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108 unit 2 | Working Within the Organization CikguOnline
Providing Psychological Safety unit.They refused to sign the coffee break sheet. When
asked why they had not signed it, they replied “I for-
As indicated earlier, a proposed change can threaten
got,” “I couldn’t find it,” or “I was called away before
people’s basic needs. Resistance can be lowered by
I had a chance.”This organized passive resistance was
reducing that threat, leaving people feeling more
sufficient to overcome the nurse manager’s authority.
comfortable with the change. Each situation poses
The nurse manager decided that the coffee break sheet
different kinds of threats and, therefore, requires
had been a mistake, removed it from the bulletin
different actions to reduce the levels of threat; the
board, and never mentioned it again.
following is a list of useful strategies to increase
psychological safety: For people in authority, dictating a change often
■ Express approval of people’s interest in seems to be the easiest way to institute change: just
providing the best care possible. tell people what to do, and do not listen to any
■ Recognize the competence and skill of the arguments. There is risk in this approach, however.
people involved. Even when staff members do not resist authority-
■ Provide assurance (if possible) that no one will based change, overuse of dictates can lead to a pas-
lose his or her position because of the change. sive, dependent, unmotivated, and unempowered
■ Suggest ways in which the change can provide staff. Providing high-quality patient care requires
new opportunities and challenges (new ways to staff members who are active, motivated, and highly
increase self-esteem and self-actualization). committed to their work.
■ Involve as many people as possible in the design
or plan to implement change. Leading the Implementation
■ Provide opportunities for people to express their of Change
feelings and ask questions about the proposed
change. New graduates may find themselves given respon-
■ Allow time for practice and learning of any new sibility for bringing about change. Following are
procedures before a change is implemented. examples of the kinds of changes they might be
asked to help implement:
Dictating Change
■ Introduce a new technical procedure
This is an entirely different approach to change.
■ Implement evidence-based practice guidelines
People in authority in an organization can simply
■ Develop new policies for staff evaluation and
require people to make a change in what they are
promotion
doing or can reassign people to new positions
■ Participate in quality-improvement and patient-
(Porter-O’Grady, 1996). This may not work well if
safety projects
there are ways for people to resist; for example:
■ Prepare for accreditation reviews and safety
■ When passive resistance can undermine the change inspections
■ When high motivational levels are necessary to
Now that you understand how change can affect
make the change successful
people and have learned some ways to lower their
■ When people can refuse to obey the order with-
resistance to change,taking a leadership role in suc-
out negative consequences
cessful implementation of change is presented.
The following is an example of an unsuccessful The entire process of bringing about change can
attempt to dictate change: be divided into four phases: designing the change,
A new and insecure nurse manager believed that her deciding how to implement the change, carrying
staff members were taking advantage of her inexperi- out the actual implementation, and following
ence by taking more than the two 15-minute coffee through to ensure the change has been integrated
breaks allowed during an 8-hour shift. She decided into the regular operation of the facility (Fig. 8.3).
that staff members would have to sign in and out for
their coffee breaks and their 30-minute meal break. Designing the Change
Staff members were outraged. Most had been taking This is the starting point.The first step in bringing
fewer than 15 minutes for coffee breaks or 30 minutes about change is to craft the change carefully. Not
for lunch because of the heavy care demands of the every change is for the better: some changes fail