1. Unit “ 10 “ CONTROLLING

2. Controlling Final step in the management process: actions taken to ensure that actual outcomes are consistent with those Planned and anticipated. Involves setting standard, measuring performance, reporting the results, and taking actions. (this lead to corrective action).

3. Management of Change Change: Change is the process of making something different from what it was Change Agent: the one who works to bring about change Change: - The essence of life, it is as long as life goes on - Necessary for growth. - It often produces anxiety and fear. - The process of making something different from what it was.

4. - There is a sense of loss the familiar the status. Nurses are seeing change in the field of patient care, new medications, new equipment and new methods treatment Change can make crises or improvement it depends on how the change is managed

5. Change Theories: Lewin's theory: - Lewin provides a social - psychological view of change process. - He sees behavior as forces working in opposite directions within a field - The process of change here is affected by two types of forces : a. Driving forces: facilitate change. b. Restraining forces: keep system from change

6. Lewin's theory:…cont. The change agent begin by analyzing the entire system in order to identify two forces Stages needed before the planned change becomes a part of the system: 1. Unfreezing stage 2. Moving stage. 3. Refreezing stage

7. Lewin's theory:…cont. 1- Unfreezing Stage : Gather data: - Problem identification - Decide if change is needed. - Motivate participants to change. - Build a trust.

8. According to Lewin: create change occurs through three mechanisms A. Lack of confirmation: - (Expectations have not been met). B. Guilt and anxiety: - Tension level system (goal is not met) C. psychological safety: - Providing sufficient security to minimize the risk. -People will feel comfortable and attempt the change.

9. 2- Moving Stage (Implementation) - The leader put the planned change into effect. - Move the target system to a new level of equilibrium Activities in which the leader will be engaged during the changing phase: - Get participants to agree that current status is not good - Develop a plan including persons will be affected. - Sets goals and objectives - Identify areas of support and resistance. - Set target dates. - Introduce any new related information.

10. - Encourage the new behavior. - providing support to avoid resistance to change. - Ventilate the guilt and anxiety and other feelings. - Provide feedback on progress to reinforce the change process - Keep communications open. - Act as Energizer to keep interest high - Over come resistance ( tactics of unfreezing phase)

11. 3- Refreezing Stage: The change is stabilized and becomes a part of the target system Leader continue to act as Energizer, and delegates responsibility for change behavior to others in the target system

12. An Example of change: "The change to new computerized record system" by using lewin's theory of change The new system has several advantages over the old one: 1. It requires less writing 2. Eliminate repetition 3. Quicker access to stored information 4. Provides total picture of the client’s progress 5. Different kinds of health care. 6. Strongly supported by the administrators and executives

13. However: None of the staff have ever used it before. They also have not expressed any need to change the old system A side from staff members seem concerned about providing high quality care. The change identified the following: I. Driving Forces: 1. Advantages of the new system 2. Administrative support for the system 3. Staff concern about quality care. 4. Staff ability to learn the new system

14. II. Restraining forces: 1. Lack of staff participation in the selection of the system. 2. Little or no staff knowledge of the new system. 3. Potential threat to staff feeling of security ( routine ). 4. Potential threat to various disciplines because of equal access to information in the new system.

15. These opposing forces diagrammed in the following figure : Lack of staff participation No knowledge of system Threat to staff security threat to various disciplines Administrative support Advantages of the new system quality of care ability to learn system Restraining forces Status quo Driving forces

16. 1- Unfreezing stage: The change agent took the following actions: A. Disconfirmation: (Actions ) - Meet with every staff member in small groups to discuss inadequacies and problems found in the old system. B. Inducing guilt and anxiety: ( Actions ) - Demonstrate ways in which the old system interferes with quality care - Tell staff members how strongly administrators support the new system.

17. C. Providing psychological safety: ( Actions) - Assure staff members that they will learn the new system. - Staff will be involved in planning the implementation Phase. - Point out similarities between old and new systems. - Express approval of staff concern for the quality of the care given and confidence in their ability to learn the system

18. 2- Moving Stage (Changing) a) Introduce new information: Teach the staff how to use the new system. b) Encourage the new behavior: - Begin with practice using examples from ready situations - Have the staff begin using the new system according to the plan. c) Continue the supportive climate: - Allow a adequate time for learning and practice before implementation. d) Provide opportunities for ventilation: - Ask staff how they feel about the new system and listen and respond to what they say about it

19. e) Provide feed back and clarification of Goals: Check computerized records and evaluate progress Ask staff how well new system is working f) Present your self as Trustworthy : - Open and direct communication - Make sure that all staff were include in implementation as promised g) Overcome resistance: h) Act as Energizer: - Take every opportunity to promote the new system. - Demonstrate interest in staff progress.

20. 3- Refreezing Stage (change agent actions) 1) Continue acting as Energizer: - Keep the new system visible through news letters, meetings and so forth. - Continue to show interest in staff progress and feeling about the new system 2) Continue guiding new behavior: - Continue to check computerized records to see how well the new system is working - Help staff correct mistakes and provide needed information 3) Delegate increased responsibility to others: - the outcome of the new system is turned over to the staff member and their supervisors

21. Comparison of Chang Models RogersHavelockLippittLewin 1- Knowledge 2- Persuasion 3- Decision. 1- Building a relationship 2 Diagnosing the problem. 3-Acquiring resources 1- Diagnose problem 2-Assess motivation 3-Assess change agent’s motivations and resources. 1- Unfreezing 4-implementation4- Choose the solution 5- Gaining acceptance 4- Select progressive change 5- Choose change agent role. 2- Moving 5- Confirmation6- Stabilization6- Maintain change. 7- Terminate helping relationship 3- Refreezing

22. Barriers of Change (Resistance) 1- Threatened self- Interest. 2- Inaccurate perception: example, staff resist use of computer basing on the perception that computerization will reduce their freedom in choosing working hours and days off. 3- Objective disagreement: feel the change will benefit the organization. 4- Psychological reaction: feel that their freedom has been threatened or eliminated. 5- Low tolerance for change : (low self confidence) Change agent must understand why people resist change and be able to deal with resistance.

23. Techniques for dealing with resistance: 1. Participation: (persons affected by change) 2. Manipulation: (view change as less costly or more beneficial). 3. Education: (for individuals about the change) 4. External agents: (outside the organization) 5. Incentives: حوافز (the benefits) 6. Supportive behavior: (training new skill, counseling services) 7. Gradual introduction: (change gradually)