces must be analysed and Lewin’s three-step model can help shift the balance in the direction of the planned change. According to Lewin, the first step in the process of changing behaviour is to unfreeze the existing situation or status quo. Unfreezing is necessary to overcome the strains of individual resistance and group conformity. Existing beliefs and behaviours are challenged; participants in the change process are made aware of the necessity of change. Lewin’s second step in the process of changing behaviour is movement. In this step, it is necessary to move the target system to a new level of equilibrium. Three actions that can assist in the movement step include: persuading employees to agree that the status quo is not beneficial to them and encouraging them to view the problem from a fresh perspective, work together on a quest for new, relevant information, and connect the views of the group to well-respected, powerful leaders that also support the change. The third step is refreezing. This step needs to take place after the change has been implemented in order for it to be sustained or “stick” over time. It is likely that the change will be short lived and the employees will revert to their old equilibrium (behaviours) if this step is not taken. It is the actual integration of the new values into the community values and traditions. The purpose of refreezing is to stabilize the new equilibrium resulting from the change by balancing both the driving and restraining forces.
The first stage of our change management approach is to identify the key stakeholders. Our aim is to involve them from the beginning, learn from their experiences, and have real time feed back about the project.
When discussing with all stakeholders, we manage to bring to light the limitations of the current system, demonstrate the benefits of the proposed system, and persuade the participants to work together to implement the new system.
The second stage consists in formulating a list of Champions. These usually are team leaders or self-motivated personnel designated by the team leaders. These are essential in driving the change, influencing their peers, sustaining the change and evaluating the impact.
The champions should see some benefits in being involved. Most would have interest in improving patients care or aim at pursuing further professional development.
The third stage consists in putting changes in place with the help of Executives and Champions. These usually follow a long campaign of education, training and publicity. Setting up deadlines is important to keep to team focused. It depends on the type of change project, we may pilot changes in one area and over a period of time or the change is launched widely at one time throughout the organization.
1/ It is important to remember Health systems are complex systems and a change in one part of the system may generate a ‘Domino’ effect backward and forward.
2/ It is also important to bear in mind that Health Professionals are highly educated and intelligent people of the society. Hierarchal approach of management has usually a negative effect on the whole organization. A persuasive style based on negotiation and evidence is usually a good approach.
3/ Finally, one would always to remember that any change process should have ‘Patient interests’ at the centre of what the organization aims to achieve from that change. If for example the project is about saving money, plans should be there to ensure patient safety during the change project and some of saved money should be re-invested in improving patient care