Organizational Change

2022-2023
Session Rules
 Objectives

At the end of this discussion, every candidate will be able to:

 Discuss the concepts of change and organizational change

 List forces affecting change

 Differentiate among types of change

 Explain theories of change

 Understand emotional responses to change

 Recognize resistance to change

 Identify strategies to overcome resistance for change

 List steps for planned change

 Apply role of nurse manager in management of creativity

 Outlines

 Introduction
 Definition of organizational change
 Forces affecting change
 Types of change
 Theories of change
 Emotional responses to change
 Resistance and variable to change
 Strategies to overcome resistance for change
 Steps for planned change
 Role of nurse manager in management of creativity
 Introduction

 Today, nurses continue to work in a changing healthcare atmosphere

which requires constant adaptation, and the ability to build
relationships with interdisciplinary healthcare teams and to survive
in a complex multilevel organization.

 Organizational change can be very complicated since most

individuals within any organization are initially resistant to change.
Introduction cont.,

“Nothing is permanent but change.” Heraclitus (c. 500 BC).

Change is driven by many factors:

 the increasing cost of health-care delivery,
 the nursing shortage,
 the rapid advancements in technology and information
management,
 new expectations by the public to have a more active role in
health-care decisions.
 Definition of change

 Change can be defined as an attempt to alter or replace

existing knowledge, skills, attitudes, norms, and styles of
individuals and groups. It is a discontinuity of the subjects
past behaviors and their perception of that discontinuity.
 Change means to be different, to cause to be different, or to
alter.
 It may be personal or organizational, can occur suddenly or
incrementally and be planned or unplanned
 Change management :

is a systematic approach

to dealing with transition

or transformation of an organization's goals

, processes or technologies for change

both from the perspective of

an organization and on the individual level.

 Also, change management the process, tools and techniques to
manage the people-side of business change to achieve the
required business outcome, and to realize that business change
effectively within the social infrastructure of the workplace.
 The purpose of change management is to implement strategies
for effecting change, controlling change and helping people to
adapt to change. Such strategies include having a structured
procedure for requesting a change, as well as mechanisms for
responding to requests and following them up.
 Change agent is the person who seeks to cause or create
change.
 Target system: the target or client or change system is the
individual, group, organization, community or other systems
in which leader or manager or any change agent proposes to
bring about change.
 Driving forces: behaviors that facilitate and push toward
change.
 Restraining forces: behaviors that impede pushing against
the change
Restraining forces include Examples of driving forces might
include
• Conformity to norms,
• A desire to please one’s boss,
• An unwillingness to take risks,
• To eliminate a problem that is
• Fear of the unknown.
undermining productivity,
• To get a pay raise, or
• To receive recognition.
 Types of change

1) Unplanned or unexpected change, Reactive

Occurs in response to some events or problems as it rises, so it is
crisis driven, isolated and short lived.
The change agent can cope with unexpected change by:
 Remaining calm.

 Analyzing the situation for few minutes that is why the

change is occurring as well as assessing its occurrence.

 Reprioritizing to cope with the unexpected this is

redistribution of the workload or reassigns personnel.

 Evaluating continuously, while supporting individuals during

the unexpected change process.

Types of change cont.,

Nurses deal with adjustments to unplanned change daily.

Examples might include an unexpected admission, an employee
sick call that leaves staffing short, or a sudden need to transfer a
patient to the critical care unit.
Types of change cont.,

2) Planned change, proactive

 A purposeful designed effort to bring about improvement in a
system .That is with the assistance of a change agent.
Types of change cont.,

 It is also by design, not by default: thorough, systematic

planning provides structure for the change process and a map
to follow toward a planned destination.
 In nursing practice, education and management change is
planned. It begins with the plan for revising existing
structures and processes, proceeding to the actions to achieve
the desired outcomes and evaluation of the success in creating
something new or different.
Types of change cont.,

Strategic Change
 Strategic Change is usually implemented at the organizational
level, which may affect the various components of an
organization and also the organizational strategy.
Types of change cont.,

Operational Change
 This kind of change becomes a requirement or the need when an
organization is faced with competitive pressures. The focus is laid more on
quality improvement or improvement in the delivery of services for an
edge over the competitors.
Types of change cont.,

 This may include bringing in changes in:

 the current technology,
 improving/re-engineering the existing work processes,
 improving the distribution framework or the product delivery,
 better quality management and improving the coordination at an inter-departmental
level.
Forces that influence change
 A- Internal forces
These come from within the organization (for organizational
change) or from within the person (for individual change).

 Examples:
 Need for increase productivity

 Staffing pattern changes

 Need for cost containment

 Work process changes

 Need for quality of work life

 Low satisfaction
 Internal forces

 Changes in managerial personnel

 Changes in work climate

 Declining effectiveness

 Crisis

 Deficiency in existing system

 Employee expectation
Forces that influence change cont.,

B- External forces
These are change comes from outside the person or the organization.
 Example:
 Health care economics as consumer demands.
 Technology advances.
 Political change.
 Changing demographics.
 Sociocultural change.
 Globalization
 Workforce diversity
Change theories
 The general concepts that are used to explain the
change process usually describe the interactions of the
change agent with the internal and external
environment.
 The skills required to positively influence and motivate
members of a working team require an understanding
of a variety of change theories that impact their ability
to be successful.
Change theories cont.,

 There are several theories that have been used to explain

change within any large healthcare system include:
 Lewin’s unfreeze-change-refreeze,
 Kotter’s eight steps,
 Rogers’ diffusion of innovation.
 Havloc Theory
 1- Lewin‘s force field model (1951)

 Lewin (1951) theorized that people maintain a state of status quo or

equilibrium by the simultaneous occurrence of both driving forces
(facilitators) and restraining forces (barriers) operating within any field.

 Lewin’s (1951) model suggested that people like feeling safe, comfortable,
and in control of their environment. For change to occur then, the balance
of driving and restraining forces must be altered. The driving forces must
be increased, or the restraining forces decreased.
Lewin‘s force field model cont.,

He identified three phases through which a change agent must

proceed before a planned change can be realized becomes part
of the system. These phases included
Lewin‘s force field model cont.,

1- Unfreezing Stage
Unfreezing occurs when the change agent convinces members of
the group to change. Thus, people become discontent, aware of a
need to change and the perceived need for change is increased.
Also, the change agent loosens or unfreezes the factors or forces
that are maintaining present equilibrium. By increasing the
perceived need for change
 Many change efforts are not successful because they become
one of hundred priorities”.
 To make a successful change effort , the leader must clear
away the competing priorities and shine a spotlight on the
need for a change to happen.
Lewin‘s force field model cont.,

Responsibility of the change agent in an unfreezing stage:

 Gather data.
 Accurately diagnose the problem.
 Decide if the change is necessary.
 Make others aware of the need for the change.
Lewin‘s force field model cont.,

2- Movement Stage
During this stage, the change agent identifies, plans, and
implements appropriate strategies to bring about the change.
Lewin‘s force field model cont.,

Responsibility of the change agent in moving stage:

 Develop a plan

 Set goals and objectives

 Identify areas of support and resistance

 Include everyone in the planning that will be affected

 Establish target dates

 Develop appropriate strategy for alteration

 Implement the change

 Be available to support others through the process

 Employ tactics for overcoming resistance

 Evaluate the change

 Modify if necessary
Lewin‘s force field model cont.,

3- Refreezing
 During this stage, the changes are stabilized and so that it
becomes integrated into the status quo.
 It is the time when positive feedback and encouragement help
to solidify the changes. Support others so that the change
remains in place.
Lewin‘s force field model cont.,

 Change agents must be patient and open to new opportunities

during refreezing, as complex change takes time and several
different attempts may be needed before desired outcomes are
achieved.
 Measuring the impact of change should always be a part of
refreezing.
Lewin‘s force field model cont.,

 Because change needs at least 3 to 6 months before it will be

accepted as part of the system, the change agent must be sure
that he or she will remain involved until the change is
completed.
 If refreezing is incomplete, the change will be ineffective and
the pre-change behaviors will be resumed.
 2- Kotter’s Eight-Stage Change Process

 Kotter (1996) outlined an eight-step process that act as a

principles to provide a systematic framework to successfully
create and lead change within an organization.
 The use of these guiding principles have assisted in
successfully changing the culture of the organization.
Therefore, nurses may be involved in leading changes within
a clinical environment and providing feedback to others as the
change is implemented.
Kotter’s Eight-Stage Change cont.,

Examples
 The initiation of a new Electronic Medical Record (EMR)
computer system that requires patient centered initiatives. In
order to fulfill a task of this nature, the nurses would need an
understanding of a change process.
 Nurses working with a noncompliant diabetic patient would
create a sense of urgency about the patient’s blood glucose
levels.
Embedded in Kotter’s (2001) eight-step process are the
following organizational steps:

1. Establish an urgency 6. Generate wins

2. Create a coalition 7. Never let up, and

3. Develop a vision 8. Incorporate cultural

4. Communicate the vision change.

5. Empower others
 3- Rogers’ diffusion of innovation (DOI) 1962

 Innovation has been defined as a process that occurs when an

idea is introduced and when members of the organization use
it.
 It is also defined as an “idea or practice that is perceived as
new by an individual . . .” (Rogers 2003).

 The focus of the DOI theory is on adopting an innovation

rather than changing a behavior.
Rogers’ diffusion of innovation (DOI) cont.,

 In healthcare organizations, Berwick (2008) suggested that

healthcare workers needed to be competent at using a new
product or innovation before adapting it to their environment.
Rogers’ diffusion of innovation (DOI) cont.,

According to Rogers, there are five stages involved in the decision making process
related to adopting an innovation.

These include:

1. Knowledge: Develop the awareness of innovation and have an idea of how it

works.

2. Persuasion: Form an opinion which can be positive or negative favorable.

3. Decision: Choose to adopt or reject the innovation and engage in activities that
reflect the decision.

4. Implementation: Use the innovation.

5. Confirmation: Evaluate the results of the innovation used.

Rogers’ diffusion of innovation (DOI) cont.,

Rogers (2003) also describes five attributes that affect an

individual’s decision to adopt or accept the innovation. These
include:

1. Relative advantage (Is the innovation better than the

current practice?)

2. Compatibility (Is the innovation consistent with values,

previous ideas, and/or perceived needs?)
Rogers’ diffusion of innovation (DOI) cont.,

3. Complexity or simplicity (How difficult or simple is the

innovation to use?),

4. Trialability (Can the innovation be experienced on a limited

basis?)

5. Observability (Will the results of an innovation be viewable

to potential adopters?).
Rogers’ diffusion of innovation (DOI) cont.,

 Rogers also developed five categories of adopters based on

innovativeness.
 Innovativeness being the amount of time it takes for an
individual to adopt to the new ideas as compared to others in
the system.
five categories of adopters
 Innovators
 Early adopters
 Early majority
 Late majority
 laggards
 4- Havloc Theory

 Havelock's theory of change is a linear model that generally

resembles Lewin's model, with an emphasis on planning and
an understanding of the possibility that people, and systems
may be resistant to change.
4- Havloc Theory cont.,

The 6 Aspects of Havelock's Theory of Change.

 Relationship. It states that relationship with the system in
need of change needs to be established. This could be
regarded as a stage of "pre-contemplation" where things are
going along as usual.
4- Havloc Theory cont.,

 Diagnosis. Once the agent of change is comfortable with the system as it

is, the person or entity being evaluated needing change is evaluated to see
if there is any awareness of a need for change.

 Acquire resources for change. At this change, the need for change is
understood and the process of developing solutions begins by gathering as
much information as possible that is relevant to the situation that requires
change.
4- Havloc Theory cont.,

 Selecting a pathway. It is when a pathway of change is selected from

available options and then implemented.
 Establish and accept change. Once the change has been put in place, it
must be established and accepted.
 Maintenance and separation. Now that the change is successful, the
change agent should monitor the affected system to make sure that it is
successfully maintained.
 Emotional response to change

Ten emotional stages of planned change, characteristics and

interventions:
1-equilibrium
2-denial
3-anger
4-bargaining
5-chaos
6-depression
7-resignation
8-openness
9-readiness
10-reemergence
 Interventions Characteristics\symptoms Phase
Make employees aware of changes in State of emotional and 1-equilibrium
the environment which will have intellectual balance.
impact on the status quo. Sense of inner peace with
personal and professional goals.
• Employ active listening skills as (be Energy is drained by denial of 2-denial
empathetic, non- judgmental, use the reality of a change.
reflective listening techniques).
• Avoiding isolation.
• Offering stress management
workshops.
• Recognize the symptoms, Energy is used to ward off and 3-anger
legitimate employee, feelings and actively resist change by
verbal expressions of anger. blaming others.
• Active listening, assertiveness and
problem solving skills needed by
manger.
• Employees need to probe within
for the source of their anger.
 Interventions Characteristics\symptoms Phase
• Search for real problems\ • Energy is used in an attempt to 4-bargaining
needs and brings them into eliminate the change.
the open.
• Using conflict
management skills and win
–win negotiation skills.

• Quit time for reflection. • Diffused energy, feeling of 5-chaos

• Listening skills. powerfulness, Insecurity and sense
• Inner search for both of disorientation.
employee and organization • Loss of identity and direction.
identity and meaning.
• Provide necessary No energy is left to produce 6-depression
information in a timely result.
fashion.
• allow pain to be expressed
only.
• long- term patience, take
one step at a time as
employees learn to let go.
• expect employees to be Energy is expected to accept 7-resignation
accountable for reactions to change passively. Lake of
behavior. enthusiasm.
• allow them to move at their
own space.
• Patiently explain again, in Renewed energy is an 8-openness
detail, the desired change. available.
• Assume a directive There is willingness to use 9-readiness
management style: energy to explore new events.
• Assign tasks, monitor tasks
and results so as to provide
direction and guidelines.
• Mutual answering of Energy is rechanneled 10-reemergence
questions. producing empowerment and
• Redefinition of career, employees become more
mission, and culture. proactive.
• Mutual understanding of role
and identity.
• Employee will take action
based on own decisions.
 Resistance to change

 Resistance to change or attempting to the status que is to be

expected as integral to the whole process of change.
 It is a natural response to change. Even though change is
inevitable, it creates instability in our lives, and some conflict
should always be expected.
Resistance to change cont.,

 Level of resistance depends on:

 Type of proposed change. Ex:

Technological changes: less resistance than changes that are perceived

as social or that are contrary to established customs or norms
 Whether the change is mandated or proactive

Proactive change is generally less emotional than mandated change;

yet, the lines often blur between the two because proactive change
launched by one group may be perceived as mandated change by
another.
Matejica and julian(1997) Variables leads to
resistance to change

 Respect: change agent must be credible. When he/she is a distrust

member in the organization ,there is will be resistance.

 Evaluation: employees needs to know enough about the change to

measure its effect on them, but they often receives bits and pieces of

information regarding the change ,which make them believe that the

change is unwarranted or personally harmful.

 Satisfaction: many employee may be satisfied present situation, their

comfort with the way things are currently done .may lead to resistance
Variables leads to resistance to change cont.,

 Ignorance: lack of knowledge and skills to handle the

change.
 Strength: resistance is meant to show the power of employee
that can be wield.
 Tradition: employees argue that some tradition are worth to
kept but some tradition need to be change
Variables leads to resistance to change cont.,

 Anxiety: fear of unknown

 Norms: changes that violate the group acceptable pattern will
be resisted.
 Commitment: the degree to which employee perceive the
organization’s vision and the extent to which they feel
committed to its goals. A clear vision enhance commitment
 Expectation: employee may expect managers to accept
change, change start with managers to accept the change
Strategies to overcome resistance for changes

 Selecting the appropriate strategy for change is crucial in

facilitating the process and achieving the desired outcomes.
 Selecting a strategy for change require the nurse to have
problem solving, decision making and communication skills.
 Selecting the appropriate strategy depends on:
 Power of the change agent
 The ability of the group to change/ the amount of resistance
expected from the subordinates
 Types of strategies

 Rational–empirical
 Power–coercive strategy
 Normative–re-educative
Classic Strategies for changes cont.,

1-Rational–empirical
 Assumes that people are rational (guided by reason) and receptive to
change when given adequate facts.
 Knowledge is the major source of power.

E.g.
 Assumption that the dissemination of research findings will change
nursing practice.
 The distribution of leaflets outlining the spread risks of COVID will alter
the population’ practices.
Classic Strategies for changes cont.,

 This approach work best when the planned change is easy to

understand, implement and very little resistance from target
system or when the change is perceived as reasonable.
Classic Strategies for changes cont.,

2- Power–coercive strategy
 Most commonly used and associated with the historical development of
nursing organizations.
 The application of power by legitimate authority, economic sanctions, or
political clout of the change agent to achieve the desired outcome.
 These strategies include influencing the enactment of new laws and using
group power for strikes or sit-ins.
 It assumes that persons with less power will always comply with the plans
and directions.
Classic Strategies for changes cont.,

 Result of an individuals need to please a supervisor, or fear of losing their

job. E.g.
 Managers to staff nurses.
 Doctors and nurses to patients.
 Teachers to students.

 These strategies assume that people often are set in their ways and will
change only when rewarded for the change or when they are forced by
some other power–coercive method.
 Resistance is handled by authority measures; the individual must accept it
or leave.
Classic Strategies for changes cont.,

3- Normative–re-educative (Participative)
 Contrast with the 2 previous strategies (up- down).
 People need to be involved in all aspects of change process.
 Change will only occur when attitudes and relationships are
altered.

 These strategies use group norms and peer pressure to

socialize and influence people so that change will occur.
Classic Strategies for changes cont.,

 The change agent assumes that humans are social creatures,

more easily influenced by others than by facts. This strategy
does not require the change agent to have a legitimate power
base. Instead, the change agent gains power by skill in
interpersonal relationships.
E.g.
 Involving all levels of the nursing organization in the change

process.
 Patient- centered and student- centered approach.
 An example may be reflected in the change agent who wants
someone to stop smoking. The change agent might present
the person with the latest research on cancer and smoking
(the rational–empirical approach); at the same time, the
change agent might have friends and family encourage the
person socially (normative–reeducative approach). The
change agent also might be penalize the smoker person
(power–coercive approach).

By selecting from each set of strategies, the change agent

increases the chance of successful change.
 Which is the best?

Utilizing a combination of the three strategies to achieve the

desired outcome.

Depends on:
 Situation.
 Individuals’ knowledge, values, believes attitude and past
experiences.
 Willingness of the group.
 Steps for planned changes
Spradley’s model of change

A) Assessment:
 Identify the problem.

 Collect the data.

 Analyze the data.

B) Planning:
 Plan the change.

C) Implementation:
 Implement the change

D) Evaluation:
 Evaluate the change.

 Stablize the change (refreezing)

A) Assessment

Step1: Identify the problem

 It is to recognize the symptoms of a problem that indicating a
need for a change through describing the present situation as it
is now and comparing it with the way it should be.
 It is an important to determine the nature and the cause of the
need to change and its potential effect on the target system.
Step2: Collect the data
 Gathering structural, technological, and people information
and effects of these elements on the process.
 Assessing the cost, benefits and resources.
 The change agent collects data internal and external to the
target system.
 To determine the nature and the cause of the problem or the
change needed.
Step3: Analyze the data
 Make a list of all reasonable, broad alternative and then

analyze them with determining the advantages,

disadvantages, risks, possible consequences and risk
involved in each on.
 Identifying possible solutions, barriers, and strategies.

 Revise the experience and solution tried by others.

 Analysis the resources. look for obstacles and choose

the option most likely to succeed.

 Identify the driving and restraining forces using

challenges.
Five –step procedure the change agent should follow in
conducting force field analysis:
 Brainstorming to produce list of driving and restraining forces

 Estimating the strength of each force

 Plot the forces on a chart

 Note the most important forces, then research and analyzing

them
 List and document possible responses or action that might

strength each important driving forces or weakens each

important restraining force
B) Planning

Step4: Plan the change

 State goal and specific measurable objectives and also the
time allotted.
 Establishing the who, how, what, and when of change.
 Allocating resources, budget and evaluation methods.
 Plan for resistance management
There are three kinds of tactics can be used to unfreeze the
target system:

1-Introducing diconfirmation: is a confrontation with conflicting

evidence

This confrontation makes the target system feel uncomfortable or

dissatisfied with its present condition so that it will want to change

The disconfirming evidence may be information, example, or

experiences that challenge the status Que.
2-Inducing guilt and anxiety: Will overcome resistance to
disconfirmation .this is done by demonstrating that a goal or value that is
important to the target system is not being met or upheld

3-Providing psychological safety:

Making a change require some risk on the part of the target system so the
leader manager needs to provide sufficient security to minimize that risk.
C) Implementation

Step5: Implement the change

 Enacting the plan
 The change agent should be certain that all people concerned,
clearly understand and are prepared for the change.
 What to expect, the meaning of change and what will be
required of them.
Role of manager during implementation

 Introduce the new information that are needed to change

 Encourage the new behaviour and practice and
experimentation with the change behaviour.
 Allow people to make mistakes without negative
consequences but provide opportunity for success.
 Continue to provide a supportive climate to avoid an increase
in defensive behaviour and resistance to change.
Role of manager during implementation

 Provide opportunity to ventilate the guilt and anxiety as well as other

feeling such as anger &hostility.
 Provide feedback on progress and clarification of goals to reinforce the
change process.
 Present individuals as trustworthy person in order to keep communication
open.
 Act as energizer to keep interest high and to keep the change process
towards moving forward.
 Overcome resistance that may still arise by using the tactics of unfreezing
phase
D) Evaluation

Step6: Evaluate the change

 Determining effectiveness of change and achieved objectives
and benefits ---- qualitative as well as financial and the
documented evidences of being achieved
 Evaluate if the method that used to achieve the goals were
good or need to change.
Step7: Stablize the change (refreezing)
 Taking measures to reinforce and maintain the change.
 A well-developed change plan includes a design for
stabilization.
 In order to be sustained a change must be refined and
standardized.
Roles of change agent

1. Consulting:
As a consultant, manager places employees in touch of
data from outside organization or helping organization
members to generate data from within organization.
The overall purpose is to help employees find solution
to problems through analysis valid data.
Role of change agent

2- training
 Help organization members derive implication for
action from present data and
 Provide organization members with anew set of
skills- the ability to retrieve, translate and use new
data to solve future problem
Role of change agent

 3- research
 The manager assume the role of researcher, as
a researcher, manager may train organization
members in the skills needed for valid
evaluation of effectiveness of action plans that
have been implemented.
 Becoming an effective change agent

Nursing managers can be effective change agents:

 Has the control over his attitude and the way he manage the

change.
 That includes being defensive, giving advice, and

premature persuasion.
 possesses self confidence, knowledge of the change

process, and the interpersonal skills to help participants to

accept, allow and see the process of change as a change.
 should be pioneer, an explorer, and a positive
enthusiastic player and focusing on removing
obstacles and moving forward.
Becoming an effective change agent cont.,

 Take the ownership of the change: taking full personal

responsibility for moving forward.
 Careful choose the issue of change: some issues are worth a
challenge, others in the bigger scheme of things are not.
 Try to keep a sense of humor: organizational change is
difficult, so being a change agent is more difficult and it will
be not healthy for him and the organization, so it is an
important to have sense of humor.
Becoming an effective change agent cont.,

 Focus on an inventing a new future and rather than fix the

past (Creation)
 to be creative and taking the risk, thinking of new ways to
do things and new opportunity for growth focusing on what
is coming and anticipating how to acquire the knowledge
and skills to succeed in the new environment
Becoming an effective change agent cont.,

 Create a healthy work environment: Change agent has the

responsibility to structure organizations such as a way that
dignity, integrity, honesty and compassion are preserved.
 Learning to cope with ambiguity, having
stamina, being skillful in group
management.
 Be able to combine ideas from unconnected
sources, give participants a lot of
information and being a catalyst for change
 Leader-managers must act as role models to subordinates during the
change process.
 The leader-manager must attempt to view change positively and to impart
this view to subordinates.
 Rather than viewing change as a threat, managers should embrace it as a
challenge and an opportunity for growth. and the chance or opportunity to
do something new and innovative.
 Indeed, the leader has two responsibilities in facilitating
change in nursing practice. First, leader managers must be
actively engaged in change in their own work and model this
behavior to staff.
 Second, leaders must be able to assist staff members in
making the needed change requirements in their work.
 Create enthusiasm and passion for renewing the profession; to
embrace the change of locus of control, which now belongs to
the health-care consumer; and to engage a new social context
for nursing practice.
 References

 Marquis, B. L. & Huston, C. J. (2017). Leadership Roles and Management

Functions in Nursing: Theory & Application (9th ed.). China: Lippincott Williams
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 Korniewicz, D. M. (2015). Nursing Leadership and Management The Advanced
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 Hughes, L., Ginnett, C., & Curphy, J. (2019). Leadership Enhancing The Lessons
Of Experience (9th ed.). USA: McGraw-Hill/Irwin, 580-585
 Roussel, L., Thomas, P., & Harris, H., (2016). Management and leadership for
nurse administrators (7th ed.). USA: Jones & Bartlett.
 Weiss, S., A., Tappen, R. M. (2015). Whitehead, Essentials of Nursing Leadership
& Management (6th ed.). USA: F.A. Davis Company, 133-143.
 Chreim, S., & Williams, B.E. (2012). Radical change in
healthcare organization: Mapping transition between
templates, enabling factors, and implementation processes.
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 Juneja, P. (2015). Management study guide. Different Types
of Change. Available at
https://www.managementstudyguide.com/types-of-change.ht
m