Change Management
The literature review emphasizes the use of medical interventions and the efforts of individual professional and non-professional caregivers. The medical interventions and non-medical interventions are strategically combined through appropriate means to ensure proper care delivery to the patients. The main argument for the change is the fact that a combination of pharmacological and non-pharmacological interventions in dementia care without teamwork in care management causes minimal positive outcomes. Change is an essential aspect of managing dementia cases and or professional nursing practice. Hussain et al. (2018) noted that change is an important aspect to realize nursing teamwork in dementia care management, which ultimately improves coordination and collaboration with the view of improving outcomes in care.
Despite the existing care strategy realizing some positive movements in the management of people living with dementia, the lack of teamwork in healthcare systems affects the system’s inefficiencies. The inefficiencies in the health care network affect service delivery to the people living with dementia. Care for people with living with dementia and their caregivers is demanding because the disorder has a multi-domain symptom profile; it is progressive in nature, and it has a huge impact on a person’s life and that of family and the broader community (Cations, et al., 2018). Implementing teamwork in dementia care involving all stakeholders is important to develop new behaviors in the coordination of resources through all stakeholders’ involvement (Hussain, et al., 2018). Change as a process in management of healthcare system requires a procedural process where a change idea follows and strategically suits into the health systems or a particular project (NHS, 2019). The change program need to be well structured to avoid situations where people come out of the change process negatively affected and demotivated (NHS, 2019).
Structural change is a common aspect in UK health sector where it involves creating and recreating organization and its components to improve care delivery (Cations, et al., 2018). The NHS evolves continuously to incorporate new practices and latest technological innovations that ensure that new workplace behaviors are adopted to improve the quality of outcomes (Cations, et al., 2018). Appropriate change management requires the incorporation and involvement of the professional healthcare providers to ensure that they improve the quality of services (Leng, 2012). The NHS relies on the advice of NICE on strategies to be implemented throughout the change process to ensure that professionals in healthcare systems give high quality healthcare (Leng, 2012). According to England, N. H. S. (2019), change programs successful especially when new and improved quality standards in healthcare are developed creating cost effective services in diagnosis, treatment, prevention and management of health disorders. Successful change is associated with healthcare practices and behaviors that are effective, guarantees patient safety and improve patient experience and outcomes (Leng, 2012). The World Health Organization (2017) emphasized that change management in dementia care should create a blueprint that prioritizes improvement in diagnosis, treatment, and care.
Change management is effective mainly when the improvement plan is guided mainly by a theory that defines the change and creates proper implementation of change programs (Manchester, et al., 2014).The SIP is implemented to develop new behaviors in the coordination of resources through all stakeholders’ involvement. Kurt Lewin’s change model is deemed to be the most practical that can significantly facilitate the understanding of the change process and enhance its implementation (Hussain, et al., 2018). According to Hussain, et al. (2018), Kurt Lewin’s model is a positive model that indicates the various stages of change during the implementation of the change programs hence provides clear guidelines. The service improvement model aims at improving the quality of early diagnosis through teamwork to ensure that decisions that concern the medication are made at an appropriate time. The SIP emphasizes the need to create teamwork in care provision involving professional nurses and volunteers in the healthcare field during dementia care. The pulling of efforts together by all healthcare players ensures that various services are provided (Grand, et al., 2011). The teamwork strategy offers maximum support to people with dementia in society and their caregivers (Grand, et al., 2011). The support and coordination of resources enhance the measures to increase early diagnosis and quality to ensure that dementia cases are effectively found at an early stage (Galvin, et al., 2014). Teamwork will bring health professionals together to enhance information sharing procedures and learning on the need to improve dementia care (Galvin, et al., 2014). Lewin’s model provides essential anchors of unfreezing, changing, and refreezing to ensure that the teamwork change in dementia care is communicated, implemented, and reinforced to improve clinical outcomes (Manchester, et al., 2014). Lewin’s 3-step model of freezing, changing, and refreezing can be integrated into service plan change for dementia through educational processes, diagnosis, care, treatment, and other clinical procedures (Manchester, et al., 2014).
Kurt Lewin’s First Phase: Unfreezing
Implementation of the change process usually comprises of using the current state of the organization and to have it changed into a new and desired state (Hussain, et al., 2018). The unfreezing stage aims to create awareness among the people within the healthcare system of the upcoming change. The unfreezing stage is dominated by communication of the anticipated change and creating awareness among all people involved in the change to reduce resistance to the change (Lewin’s 3-Stage Model of Change, 2012). Communication will be undertaken in different groups where nurses, doctors, volunteers, and the community will be addressed on the upcoming changes. The first stage mainly involves the determination of the need for change, gather enough leadership support developing a strategic communication plan, and appropriately managing employee resistance (Hussain, et al., 2018).
According to Manchester, et al. (2014), unfreezing can be ensuring that there is an adequate level of preparedness for change, preparing the workers, and initiating the implementation by using good leadership skills to communicate with members. The SIP aims at implementing teamwork among healthcare workers, volunteers, and other stakeholders to create an opportunity to increase awareness among the public regarding dementia care (Manchester, et al., 2014). Implementation of teamwork through the stages of Lewin’s model reduces the resistance to change and improves the collective measures put in place to diagnose dementia at an early stage and other clinical measures (Manchester, et al., 2014). According to Iliffe, et al. (2002), to achieve an acceptable change in dementia care, priority should be given to improve early detection, intervention, and management of dementia patients. The SIP also outlines that additional training will be offered to nurses, volunteers, and caregivers on making teamwork change successful and increase awareness about the change.
Lewin’s Second Phase: Move
The second phase is the moving/changing phase that involves the actual rollout of the change process after creating enough awareness and communication to workers (Lewin’s 3-Stage Model of Change, 2012). The moving stage is characterized by doing the actual shift from the old practices and behaviors into the adoption of new behaviors and practices (Hussain, et al., 2018). The second phase requires consistency in communication regarding the change, addressing the misinformation cases, engaging employees in change programs, and encouraging informed leadership (Hussain, et al., 2018). At the moving/changing stage, teamwork strategies will be rolled out in all aspects of dementia care as part of the collaborative care model. The effective teamwork change will ensure that all professional nurses coordinate among themselves and with the volunteers and family caregivers to ensure that dementia care outcomes are improved. The teams will be developed across the healthcare systems to allow for information sharing and exchange of valuable knowledge that can make the collaborative care model a success. Teamwork is an effective tool that develops an effective patient-centered healthcare service delivery system (Babiker, et al., 2014). Dementia management teams will be spread across dementia training and awareness, diagnosis, clinical service delivery, and home care. The coordination of health and social care personnel improves service delivery and ensures that the resource base is wider to conduct dementia diagnostics without massive pressure (Su, et al., 2017).
Lewin’s Third Phase: Refreeze
The refreezing stage focuses on reinforcing the implemented change in an organization to ensure that new practices and behaviors are adopted and normalized (Lewin’s 3-Stage Model of Change, 2012). The stage is critical to ensure that important change aspects are kept stable and running and ensuring that workers are entirely motivated by the change. The SIP in appendix C establishes a teamwork framework for homecare teams to reinforce change in all care areas. The teamwork change aims to coordinate the available skills and resources to make positive dementia care, discoveries, and early diagnosis. Dementia care teams, like other healthcare teams, are required to coordinate and improve service delivery and meet the needs of the people living with dementia (Rosen et al., 2018). Rewarding the performing teams creates a sense of motivation that makes all groups follow the direction created by the implemented change. The Nursing and Midwifery Council (NMC) offers professional guidance on teamwork among stakeholders that teams can rely on in caring for people living with dementia by creating nursing needs that have to be offered (Nursing Standard, 2020). The SIP implementing a teamwork approach ensures that there is appropriate planning to build the capacity to assess all dementia cases in a given population (Banerjee & Wittenberg, 2009). The SIP emphasizes offering training and support to teams, celebrating successful change implementation, and rewarding the teams to sustain positive change.
Strengths and Weaknesses of Lewin’s model
Kurt Lewin’s model of unfreezing, changing, and refreezing is the most acceptable in creating guidance to the implementation of change (Hussain, et al., 2018). Hussain, et al. (2018) noted the model identifies the three activities that can effectively manage the implementation of change; planning, commitment planning, and change management. Lewin’s model is an effective and an already proven model that is easily practiced in the context of healthcare management of change and clinical nursing practice (Hussain, et al., 2018). The change model has three distinct phases of unfreezing, moving, and refreezing, where each phase elaborates on the sequence of actions during the implementation of change (Hussain, et al., 2018). The model strategically plans the change process leading to positive movement and reinforcement of intended behavioral change. Hussain, et al. (2018) noted that the Lewin’s model is highly preferred because it focuses on factors affecting people and addresses them in the process of implementing change.
Despite Lewin’s model being adopted on a wide scale, it has various weaknesses that make it not entirely functional. Lewin’s change model is not as simple as it may be thought because the three stages can be interpreted differently; hence it fails to fill certain change management gaps (Hussain, et al., 2018). Additionally, Manchester, et al. (2014) acknowledged the fact that the model is highly unpredictable and may not be appropriate to use unfreezing, moving, and refreezing phases in implementing change.
Barriers to change
Change is important for an organization, especially when existing in important service delivery sectors where competition within the environment is based on the quality of services offered. The change illustrates the migration of organizational behaviours and practices from the original state to a desired future state (Manchester, et al., 2014). The uncertainty of the desired future change is an aspect that creates concern among the people who are worried about their coping abilities, competency, flexibility, and their expected worth after change (Hussain, et al., 2018). The barriers to change are required to be understood by the organization’s decision-makers to ensure that the change management process becomes successful (Rosen et al., 2018). Therefore, it is important to understand the barriers to change to ensure that the existing gap between the current state and desired future state is addressed on time to minimize the negative implications for the entire process.
Employees highly fear the change process due to their perception of its negative implication to job stability and security (Hussain, et al., 2018; Rosen, et al., 2018). Employees are required to actively be involved in change management to minimize the rates of resistance (Hussain, et al., 2018). Employee’s opinions should highly be encouraged during the process by ensuring free communication regarding change processes.
When an organization lacks an effective communication strategy and plan change may encounter a barrier hence affecting the involvement of all members (Richards, et al., 2013). Employees in an organization do not need to know about the imminent change only. They need to know exclusive information on change and how it affects them in general (Richards, et al., 2013). Change takes a long time, and barriers pose a threat to the desired pattern of new behaviour.