NSG/557 Week 4: Comparing Change Models, sample paper

Lewin, Kotter, Rogers or Bridges? Choosing a Change Model for Replacing a Pediatric Inpatient Unit With a Short-Stay Unit and a Regional Partnership

[Student Name]

University of Phoenix

NSG/557: Organizational Dynamics and Systems Thinking

Week 4 Assignment

[Instructor Name]

[Date]

The hospital, its decision and all details are a composite written for a model paper.

In Weeks 1 to 3, systems, structural and cultural analyses examined our community hospital's underused pediatric inpatient unit. The system board has now decided. The 14-bed inpatient unit will close in six months. In its place, the hospital will open a four-bed pediatric short-stay unit adjacent to the emergency department for children expected to need less than 24 hours of care, sign a formal partnership with the regional children's hospital covering transfer criteria, telehealth consultation and nurse rotation, and create pediatric readiness nurse roles for the emergency department and maternity unit. This paper chooses a change model to guide the transition.

Criteria From Earlier Weeks

The earlier analyses suggest five criteria for a model. It must handle a change decided above the hospital, since the system board holds authority. It must engage informal leaders, the two senior pediatric nurses and the community pediatrician, who hold more influence than their positions. It must address loss, since the closure conflicts with deep assumptions about care close to home and with pediatric nurses' identity. It must coordinate several units and an outside partner. And it must support learning, because the new model's effects on the emergency department and the region are uncertain.

Model 1: Lewin's Three Stages

Lewin (1947) pictured change in three steps: loosening the grip of current habits, shifting to new ones and then stabilizing them. The model is clear and useful for explaining that people must first let go of old ways. It is less specific about how to build support across many groups, and refreezing suggests a stable end state, while this change will need continuing adjustment. Fit: moderate.

Model 2: Kotter's Eight Stages

Kotter (2012) laid out eight stages for leading change in organizations, beginning with urgency and a coalition to guide the work, moving through a vision that is widely communicated, broad action and early wins, and ending with gains that are consolidated and new ways anchored in the culture. The model is built for large, multiunit changes that need broad support and addresses coalition-building explicitly, which fits the need to engage informal leaders. Its weakness is limited attention to individual loss. Fit: strong for the organizational change.

Model 3: Rogers's Diffusion of Innovations

Rogers (2003) explained how innovations spread through a social system through adopter categories and characteristics such as relative advantage and compatibility. It fits the adoption of new practices, such as the short-stay criteria, but less well a closure that is not optional. Fit: useful for parts of the change.

Model 4: Bridges's Transition Model

Bridges (2009) separated the change that happens around people from the inner transition they go through, which he described in three phases: an ending, in which people let go; a neutral zone, an uncomfortable in-between time; and a new beginning. The model speaks directly to loss and identity, which the cultural analysis identified as the main source of resistance. It says little about organizational steps. Fit: strong for the human side.

The Choice: Kotter With Bridges

No single model meets all five criteria. Kotter's stages organize what the hospital must do; Bridges's phases describe what its people will go through, and a plan that attends to only one of them will fail at the other. The plan will use Kotter's eight stages as the organizational structure and Bridges's transition model to guide how each stage treats the people losing the unit. Diffusion concepts will inform how the short-stay criteria and telehealth consultation are introduced.

Applying the First Four Stages

Stage 1, urgency. The case for change will be presented honestly, with the unit's census, the reinforcing loops found in Week 3 and the risk that children are already being transferred for lack of pediatric skill. Urgency will be framed around children's care, not only cost. Bridges's ending phase begins here: leaders will acknowledge openly what is being lost.

Stage 2, guiding coalition. The coalition will include the chief nursing officer, the women's and children's director, the emergency department director, the two senior pediatric nurses, the community pediatrician, a children's hospital liaison and a parent from the hospital's family advisory council. Including informal leaders gives the coalition credibility the formal structure lacks.

Stage 3, vision. The coalition will write a vision in the hospital's own values: "Every child in our community gets the right care at the right place, starting here." The vision connects the change to care close to home rather than contradicting it.

Stage 4, communication. The vision will be shared first with pediatric staff in person, before any public announcement, then with the emergency department, maternity, physicians, the community and families, each in forums suited to them, over the six months before closure.

Why Not Lewin Alone

Lewin's model remains useful as a way to explain the change simply to staff: the old unit must be let go, the new model built and then made routine. But a three-step description gives little guidance on who should lead, how to communicate with many groups or how to measure progress, all of which this change requires.

Measures for Each Stage

Each Kotter stage will have a sign of progress: attendance and questions at the first staff meetings for urgency, a coalition that meets every two weeks, a vision statement tested with staff and families, communication reaching every affected group before public announcement, written transfer criteria, the first short-stay admissions, extension to the maternity unit and inclusion of the new model in orientation.

Applying the Later Stages

Stage 5 will remove barriers, such as unclear transfer criteria, by writing them with the children's hospital. Stage 6 will seek short-term wins, such as the first month of short-stay admissions or a smooth winter surge under the partnership. Stage 7 will extend the change, for example by adding pediatric telehealth to the maternity unit. Stage 8 will anchor the new model in orientation, policy and the hospital's stories about itself. Throughout, Bridges's neutral zone will be managed with frequent check-ins, temporary roles and clear information, and the new beginning will be marked when pediatric readiness nurses take their new roles.

The Nurse Leader's Place in the Model

As director of women's and children's services, I sit in the guiding coalition and carry particular responsibility for the stages that touch nurses: communicating the vision to staff, removing barriers to new roles and making early wins visible. Kotter (2012) stresses that change leaders must communicate the vision many more times than seems necessary, and in this change that means face-to-face conversations on every shift.

Conclusion

Replacing a pediatric inpatient unit with a short-stay unit and regional partnership is both an organizational change and a personal transition. Kotter's eight stages suit the organizational work of building a coalition and support across units, and Bridges's model suits the loss that staff and the community will feel. Used together, with diffusion concepts for new practices, they give the hospital a plan that addresses both what must be done and what people will go through.

References

Bridges, W. (2009). Managing transitions: Making the most of change (3rd ed.). Da Capo Press.

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103

Rogers, E. M. (2003). Diffusion of innovations (5th ed.). Free Press.