Nursing Change Management Theories

Nursing Change Management Theories

As nurses, we are often faced with changes in policies, procedures, technology, and the overall healthcare environment. Effectively managing these changes is crucial for providing high-quality patient care and maintaining a positive work environment. Several nursing theorists have developed change management theories to help guide healthcare professionals through the change process.

Change Management Models in Healthcare

Change is a constant in the healthcare field. New treatments, technologies, processes and regulations are always emerging. As a nurse, you’ll need to be able to adapt to these changes smoothly and effectively. This is where change management models come in.

Change management models are frameworks that provide structured approaches for implementing changes within an organization. They outline the key steps, activities and best practices to follow to increase the likelihood of a successful change implementation. Using a proven model can help reduce resistance, confusion and disruption when changes occur.

One popular change management model used in healthcare is the ADKAR model. ADKAR stands for:
• Awareness 
• Desire
• Knowledge
• Ability 
• Reinforcement

This model focuses on the people side of change. 

In the Awareness phase, you build awareness about the need for change and its benefits. In a hospital setting, this could involve educating nurses about a new electronic medical records system being implemented.

The Desire phase aims to inspire a real desire to support and participate in the change. Leaders work to address concerns and highlight how the change will positively impact staff and patients.

The Knowledge phase provides the information, training and instructions people need to understand the change and develop new skills. With a new records system, nurses would receive hands-on training.

In the Ability phase, nurses can practice using the new system with support until they have the ability to put their new knowledge and skills into practice proficiently.

Finally, the Reinforcement phase aims to reinforce the change as the new norm through rewards, celebrations, coaching and metrics.

Another common model is Kotter’s 8-Step Process. This linear model outlines 8 key steps for leaders to follow:
1. Create a sense of urgency
2. Build a guiding coalition  
3. Form a strategic vision
4. Enlist a volunteer army
5. Enable action by removing barriers
6. Generate short-term wins
7. Sustain acceleration
8. Institute change

Other change models include Lewin’s Three-Stage Theory, the PDCA (Plan-Do-Check-Act) Cycle, and the Bridges’ Transition Model. Each has its own unique approach.

No single model is best – the right one depends on the situation. Some models focus more on the human/psychology side, while others emphasize project activities. Most incorporate similar core principles like building awareness, enabling action, managing resistance and making changes stick.

Nursing Change Management Theories for Nursing Students

As change is critical in the ever-evolving healthcare landscape, nursing students who understand and can apply change management theories and frameworks are more likely to succeed in implementing and sustaining positive changes that ultimately improve patient care and organizational performance.

Understanding of Change Theory

Here is a brief explanation of understanding change theory:

Change theory refers to the conceptual models and frameworks that describe and guide how to effectively implement change within an organization or system. Understanding change theory is important because it provides structured approaches and principles for navigating the complexities involved in enacting meaningful change.

Some key aspects of understanding change theory include:

  • Recognizing that change involves a process, not a one-time event. Change theories outline phases or stages that change efforts move through.
  • Appreciating the human/psychological factors that influence people’s reactions and resistance to change. Many theories emphasize activities to increase awareness, desire, and acceptance.
  • Utilizing proven activities, best practices, and tactics prescribed by change models to increase the likelihood of success when implementing changes.
  • Adopting a systematic mindset about preparing for change, managing the transition process, solidifying new ways of operating, and continuously improving.
  • Selecting the appropriate change theory/model based on the type of change, organizational context, and goals.

Kurt Lewin’s Model of Change(3-stage model of change)

Kurt Lewin, a pioneering psychologist, developed one of the earliest and most widely recognized change management theories in the 1940s. His theory involves three fundamental stages:

a. Unfreezing:

In this initial stage, individuals or organizations must recognize and confront the need for change. This involves analyzing the driving and restraining forces that impact the current state. Unfreezing creates motivation to change by highlighting gaps between the desired state and the current reality. For example, a hospital may realize the need to transition from paper-based to electronic health records to improve efficiency, reduce errors, and enhance patient care.

b. Change (or Moving):

Once the organization is ready to change, the second stage involves implementing the desired change or new practices. During this transition phase, organizations should provide clear guidance, training, and support to help individuals adopt the new behaviors or processes. Continuing the example, the hospital would begin training staff on using the new electronic health record system, addressing concerns, and gradually phasing out paper records.

c. Refreezing:

In this final stage, the changes become integrated into the organization’s culture, policies, and standard operating procedures. The new behaviors or practices are reinforced and stabilized through ongoing monitoring, feedback, and adjustments as needed. The hospital would reinforce the use of electronic records through updated policies, continued training, and addressing any remaining barriers or resistance.

Everett Rogers’ Diffusion of Innovation Theory

Everett Rogers, a sociologist, developed a theory in the 1960s that explains how new ideas or innovations spread through a social system over time. He identified five categories of individuals based on their willingness to adopt change:

a. Innovators: The first individuals to adopt an innovation. They are typically risk-takers and have a high tolerance for uncertainty.
b. Early Adopters: Those who embrace change before the majority. They are often opinion leaders and influential in their social circles.
c. Early Majority: Individuals who adopt change after a varying degree of time, once they have seen evidence of the innovation’s benefits and usefulness.
d. Late Majority: Those who are skeptical of change and adopt it only after most others have done so, often due to economic necessity or peer pressure.
e. Laggards: The last group to adopt an innovation. They are typically resistant to change and may hold traditional values or have limited resources.

Understanding these categories can help nurses and healthcare organizations tailor their communication and change strategies to address the unique needs and concerns of each group.

Related Article: Relevance Change Theories in Health Care

Kotter’s 8-Step Change Model

John Kotter, a Harvard Business School professor, developed an 8-step process in the 1990s for leading organizational change effectively. This model emphasizes the importance of creating a sense of urgency, building a guiding coalition, and sustaining momentum throughout the change process:

  • Create a sense of urgency by highlighting the need for change and the potential risks of maintaining the status quo.
  • Build a guiding coalition of influential leaders and stakeholders who can drive the change effort.
  • Form a strategic vision and initiatives that clearly articulate the desired future state and the steps to achieve it.
  • Enlist a volunteer army by involving and empowering frontline staff in the change process.
  • Enable action by removing barriers, such as outdated policies or lack of resources, that could impede the change.
  • Generate short-term wins by celebrating and recognizing small successes along the way, which builds motivation and momentum.
  • Sustain acceleration by continuing to build on the change’s momentum and addressing any remaining resistance or obstacles.
  • Institute change by integrating the new practices, behaviors, or systems into the organization’s culture and ensuring they are consistently reinforced.

Related Article: Best Change Management for Nursing

Havelock’s Change Theory

Ronald Havelock, an educational psychologist, developed a theory in the 1970s focused on the process of planned change. His theory involves six interconnected stages:

  • Building a relationship between the change agent (the individual or group leading the change) and the client system (the individuals or organization undergoing the change). This involves establishing trust, understanding the client’s needs, and creating a collaborative partnership.
  • Diagnosing the problem or identifying the specific areas that require change. This stage involves gathering data, analyzing the current situation, and defining the desired outcomes.
  • Acquiring relevant resources, such as knowledge, skills, materials, or funding, necessary to implement the change successfully.
  • Choosing the solution or change strategy that best addresses the identified problem or need, based on the available resources and the organization’s unique context.
  • Gaining acceptance by involving stakeholders, addressing concerns, and building support for the proposed change through effective communication and participation.
  • Stabilizing the innovation and generating self-renewal by monitoring the change’s implementation, making adjustments as needed, and promoting continuous improvement and adaptation.

Lewin’s Force Field Analysis

In addition to his Change Theory, Kurt Lewin also developed the Force Field Analysis, a tool to identify and analyze the driving and restraining forces involved in a change process. This analysis helps organizations understand the factors that support or hinder change and develop strategies to leverage the driving forces and mitigate the restraining forces.

Driving forces are factors that facilitate or push the change forward, such as a desire to improve patient outcomes, external pressures (e.g., regulations or market demands), or strong leadership support.

Restraining forces are factors that resist or impede the change, such as fear of the unknown, lack of resources, or deeply ingrained habits or culture.

By conducting a Force Field Analysis, organizations can identify the specific driving and restraining forces impacting a particular change initiative and develop targeted strategies to strengthen the driving forces (e.g., providing training, addressing concerns) and weaken the restraining forces (e.g., removing barriers, challenging assumptions).

Applications of Change Management Models

1. Implementing electronic health records (EHR) systems
2. Introducing new clinical practice guidelines 
3. Adopting telehealth or virtual care models
4. Merging or acquiring healthcare organizations
5. Enhancing patient safety reporting and processes
6. Transitioning to value-based care delivery 
7. Expanding service lines (home health, urgent care, etc.)
8. Improving care coordination and team-based practices
9. Redesigning outpatient clinic workflows
10. Applying Lean principles to reduce waste
11. Integrating new medical devices or technologies  
12. Responding to new healthcare regulations or legislation
13. Establishing new quality improvement initiatives
14. Transitioning leadership or management structures
15. Integrating newly acquired physician practices
16. Standardizing supply chains across hospital systems  
17. Shifting from volume-based to value-based reimbursement
18. Implementing wellness and population health programs
19. Redesigning nursing education curricula
20. Changing organizational cultures and mindsets


What are change management theories?

Change management theories are frameworks and models that provide guidance on how to effectively manage organizational change. These theories offer insights into understanding the process of change, predicting its impacts, and implementing strategies to facilitate successful transitions within an organization. Some common change management theories include:

  1. Lewin’s Change Management Model: Developed by psychologist Kurt Lewin, this model consists of three stages: unfreezing, changing, and refreezing. It emphasizes the importance of preparing for change, implementing the change, and then stabilizing the new state to make it permanent.
  2. Kotter’s 8-Step Change Model: Proposed by Harvard Business School professor John Kotter, this model outlines eight steps for managing change, including creating a sense of urgency, forming a powerful coalition, communicating the vision, empowering employees, and anchoring the change in the organizational culture.
  3. ADKAR Model: Developed by Prosci, the ADKAR model focuses on individual change by addressing five key elements: Awareness, Desire, Knowledge, Ability, and Reinforcement. It provides a framework for understanding how individuals move through the change process and what interventions are needed at each stage.
  4. Satir Change Model: Created by family therapist Virginia Satir, this model describes change as a process that involves four stages: late status quo, resistance, chaos, and integration. It emphasizes the importance of addressing emotional reactions to change and facilitating open communication and collaboration.
  5. Bridges’ Transition Model: Developed by William Bridges, this model focuses on managing transitions that occur during change. It consists of three stages: endings, neutral zone, and new beginnings. The model highlights the importance of acknowledging and addressing the psychological and emotional aspects of change.

What is Rogers’ nursing change theory?

Rogers’ Nursing Change Theory, also known as the Diffusion of Innovations Theory, was developed by Everett Rogers, a communication scholar, in 1962. While not specifically a “nursing change theory” in the traditional sense, it has been widely applied in various fields, including nursing.

The theory focuses on how new ideas, innovations, or practices spread and are adopted within a social system. In the context of nursing, this theory can be applied to understand how new healthcare practices, technologies, or interventions are adopted by nurses and healthcare organizations.

Rogers identified five stages through which individuals and organizations pass when adopting a new innovation:

  1. Knowledge: In this stage, individuals become aware of the existence of the new innovation and gain knowledge about its features and benefits.
  2. Persuasion: During this stage, individuals actively seek information about the innovation and evaluate its potential advantages and disadvantages. They may be persuaded to adopt or reject the innovation based on this evaluation.
  3. Decision: In this stage, individuals make a decision about whether to adopt or reject the innovation. Factors influencing this decision include perceived compatibility with existing practices, complexity, trialability (the ability to experiment with the innovation), and observability (the visibility of the innovation’s results).
  4. Implementation: Once the decision to adopt the innovation is made, individuals begin to implement it in practice. This stage involves overcoming barriers and challenges associated with integrating the innovation into existing workflows and routines.
  5. Confirmation: In the final stage, individuals seek reinforcement and validation of their decision to adopt the innovation. Positive outcomes and experiences with the innovation lead to its continued adoption and integration into the social system.

What is the change theory of Karl Lewin?

Kurt Lewin, not Karl Lewin, was a psychologist who is often considered the founder of modern social psychology and is renowned for his work on understanding group dynamics and organizational change. While Lewin is not typically associated with a specific “change theory,” he developed a model known as the “Lewin’s Change Management Model,” which is widely used in organizational change management.

Lewin’s Change Management Model consists of three key stages:

  1. Unfreezing: In this stage, the status quo is destabilized to prepare individuals and the organization for change. It involves creating awareness of the need for change, overcoming resistance to change, and encouraging a readiness to embrace new ways of thinking and behaving.
  2. Changing (Transition): Once the organization is unfrozen, the actual change is implemented. This stage involves introducing new processes, structures, or behaviors and facilitating the transition from the old way of doing things to the new way. Communication, training, and support are crucial during this stage to ensure that individuals adapt effectively to the change.
  3. Refreezing: In the final stage, the changes are reinforced and integrated into the organizational culture to make them permanent. This involves solidifying the new practices, norms, and behaviors and ensuring that they become the new standard operating procedures. Continuous reinforcement and support are necessary to prevent regression to the old ways of doing things.

What is the difference between Lewin and Kotter change model?

Lewin’s Change Management Model and Kotter’s 8-Step Change Model are two prominent frameworks for managing organizational change, each with its own approach and emphasis. Here are some key differences between the two:

  1. Number of steps/stages:
    • Lewin’s model: Lewin’s model consists of three stages: unfreezing, changing, and refreezing. It emphasizes the need to prepare for change, implement the change, and then stabilize the new state.
    • Kotter’s model: Kotter’s model consists of eight steps: creating a sense of urgency, forming a powerful coalition, creating a vision, communicating the vision, empowering others to act on the vision, planning for and creating short-term wins, consolidating improvements and producing more change, and institutionalizing new approaches. Kotter’s model provides a more detailed roadmap for managing change, with specific actions to be taken at each step.
  2. Focus:
    • Lewin’s model: Lewin’s model focuses on the process of change itself, emphasizing the importance of unfreezing the existing state, making the change, and then refreezing the new state to make it permanent.
    • Kotter’s model: Kotter’s model focuses on the leadership and management aspects of change, highlighting the need for strong leadership, clear vision, effective communication, and empowerment of employees to drive change successfully.
  3. Timeframe:
    • Lewin’s model: Lewin’s model is more general and does not specify a timeframe for implementing change. It is flexible and can be adapted to different organizational contexts.
    • Kotter’s model: Kotter’s model provides a more structured approach with specific steps to be completed in a sequential order. It is designed to be implemented over a relatively short timeframe to drive rapid and effective change.
  4. Leadership role:
    • Lewin’s model: Lewin’s model does not explicitly focus on the role of leadership in driving change. While leadership support is implied, the emphasis is more on the process of change itself.
    • Kotter’s model: Kotter’s model places a strong emphasis on leadership, highlighting the critical role of leaders in creating a vision, communicating it effectively, and mobilizing support for change throughout the organization.