Kurt Lewin introduced the Change Theory of Nursing, and it has been one of the widely used models when implementing change in nursing. Lewin’s model has three stages – unfreezing, change, refreeze, which underscore the three major concepts of this theory including driving forces, equilibrium, and restraining forces [1]. In the unfreezing phase, all stakeholders involved in the process are prepared to accept change by letting go of old mind sets and ways of doing things. In the second stage (change), the proposed change is implemented, and thus it is also known as the “movement” stage [2]. Therefore, meticulous planning, effective communication and fostering teamwork should be ensured for the successful implementation of the entire process. The last stage is refreezing, the involved stakeholders move from the transition phase to a more stable state, which could be termed as a state of equilibrium [3]. At this stage, people have internalised the new way of conducting business, accepted the change, and formed new relationships.
At one point in my nursing career, I worked in a large hospital and I experienced a change process. In a bid to improve patient safety, bedside nurses (including myself) were required to adopt standardised checklists during handover at the end of every shift. The goal of this change process was to ensure that nurses do not make medication errors due to the lack of the right information concerning their patients. During the unfreezing phase, a nurse leader was responsible to oversee the implementation of the change process. He communicated through a circular sent to all beside nurses and we were called for a face-to-face meeting whereby the need for the change was explained in detail. We were all allowed to ask questions or contribute in any way we thought we could support the change process. The key stakeholders involved in this process were the hospital’s management, a chief nursing officer (CNO), the nurse leader, bedside nurses, and patients. The key stakeholders were all included by being allowed to give their contribution and suggestions concerning the change process.
During the first briefing, the CNO, who was representing the management, and the nurse leader were in attendance. The nurse leader started by explaining why the change process was needed to prevent or minimise medication errors by bedside nurses. We were given a week to process the proposal and make suggestions based on what we felt needed to be done as the change agents in this process. The team was kept informed through open and constant communication from the nurse leader. We were supposed to attend training twice a week whereby we were shown how to adopt the standardised shift handover checklists. In addition, the nurse leader formed a WhatsApp group and we all agreed that we would join it for easy and open communication. In the second (change) phase, all bedside nurses implemented the proposed changes and started using the standardised checklists during handover at the end of every shift.
The primary barriers to change were the expected unwillingness by the change agents to spend extra time filling in handover checklists at the start and end of every shift. In addition, some bedside nurses argued that they had never made a medication error, and thus they did not think that a change process was necessary. However, the nurse leader explained in depth why the adoption of standardised checklists was important because a single medication error could be highly costly to the involved patients, nurses, and the hospital at large. Ultimately, we all agreed that there was a need for change and the proposal was successfully implemented. In the refreezing phase, all bedside nurses internalised the use of the standardised checklists, and it became one of the hospital’s protocols. I believe that the ingredients to success for this change process were the open and detailed communication from the nurse leader and the involvement of all stakeholders. In the end, everyone owed the change process because we were all involved from the beginning.
Reference List
Cummings S, Bridgman T, Brown KG. Unfreezing change as three steps: rethinking Kurt Lewin’s legacy for change management. Human Relations. 2016 Jan;69(1):33-60.
Hussain ST, Lei S, Akram T, Haider MJ, Hussain SH, Ali M. Kurt Lewin’s change model: a critical review of the role of leadership and employee involvement in organisational change. Journal of Innovation & Knowledge. 2018 Sep 1;3(3):123-127.
Wojciechowski E, Pearsall T, Murphy P, French E. A case review: integrating Lewin’s theory with lean’s system approach for change. Online Journal of Issues in Nursing [Internet]. 2016; 21(2): n.p. Web.