Change Management Model: The Human Element
Perhaps the best model to explain the human element is the Kubler-Ross Cycle of Grief. This model visually represents the emotional upheaval of terminally ill patients as they adapt to impending loss. The elements of shock, resistance, bargaining, and anger, which gradually turn to acceptance and adjustment are reinterpreted in many organizational change methodologies. Visually similar to Kubler-Ross, the Satir model, developed by family counseling pioneer Virginia Satir, also recognizes that a "breakdown" involving resistance and chaos leads to integration and a new status quo.
Today's models for managing change in the workplace are divided into those systems that change the individual to work better in a team and those structures that provide a step-by-step framework to plan, measure, and realign a large group or organization.
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Individual Change Systems to Support Organizational Change Management
Stephen Covey's breakthrough book, The Seven Habits of Highly Effective People, is used for both individual and organizational leadership innovation. The model calls for change at a personal level that advocates "to do good, you must first be good." This system is dependent on learning effective ways to modify habits. Covey once said, "…we believe that organizational behavior is individual behavior collectivized."
The Nudge Theory found in the 2008 book, Nudge: Improving Decisions About Health, Wealth, and Happiness, by Richard H. Thaler and Cass R. Sunstein, is a behavioral concept that encourages less enforcement and more indirect encouragement as a method for behavior modification. One example involves a parent demanding that a child clean their room. The theory calls for using a method to indirectly foster compliance. In this case, a redirection would be the creation of a game that has a clean room as an outcome. Like Covey's "habits," individuals modify their response for a better organizational outcome.
The Switch Method found in the book Switch, How to Change Things When Change is Hard, is a broad-based transformative method suited for personal enrichment and organizational change. Resistance (identified in most change methodologies) is defined by the Switch Framework as a "lack of clarity" that is remedied by good communication. In an illustration of how our minds adapt, the example uses the analogy of moving an enormous elephant (our emotional self) by a rider (our rational self) down a new path (changing environment).
More models for individual change to support a collective include the Prosci ADKAR change management model by Jeff Hiatt, which has a process that advocates Awareness, Desire, Knowledge, Ability, and Reinforcement through phases, preparation, design, implementation, and sustainability.
Organizational Models that Provide a Structured Approach for Group and Institutional Change
To successfully implement change, most models recognize and speak to the critical need for large "buy-in" as an almost universal concept. There is also recognition that full compliance, especially in the initial stage, is difficult. Rogers’ Tech Adoption Curve illustrates the “lifecycle” of this concept. A bell shaped curve shows that adoption starts with the innovators, rises as majority participants onboard, and finally ends with acceptance by a reluctant group called “laggards.” This concept of initial reluctance is addressed in most models for innovation and change management.
There are change mechanisms that are part of a systematic process of innovation management like the Deming Cycle, also known as Plan, Do, Study, Act, (PDSA). This model is a formalized process within ISO 9001 standards for process improvement to systematically identify and implement changes. These changes are more process oriented and seem to exclude the variance of human emotional resistance to change.
The Bridges Transition model involves three steps that mirror some of the Kubler-Ross model by recognizing and planning for initial frustration and anger, impatience and resentment, in their steps. The plan advocates working towards acceptance and renewed commitment and energy. The method also recognizes that change is constant, and the steps include "ending, losing, letting go," creating the "neutral zone," and providing a "new beginning" - all of which provide structure and are repeatable.
Developed in the 1940s, Kurt Lewin's easy 3 step model for change is known as the "unfreeze, change, refreeze" system. In this model, emphasis is placed on ways to work around resistance through good communication, "buy-in" at all levels, recognition of the emotional element of change, and then "cementing" the new normal. The visual of reshaping an organization like a block of ice that is melted, remolded, and then frozen again illustrates the system.
In John Kotter's change management model, creating urgency is a critical first step to initiate change. Additional steps, outlined in the book Leading Change, include: build coalitions and vision, remove obstacles, create short term "wins," build on the change, and anchor the change in the new structure. This eight-step process calls for patience, especially in the first critical steps to achieve high initial participation.
The McKinsey change management framework developed in 1978 by Tom Peters, Robert Waterman, Richard Pascale, and Anthony Athos, focuses on two sides of change methodology. Calling these elements the “hard” and the “soft,” the seven structural pieces include, strategy, structure, and systems which are defined, and shared values, style, staff, and skills which are more fluid. This complex model works at aligning and inter-relating the seven elements to provide a process for continuous realignment.
The EASIER method is outlined in the book How to Manage Organizational Change by D.E. Hussey. The acronym outlines a structure for Envision,
Activate, Support, Implement, Ensure, and Recognize. The name itself promotes the idea that change can be made easier through a structured methodology.
Whether the agent of change management is focused on the individual or the entire organization, most of these systems and models advocate a patient attitude especially in the beginning of the process. Another universal caution is to move at an appropriate pace without shortchanging any of the steps or elements. Just like the grief process, the many models for change follow a pattern that has "break down" elements called resistance, disruption, chaos, or anger. After the "breakdown," acceptance is built and a new normal is achieved.
Comparison of Change Management Methodologies
Since change, for many, is a loss of control, comfort, or territory, effectively working through the emotional elements remains a key factor for the successful implementation of innovative change. As outlined in this article, there are many routes to change - the following chart provides an overview of each model and where they can best serve your organization.
Embracing Change in Healthcare Organizations
Often, change is an unwelcomed and worrisome concept that impacts organizations and challenges their well-understood, comfortable processes. This is especially true in healthcare organizations, where many moving parts and regulations bind organizations to simple yet dated processes.
Specific changes to an organization’s current processes can maximize efficiency, improve overall patient and provider satisfaction, and improve security and compliance efforts. However, implementing change in a healthcare organization requires a strong attention to detail regarding patients and service providers, as well as stringent security measures, ensuring that all data and health information is secure and maintained. To effectively embrace and implement changes, you need a powerful, real-time, and secure tool to maintain business efficiency and data security.
Smartsheet is a work execution platform that enables healthcare companies to improve work efficiency, scale repetitive processes, and securely store and share protected health information. Streamline documentation, improve communication of changes across your organization, and modify healthcare processes for the better, while also maintaining top-level data security compliant with HIPAA's regulatory requirements. Track the progress of changes in individual processes with all-up reports and centralized, real-time dashboards.
Interested in learning more about how Smartsheet can help you maximize your efforts? Discover Smartsheet for Healthcare.
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