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Unit “ 10 “. CONTROLLING. Controlling. Final step in the management process: actions taken to ensure that actual outcomes are consistent with those Planned and anticipated .

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unit 10

Unit “ 10 “



Final 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).

management of change
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


- 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.

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

change strategies
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

change strategies cont
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.

change strategies cont7
Change strategies:…cont.

The change agent gains powerby 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 cloutنفوذ سياسي)

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

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 .

change theories
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 :

Driving forces: facilitate change.

Restraining forces: keep system from change

lewin s theory cont
Lewin's theory:…cont.

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

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

Unfreezing stage

Moving stage.

Refreezing stage

lewin s theory cont11
Lewin's theory:…cont.

1- Unfreezing Stage :

Gather data:

Problem identification

Decide if change is needed.

Motivate participants to change.

Build a trust .

according to lewin create change occurs through three mechanisms
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.

2 moving stage implementation
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.

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)

3 refreezing stage
3- Refreezing Stage:

The change is stabilized and becomes a part of the target system

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

an example of change the change to new computerized record system by using lewin s theory of change
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:

It requires less writing

Eliminate repetition

Quicker access to stored information

Provides total picture of the client’s progress

Different kinds of health care.

Strongly supported by the administrators and executives


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:

Advantages of the new system

Administrative support for the system

Staff concern about quality care.

Staff ability to learn the new system

II. Restraining forces:

Lack of staff participation in the selection of the system.

Little or no staff knowledge of the new system.

Potential threat to staff feeling of security (routine).

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

these opposing forces diagrammed in the following figure
These opposing forces diagrammed in the following figure :

threat to various disciplines

No knowledge of system

Lack of staff participation

Threat to staff security

Restraining forces

Status quo

Driving forces

Administrative support

Advantages of the new system

ability to learn system

quality of care

1 unfreezing stage
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 .

C. Providing psychological safety:( Actions)

Assure staff members that they will learn the new system.

Staffwill 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

2 moving stage changing
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

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.

3 refreezing stage change agent actions
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 system

2) 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

barriers of change resistance
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.

techniques for dealing with resistance
Techniques for dealing with resistance:

Participation:(persons affected by change)

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

Education:(for individuals about the change)

External agents:(outside the organization)

Incentives: حوافز(the benefits)

Supportive behavior:(training new skill, counseling services)

Gradual introduction:(change gradually)

functions characteristics of change agent
Functions &characteristics of change agent:

Developing specific, measurable objectives

Listing techniques needed to accomplish of activities .

Developing a timetable for completion of activities.

Assessing resources.

Preparing a budget.

functions characteristics of change agent cont
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.