Introduction
In the recent past, many theorists have come up with models that explain change.
Some of the theorisers include Lewin, Havelock, Rogers, Lippitt and Kotter. According to
Clay and Brett (2017), Kotter illustrated an eight-step progression for cultural change. Kotter
later changed his idea of structural change from top-down to deliberate bottom-up
development. This paper will concentrate on John Kotter’s change model, application of the
theory in practical processes, driving and restraining forces during the implementation of
change.
Overview of Kotter’s change theory
The escalated rate of technology dictates changes in organizational undertakings.
Preparing people to receive and implement fresh methods of working is thus necessary.
Henry et al. (2017) expound on John Kotter’s eight basic steps for effective transformation.
First, one needs to convince people that the change is urgently needed. Second, a team of
influential leaders is to be created to represent the whole organization. The third step is
developing a realistic and attainable idea of the change. Fourth, it involves publicizing the
vision to the desired audience. Fifth, unravel any obstructions to the change and find their
solutions beforehand. In the sixth step, one needs to create rapid successes and overcome
resistance. Seventh, keep stirring the change frontward regardless of new opposition along
the way. Lastly, infuse the new amendments into the group culture.
Purpose of Kotter’s change theory
Often, unceasing success in any institution demands vital changes. Most change
actions fail due to many factors which include; tolerating too much complacency, failing to
form a competent coalition, poor choice of a vision, allowing obstacles to choke the change
process, inability to get short-term triumphs, declaring success impulsively and lastly, not
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diffusing the changes in the communal culture. Kotter’s change theory is thus designed to
help organizations avoid such errors.
Thesis statement
Kotter’s change theory provides an easy-to-use strategy for implementing change in
the nursing profession.
Major components of Kotter’s change theory
Kotter’s change model has eight key steps. Consistent with Kotter, following the
exact order of steps is crucial in attaining success. In 2017, Libby and Betsy discussed eight
steps in John’s change theory. The first step entails establishing an impression of urgency. A
high level of motivation in the target audience is crucial for the change process to succeed.
Therefore, people need to be convinced that change is necessary now. This sense of urgency
will propel them towards accepting and finally implementing the change. In the second step,
one needs to create a team of competent and persuasive leaders from the organization. The
team should be well informed about the change. This is because the team is supposed to
influence the entire system in embracing and applying the change. The third step ensures that
the aim of the change is real. Having precise strategies for attaining the goal is also key. One
should explain the means of achieving the change while focusing on the vision.
The fourth step focuses on discussing the vision to win people. All the details of the
change are simplified at this stage. It is crucial to create an environment that encourages
dialogue with the target audience. Encouragement of others to act occurs in the fifth step.
This is achieved by determining barriers to change, such as workers’ skill sets and
organizations’ structures and working so hard to find their solutions. The sixth step entails
planning on how to create quick wins. These wins help in overcoming obstructions. After that
leading the change process to long-term victories. The seventh step ensures that re-emergence
of obstructions later in the process does not cause the collapse of the process. This is realized
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by elevating the earnestness to change among the staff. In the last step, the change is
incorporated into the culture. Present staff should view the change as a benefit over the
previous way of working. New employees should clearly see the change as part of the
culture. Generally, the change should supersede the former styles in advantage.
In 2017, Donnelly and Lane reported that 70% of change projects fail. This implies
that the majority of people are really bad at adopting new ideas. Kotter identifies eight
mistakes that stumble to change efforts. To begin, accepting too much contentment causes
people to lack a reason for the change. Moreover, failure to come up with a powerful helping
coalition and having unclear vision stumbles most change procedures.
Additionally, failure to accurately communicate the details of the vision leaves people
with unanswered questions and doubts. Barriers of change that re-emerge along the process
can choke the vision. Failure to create quick wins contributes to loss of focus on the
objective. Declaring victory at the sight of the first positive victory can crumble the project
due to prejudgement. Lastly, neglecting to infuse the change into the organisational culture
causes the change to fail due to lack of a firm anchor.
Implementation of Kotter's change theory in nursing
A need for constant improvement of services in the health care sector necessitates that
nurses should embrace changes. This need has led to the application of Kotter’s theory in the
nursing field to enhance the value of services. According to Chowthi et al. (2016), Nurse
Coaches have played a crucial role in bringing about the needed changes in the nursing
profession. Further down is a description of how Kotter’s change model has been used to
communicate relevant information at the bedside while changing shifts.
Creating a sense of urgency entails motivating the workers to embrace change as a
way of solving current problems. The staff is encouraged to view a problem as an opportunity
to change and addressing it assures positive results and a more supportive environment to
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implement the change. For instance, administration in the nursing field realized the need for
precise communication at the bedside. Implementation of Kotter’s first step was effected by
exposing the demerits of poor communication during the handoff process. By discussing risk
for harming patients, nurses were willing to foster bedside communication. Competent
leaders are required to persuade others to adopt a change. In the infusion of this step in the
nursing field, nurse leaders (nurse manager, nurse educator, senior bedside nurse) were
educated about the eight steps of Kotter’s change theory by a nurse director. Additionally,
leaders used literature on safety initiatives from the institute of medicine. With all the
relevant information at hand, the cohesive leaders were equipped to create a vision for
change.
Shaping the vision and coming up with strategies to achieve it is vital. This step was
implemented in nursing by coming up with a 3-step process that included explaining the roles
of incoming and outgoing nurses and officiating communication structure for the handoff
procedure at the bedside. The results were better communication among nurses, patients, and
relatives at the bedside. After establishing the vision, it is important to share it with the
execution team. In the nursing field, articles explaining the significance of bedside handoffs
and implementation of change concurrent with Kotter’s model were availed to the staff.
Thorough education of the staff on the vision of change was conducted during staff meetings
and other educational sessions.
Effective communication and direct assistance from others are critical during the
adoption of a concept. To implement this step in nursing, the staff was empowered to
embrace the vision by reinforcing the home-grown system. Nursing groups were convened
daily to assess the efficacy of countermeasures until full adoption was achieved. Nursing
leadership provided relevant support to employees who were unpleased with change. This
was a continuous process until all setbacks to change in staff fraternity were resolved.
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Additionally, to sustain change processes, a team is encouraged to create immediate
and visible wins. During the application of this step in the nursing practice, two examples of
instant wins were identified. First, the staff was able to identify missed prescriptions on the
electronic medication record at the start of the shift. Second, the staff realized an
improvement in efficiency in work completion and that they were able to leave on time. By
emphasizing such wins, the motion of the project was strengthened.
In 2016, Small et al. explained how the nurse leaders trained and supported the staff
while maintaining the change. Moreover, the leaders emphasized the need to uphold critical
thinking, which resulted in the emergence of new procedures. Implementation of this step in
the daily management system improved patient care services. For instance, by revising the
assignments of the staff, patients were organized according to bed location, leading to
reduced walking and moving nurses near their patients. Lastly, full compliance with the
change requires a cultural initiative to enable the vision to become a norm. This step was
applied in the nursing practise by integrating bedside handoff change into new nurse
orientations and education of nurses.
Consequently, bedside handoff became a cultural practice in the unit. Acceptance
from the majority propelled the change regardless of a few opposition from a few resistant
nurses. Eventually, the new practice enhanced communication and patient satisfaction,
making a nursing field a better working place.
Potential driving forces in Kotter’s change theory.
The potential driving forces in Kotter’s model includes change agents and the nature of
the model. According to Salam et al. (2016), Change agents are essential in supporting the
process of change. In the nursing field, the change agents are the leaders of various
departments and units. First, the agents play a critical character in the consultant. They
provide nurses with relevant data from both internal and external sources. This data is
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essential in building predictive models by the management and employees. Agents can also
answer any questions from employees hence clearing all doubts concerning the change.
Second, the agents are trainers. The nurse leaders educate employees on a new skill set to
enable the staff to solve various problems in their units. Lastly, agents are researchers. As
researchers, the nurse leaders develop evaluation systems that asses the efficiency of the
change process in their respective staff members
The implementation process of the model is an easy step-by-step procedure. Kotter
provided clear steps that are easy to understand and apply. The model focuses on preparing
and embracing the change while allowing for an easy transition. The focus of the model is on
the buy-in of employees leading to success. The flexibility of the model ensured ease
incorporation into various structures.
Restraining forces in Kotter’s change theory
Restraining forces are barriers to change. Resistance comes in mainly at the transition
level. In the nursing practice, the personnel is not flexible enough to abandon the old
practices. According to research conducted by Tang and Ngang in 2019, competent nurses
tend to be rigid as they cherish their long term experience in their routine procedures.
Sometimes this leads to professional negligence, such as negligence in double-checking of
high alert medications. Such nurses believe that they don’t need to change; experience in old
ways is more important to them. Nurses are often hesitant to change their old practices due to
various reasons.
To begin with, failure to appreciate the need to change creates resistance toward
change. The aim of modernization might have been misunderstood or considered irrelevant
and incapable of solving current problems. Second, some nurses might be against the tactics
of applying the amendments rather than the change itself. Additionally, some nurses perceive
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the change as an embarrassment and threat to their self-esteem or interest, thus becoming
intolerant to change. Furthermore, a lack of trust in the nurse educators and other change
agents based on past failures in implementing changes. The nature of Kotter’s model, such as
the strict following of steps, long implementation time, and lack of room for co-creation, can
lead to frustration among the nurses if their needs are overlooked. Lastly, change agents in
the nursing practice have reported a lack of resources as one of the major restraining force.
Ways of overcoming resistance to change
In 2016, Salam et al. explained strategies that can be adopted to overcome resistance.
First, the empirical-rational approach, which assumes that the behaviour of nurses is driven
by rational self-interest, explains the resistance to change among nurses. Nurses can embrace
a change if its benefits are well explained and justified. Proper communication and
enticements are necessary for this strategy. Research has revealed that some nurses are
usually convinced of the change. Nurse educators are thus advised to target such converts and
use them as influencers. Second, we have the normative re-educative strategy, which banks
on the assumption that nurses act in line with socio-cultural norms. Nurse educators are
expected to focus on the impact of alteration in the already existing cultural activities of the
staff. The strategy should not distort the skills, attitudes, values, and relationships among the
nurses. Since culture does not evolve quickly, this strategy is effective for middle and long
term projects such as the establishment of a Magnet Recognition Program, which takes up to
five years to achieve.
Third, educators can use a power-coercive policy whereby changes are imposed on
nurses by the management. Defiant nurses are often subject to disciplinary actions. This
strategy is considered effective, especially for the changes that are urgent and must-do
nursing policies that explain the standards of care. Changes in policies such as patient
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identification before administering medicine should use this approach too. The fourth strategy
is called an adaptive environmental scheme. This involves the construction of a new
organization and, after that, transferring staff from old buildings to a new one. This strategy
is, therefore, considered impractical for the nurse educator.
The need for change in nursing practice
In 2017, Joseph and Joyce revealed that changes in nursing practice are inevitable and
paramount. This is due to the ever-evolving techniques in the field that are aimed at
improving the quality of services and enhance efficiency at work. Regulations in the nursing
practice are constantly evolving to improve the quality and safety of health care services. The
old methods are prone to errors; thus, nurses are instructed to embrace modifications to evade
such errors. Any nursing system that is reluctant to adjust is considered obsolete and with a
limited chance to advance. Just like any other business, nursing practices should aim at
satisfying its clients (patients). Therefore, any beneficial and justified change in nursing
practise should be embraced.
The implication of change in nursing practice
Changes that have been introduced in the nursing practice have improved the quality
of health care services and elevated the standards of hospitals. This is according to the
research that was conducted by Baloh et al. (2018). For instance, the introduction of clear
communication at the bedside while changing shifts have increased the level of accuracy
while handling patients. Additionally, safety for the patients has improved. This is evidenced
by the prior identification of patients by the nurse on duty before the administration of
medicine.
Furthermore, the transition of a shift has been made easier by clearly defining the
roles of each nurse, thus eliminating the possibilities of role mix-ups or exchange. The nurses
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have also been relieved of too much walking as they are stationed closer to their respective
patients. The education of nurses on the new skillsets has also improved their level of
expertise, thus equipping them to handle problems in their field of operation. Generally, the
adoption of new procedures in the nursing practice has steered growth in the profession.
Conclusion
Change theory is essential when anticipating modifications in nursing practice.
Selecting a model that effectively fits the needs of administration, staff, and patients are
crucial for sustainability. The chief causes of failure in most change progressions in nursing
practice are reluctance to support and empower the nurses to adopt the new procedures.
Embracing planned changes in nursing practice is necessary, but it can be demanding due to
resistance. Therefore one needs to have in place proper strategies to aid in dealing with the
barriers to revolution. Kotter’s 8-step model is easy to understand and can be easily applied
for effective change.
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