Wk 4/2
● Review this week’s Lewin’s change theory media resource.
● Consider the importance of change theory, as well as reflect on the application of these
theories to your healthcare organization or nursing practice.
● Research and select two additional theories or models related to change theory and
systems thinking to focus on for this Discussion.
Post a response to each of the following:
● Describe the importance and application of Change Theory and Systems Thinking for
healthcare organizations and nursing practice. Be specific.
● List two additional theories or models that you selected and explain how these might be
applied in research. Be specific and provide examples.
● Explain how theories and models provide a framework to guide projects, including your
DNP Project or dissertation.
Importance and Application of Change Theory and Systems Thinking
Lewin’s Change Theory
Lewin's Change Theory is fundamental in healthcare for understanding and managing change.
The theory involves three stages: unfreezing, changing, and refreezing.
- Unfreezing: This stage involves preparing the organization for change by recognizing the need
for change and breaking down the existing status quo. In a healthcare setting, this could mean
addressing resistance among staff to new procedures or technologies.
- Changing: This is the transition phase where changes are implemented. For example, adopting
a new electronic health record (EHR) system requires training, new workflows, and
troubleshooting issues as they arise.
- Refreezing: In this final stage, the changes are solidified into the organization’s culture. This
might involve ongoing support, policy adjustments, and performance monitoring to ensure the
new system is fully integrated and utilized .
Systems Thinking
Systems thinking is critical in healthcare as it allows for a holistic view of the organization and
how different components interact. It emphasizes the interdependence of various parts of the
system, promoting a better understanding of how changes in one area can affect others. For
instance, implementing a new patient management system requires considering its impact on
clinical workflows, patient satisfaction, and staff workload .
Additional Theories and Models
Kotter’s 8-Step Change Model
Kotter’s model provides a comprehensive approach to implementing change, focusing on
creating urgency and building a guiding coalition to sustain momentum .
1. Create Urgency: Highlight the importance of change to stakeholders, such as improving
patient outcomes through new treatment protocols.
2. Form a Powerful Coalition: Assemble a team with enough influence to lead the change.
3. Create a Vision for Change: Develop a clear vision to direct the change effort.
4. Communicate the Vision: Share the vision with all stakeholders to gain buy-in.
5. Remove Obstacles: Address barriers to change, such as resistance or inadequate resources.
6. Create Short-Term Wins: Achieve and recognize small successes to build momentum.
7. Build on the Change: Use early wins to promote further changes.
8. Anchor the Changes in Corporate Culture: Ensure the changes become part of the
organizational culture.
Application Example: A hospital implementing a new patient-centered care model could use
Kotter’s steps to ensure successful adoption. Creating urgency might involve presenting data on
patient dissatisfaction, while short-term wins could include initial patient feedback
improvements .
Rogers’ Diffusion of Innovations Theory
Rogers’ theory focuses on how new ideas spread within an organization, emphasizing the role
of innovation, communication channels, time, and social systems .
1. Innovators: Individuals who are the first to adopt an innovation.
2. Early Adopters: Respected opinion leaders who adopt new ideas early and help spread them.
3. Early Majority: Individuals who adopt new ideas before the average person.
4. Late Majority: Skeptical individuals who adopt an innovation after the majority.
5. Laggards: Last to adopt an innovation, often resistant to change.
Application Example: For the introduction of telemedicine services in a rural healthcare facility,
Rogers’ theory could help identify and engage innovators and early adopters who can champion
the technology and influence others .
Framework for Guiding Projects
Theories and models provide structured frameworks for guiding projects, including DNP
projects or dissertations. They offer a systematic approach to planning, implementing, and
evaluating changes.
- Lewin’s Change Theory: Can be used to plan a DNP project aimed at reducing hospital
readmission rates. Unfreezing could involve gathering data on readmission rates, changing
might include implementing follow-up call programs, and refreezing would ensure these
practices become standard protocol.
- Kotter’s Model: Can help in managing a project to improve nurse retention rates by creating
urgency around the high turnover rates, forming a coalition of nurse leaders, and building on
early wins like reduced resignation numbers in pilot units.
- Rogers’ Theory: Useful for a dissertation on the adoption of a new health information system,
guiding the process of engaging early adopters and opinion leaders to promote wider
acceptance.
By leveraging these theories and models, healthcare organizations can navigate the
complexities of change more effectively, ensuring that new practices are successfully integrated
into everyday operations and lead to improved outcomes.
References:
1. Hussain, S. T., Lei, S., Akram, T., Haider, M. J., Hussain, S. H., & Ali, M. (2018). Kurt Lewin's
change model: A critical review of the role of leadership and employee involvement in
organizational change. Journal of Innovation & Knowledge, 3(3), 123-127.
doi:10.1016/j.jik.2016.07.002
2. Mitchell, G. (2013). Selecting the best theory to implement planned change. Nursing
Management (Harrogate, England), 20(1), 32-37. doi:10.7748/nm2013.04.20.1.32.e1013
3. McGonigle, D., & Mastrian, K. G. (2017). Nursing informatics and the foundation of
knowledge. Jones & Bartlett Learning.
4. Kotter, J. P. (1996). Leading Change. Harvard Business Review Press.
5. Appelbaum, S. H., Habashy, S., Malo, J. L., & Shafiq, H. (2012). Back to the future: Revisiting
Kotter's 1996 change model. Journal of Management Development, 31(8), 764-782.
doi:10.1108/02621711211253231
6. Rogers, E. M. (2003). Diffusion of Innovations (5th ed.). Free Press.
7. Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of
innovations in service organizations: Systematic review and recommendations. The Milbank
Quarterly, 82(4), 581-629. doi:10.1111/j.0887-378X.2004.00325.x
8. Dearing, J. W., & Cox, J. G. (2018). Diffusion of innovations theory, principles, and practice.
Health Affairs, 37(2), 183-190. doi:10.1377/hlthaff.2017.1104
9. Melnyk, B. M., & Fineout-Overholt, E. (2015). Evidence-Based Practice in Nursing &
Healthcare: A Guide to Best Practice. Wolters Kluwer Health.
10. Grol, R., & Grimshaw, J. (2003). From best evidence to best practice: Effective
implementation of change in patients' care. The Lancet, 362(9391), 1225-1230.
doi:10.1016/S0140-6736(03)14546-1
