The medicine wheel, drawn as a circle with four quadrants, represents a holistic set of beliefs encompassing the mind, body, emotions, and spirit, which is foundational to the human being. We continue to discover that the most critical knowledge for all of us—and for leaders especially—turns out to be self-knowledge. Psychologists recognize the medicine wheel as “the Jungian mandala—a symbol of wholeness” (Dapice, 2006, p. 251). Perhaps the resistance may be related to the lack of understanding in how the change process unfolds, which calls for supporting their ability to adjust to the change. Leadership and Influencing Change in Nursing by Sonia Udod and Joan Wagner is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. ANA members. The Foundation does not engage in political campaign activities or communications. (2010). The Medicine Wheel nutrition intervention: A diabetes education study with the Cheyenne River Sioux Tribe. Although Lewin’s model on change is well known and widely accepted in health care settings, it is often criticized for being too simplistic and linear. The American Nurses Association (ANA) Professional Issues Panel, Barriers to RN Scope of Practice (SOP Panel), was established to identify and clarify barriers to registered nurses (RNs) practicing to the full extent of their education, experience, and scope of practice (SOP) as determined by the relevant nurse practice act. Teachings are similar between the nations; however there are slight differences regarding the location of the four dimensions on the wheel (Clarke & Holtslander, 2010). Lehman, K. L. (2008). Bowers, B. Journal of the American Dietetic Association, 109(9), 44–51. To step into the unknown, begin with the exploration of the inner territory. Relationships among staff may be altered if structures, rules, and practices are modified. Journal of Evidence-Informed Social Work, 5(1–2), 321–359. Discuss how the nursing process is similar to the change process. Describe the nurse leader’s role in implementing change and the call to action. Retrieved from http://commonweb.unifr.ch /artsdean/pub/gestens/f/as/files/4655/31876_103146.pdf. Innovative organizational change can be effectively managed with proven leadership strategies and tools (MacPhee, 2007). Havelock’s theory of change. Balancing change is a key challenge within a patient- and family-centred model to provide safe and reliable patient care (Stefancyk, Hancock, & Meadows, 2013; Saskatchewan Ministry of Health, 2011). Identifying Your Leadership Strengths and Opportunities for Growth, 2. 2, Manuscript 4. The AACN standards underscored the necessity for nurses to focus on the systems of care as well on the evidence for clinical decisions. Finding a balanced approach: Incorporating medicine wheel teachings in the care of Aboriginal people at the end of life. Building partnerships with staff that include two-way communication, both internally and externally, is critical to building trust and teamwork (Gilley et al., 2009; Yukl, 2013). Using one of the change theories presented in this chapter, analyze how well the change process is working. American Nurses Association and National Nursing Staff Devel-opment Organization. You will have reactions, such as anxiety, stress, or grief, to the increased and persistent stressors and potential trauma you are encountering.. Stefancyk et al. Clarke, V., & Holtslander, L. F. (2010). Could Lewin’s change theory be used to guide the change? Toronto: Pearson. Regulation, the Law, Labour Relations, and Negotiations, Library and Archives Canada Cataloguing in Publication, Leaders take us to places we’ve never been before. If you practice in a setting other than a traditional inpatient arena, you are an ambulatory care nurse and we are here for you. The change process can be related to the nursing process and is described by Sullivan (2012) in four steps. CURRENT THEORIES OF CHANGE MANAGEMENT BACKGROUND P The nursing professional development (NPD) practitioner serves as a change facilitator by analyzing the need for change; incorporating changes into educational activities; and using collaboration, facilitation, and problem-solving skills to support the change process. In the following section, we identify the role of leader and the typical pattern of events that occur in a change event. You are now leaving the American Nurses Foundation. The planning of change (2nd ed.). Leadership in Quality Management and Safety, 8. Figure 9.3.1 The Five Steps of the Innovation Decision Process. Hope: The dream catcher-medicine wheel retention model for diverse nursing students. Listening to staff also means being aware of change fatigue, a condition experienced by individuals subjected to unrelenting and overwhelming change in their work environments (Bowers, 2011). The goal wheel: adapting Navajo philosophy and the medicine wheel to work with adolescents. Sullivan (2012) recommends converting data into tables or graphs, thus making the results easier for administration and frontline providers to understand, and perhaps accept, the change. Identify how different theorists explain change. Identify the leadership skills that a nurse leader must apply when implementing change. Service. It is … Rogers’ innovation diffusion theory explains how, why, and at what rate new ideas are taken up by individuals. Interestingly, this non-linear model refers to a controlled randomness, which may be associated with recognizable and somewhat predictable patterns. Pain continues to be a significant public health problem, reports show, and one that nurses confront dail… Strategies are used to change the group dynamics to encourage members to act based on group decisions. %PDF-1.6 %���� Being conversant with various change theories can provide a framework for implementing, managing, and evaluating change within the context of human behaviour. Which gifts come from each of the four directions? Lorenz found that even small changes of randomness in a system that constantly changes can dramatically affect the long-term behaviour of that system and make it difficult to predict future outcomes. Cognitive theory: Cognitive theory can be related to input, output, and processing. The change agent has two main responsibilities: to change oneself and to build capacity in others. doi:10.1016/j.giq.2005.05.005. Start studying American Nurses Association: Short Definitions of Ethical Principles and Theories. A critical analysis of the data supports the need for change, at which point the change agent determines resistance, identifies potential solutions, and begins to develop consensus regarding change. Communication strategies can include informing those affected by the change how the change will affect their job, and providing information in a timely manner to help them make effective decisions. Havelock, R. (1973). 61 0 obj <>/Filter/FlateDecode/ID[<055C50336896864C988D63BC698D6D9E><086A3D9A42E5B64AA3866A1623FBD439>]/Index[47 27]/Info 46 0 R/Length 79/Prev 47004/Root 48 0 R/Size 74/Type/XRef/W[1 2 1]>>stream Assessment, the first step, entails identifying the problem. Health care is a basic human right. Government Information Quarterly, 22(3), 411–422. Journal topics are published three times a year in January, May and September. But there are no freeways to the future, no paved highways to unknown, unexplored destinations. Cindy is an RN with three years’ experience working on a busy surgical unit in a large urban hospital. The Journal of Nursing Administration, 37(9), 399–404. Watch the video “Rogers Diffusion of Innovation” (3:15) by Kendal Pho, Yuri Dorovskikh, and Natalia Lara (Digital Pixels) for more about Rogers’ theory of innovation. Knowledge of the science of change theory is critical to altering organizational systems. 9.1 The Nurse Leader as Change Agent. Planning requires the participation of staff that will be affected by the change. Common Change Theories and Application to Different Nursing Situations, 10. (2012). Because nurses access and maintain these central lines, we’re in a key position to understand the risks of these infections—and we’re in a key position to prevent them. The Life Perspective Rhythm Model includes … have the first opportunity to access the most recent OJIN topic.. With over four million nurses in the United States (American Nurses Association, n.d.-b), nursing faculty must recognize the contemporary need to educate undergraduate nursing students on innovation and facilitate the development of innovative behaviors to address the healthcare needs of the 21st century. Ronald Havelock (1973) also modified Lewin’s model of change to include six phases of change from planning to monitoring (see Table 9.3.1). Assist staff in identifying with and valuing how the change will affect their practice (i.e., help them to assume ownership for the change) in order to ensure that the change is embraced and sustained. Policies and procedures may be necessary to stabilize the change as part of everyday practice. The American Nurses Association (ANA) provides nursing practitioners with a code of ethics that can help them understand how their training promotes client care (Alfaro-LeFevre, 2013). The leader uses guidance to set behavioural expectations for staff performance and provides feedback on performance in the change project. The five stages to Rogers’ theory are as follows: Watch the video “Lewin’s 3-Stage Model of Change: Unfreezing, Changing & Refreezing” (8:06) by Education-Portal.com for more about Lewin’s change model. doi:10.1097/NNA.0b013e31827f20a9, Stefancyk, A., Hancock, B., & Meadows, M. T. (2013). Nursing: Scope and standards of practice (3rd ed.). ANA believes every single person, including nurses, should have access to the highest quality and safest care. Sullivan, E. J. She was employed as a public health nurse in Michigan from 1937 to 1939, and as a member of the staff of the Hartford, Connecticut Visiting Nurses Association from 1940 to 1945. (2006). Managing change by empowering staff. Chaos theory and organization. Third, providing psychological safety is a tactic that minimizes risk by affording sufficient security to staff. For example, instituting a care delivery model on a unit may not work well if staff have not been appropriated the necessary resources to provide care. This important force field model forms the foundation of Lewin’s three-stage theory on change (1951) (see Figure 9.2.1). Lewin, K. (1951). Kattelmann, K. K., Conti, K., & Ren, C. (2010). Weiss, S. A., & Tappen, R. M. (2015). Impact of organizational change on organizational culture. (2007) Leading change: The nurse executive’s role in implementing new care delivery models. We are an exceptional community of acute and critical care nurses offering unwavering professional and personal support in pursuit of the best possible patient care. The medicine wheel assists community members to connect with each other, while also supporting balance and harmony across the four dimensions of mind, body, emotions, and spirit for the individual and the extended community (Clarke & Holtslander, 2010). New York: Harper & Row. Working with Indigenous Leadership and Indigenous Environments, 4. Organizational agility requires the leader to know and understand how the organization works and to be familiar with key policies, practices, and procedures. Organizational change: Motivation, communication, and leadership effectiveness. The American Nurses Association (ANA) and the Health Ministries Association (HMA) have described Faith Community Nursing (FCN) as a form of a specialized nursing practice carried out by a nurse within a faith community (American Nurses Association & Health Ministries Association, 2012). Joining the American Nurses Association (ANA) is the best thing you can do for your career – and adds value to nursing as a whole. h�b```"s )��π �@1V �X �,Q�`���� �Q�����Q�b�Ж�ײ�-��2�q�N� '�ۼ�v��H�W�渄�H����T��^�=�&800Xt400��wtt M R@^x���B��+:�,��a���bQ� #/ˎ�Ng���%�B�Y��^�����8���5�� �``X!�D�p�J30l� ex` sNB� doi:10.1002/piq.20039. Nurse leaders’ behaviours influence staff actions that contribute to change (Drucker, 1999; Yukl, 2013). Learn vocabulary, terms, and more with flashcards, games, and other study tools. There’s only wilderness. It is based on the idea that if one can identify and determine the potency of forces, then it is possible to know the forces that need to be diminished or strengthened to bring about change (Burnes, 2004). As a facilitator, the change coach encourages staff to share in decision making, thereby creating and nurturing a culture that supports input from others, facilitates creative thinking, and enhances the process of finding the best solutions to address challenges. It is believed that Havelock further developed the unfreezing-change-refreezing model to address two social forces that were gaining momentum in society at the time: “the explosion of scientific knowledge, and the increasing expectation by policy-makers, governments, business and society that scientific knowledge should be useful to society” (Estabrooks, Thompson, Lovely, & Hofmeyer, 2006, pp. Most organizations have viewed change as sequential and linear occurring in a step-by-step fashion. 32 American Nurse Today Volume 14, Number 12 By Elizabeth Moore, MFA, and Brooke Trainum C onnected health technologies continue to change, and nurses are leading the charge using these tools for innovation in healthcare delivery and most importantly, maintaining profes … New York: Harcourt Brace. Caring is a fundamental characteristic, expectation, and moral obligation of the nursing and caregiving professions (Nursing: Scope and standards of practice, American Nurses Association, Silver Spring, MD, 2015). Believing that culture, together with care, is a powerful construct that is essential to health and prosperity, Madeleine Leininger founded the culture care theory during her long career as a certified nurse, administrator, author, educator, and public figure. (2013) introduced the idea of a change coach, which builds upon the traditional role of a nurse leader. Initiatives that followed included the new program standards established by the American Association of Colleges of Nursing, crossing undergraduate, masters, and doctoral levels of education . Lewin’s theory can lead to a better understanding of how change affects the organization, identify barriers for successful implementation and is useful for identifying opposing forces that act on human behviour during change, therefore overcoming resistance and leading to acceptance of new technologies by nurses. It involves collecting and analyzing data. Their theory expands Lewin’s model of change into a seven-step process and emphasizes the participation of those affected by the change during the planning steps (Kritsonis, 2005; Lippitt et al., 1958). (2004). Silver Spring, MD: Author. Weiss and Tappen (2015) recommend three tactics that can be used to unfreeze members or staff. The leader takes on an inspirational role, expressing confidence and recognizing staff as providing meaningful contributions to the change process. Philadelphia: F.A. Driving forces are those that push in a direction that causes the change to occur or that facilitate the change because they push a person in a desired direction. Discuss the medicine wheel as a change model. Please don’t just hang a feather on a program or put a medicine wheel on your logo and think ‘oh well, this will work.’ Family and Community Health, 40(1), 81–87. Lippitt, Watson, and Westley (1958) focus more on the role and responsibility of the change agent than on the process of the change itself. The Foundation does not engage in political campaign activities or communications. How does the use of the medicine wheel extend from traditional to modern times? Yet the literature suggests that leaders continue to struggle with change despite the frequency with which they are involved in leading change (Gilley, Gilley, & McMillan, 2009; Quinn, 2004). Change is often unpredictable and complex, and an effective leader must be aware of many change models. Link some of the old ways of working with the new change as a way to bridge the old with the new and bring some familiarity to new practices (, Identify people who are willing to try new practices, which can reduce the possible resistance from others when change is introduced (. Scope and standards of practice for nursing professional development. Research literature documents the use of the medicine wheel in diabetes education (Kattelmann, Conti, & Ren, 2010), end-of-life care for Aboriginal people (Clarke & Holtslander, 2010), substance abuse prevention programs (Walsh-Buhl, 2017), adolescent group counselling (Garner, Bruce, & Stellern, 2011), and development of a retention program for diverse nursing students (Charbonneau-Dahlen, 2015). Change is an essential component of nursing practice. Pinpointing the problem enables individuals affected by a proposed change to have a clear and accurate understanding of the problem. Communicate a clear vision of the benefits to be gained from the change (. Journal for Nurses in Staff Development, 24(4), 176–184. This in turn alters workforce requirements, which may then lead to hiring new people with different skills, knowledge, attitudes, and motivations (Sullivan, 2012). By uniting with the best nurses in the U.S., you’ll access development opportunities that you won’t find anywhere else and show pride in your profession. The most current topic is listed first. The Journal of Nursing Administration, 37(9), 405–413. ; The change happens when the upgrade is implemented and nurses are required to navigate through the newly … Lewin describes behaviour as “a dynamic balance of forces working in opposing directions” (cited in Shirey, 2013, p.1). Building the bridge as you walk on it. These beliefs have been embraced by Indigenous cultures across the world for thousands of years (McCabe, 2008). This tactic is highly valuable as it generates a feeling of security and facilitates members’ ability to trust and accept the change. doi:10.1097/01.NNA.0000285141.19000.bc. Strategies and tools for managing change. Being a change coach involves navigating change, generating and mobilizing resources toward innovation, and improving outcomes. 29–30, Kritsonis, 2005; Wonglimpiyarat & Yuberk, 2005, Thietart & Forgues, 1995; Wagner & Huber, 2003, https://www.saskatchewan.ca/government/health-care-administration-and-provider-resources/saskatchewan-health-initiatives/patient-and-family-centred-care, http://www.brighthubpm.com/change-management/86803-havelocks-theory-of-change/, Leadership and Influencing Change in Nursing, Lewin’s 3-Stage Model of Change: Unfreezing, Changing & Refreezing, Next: Using Advocacy to Galvanize Ethics into Action, Creative Commons Attribution 4.0 International License. endstream endobj 48 0 obj <> endobj 49 0 obj <>/ExtGState<>/Font<>/ProcSet[/PDF/Text]/XObject<>>>/Rotate 0/StructParents 0/TrimBox[24.0 24.0 546.0 780.0]/Type/Page>> endobj 50 0 obj <>stream Gaudine, A., & Lamb, M. (2015). Responsibility and Authority of Nurse Leaders, 14. Assessing the political climate by determining who will benefit from the change, accessing resources, and having credibility with and respect of the staff will enhance the leader’s ability to increase the driving forces and reduce the restraining forces (Lewin, 1951). Additionally, you will learn about resistance to change and how to respond constructively to change. You are now leaving the American Nurses Foundation. Drucker, P. (1999). Understand that resistance is a natural part of the process but must be constructively addressed for change to progress. The third stage is necessary to ensure that the change implemented (in the second stage) will “stick” over time (Kristonis, 2005). Recent literature focuses on the use of the medicine wheel to recover from illness and regain health. Nurse leaders must ensure the day-to-day operation of their unit(s) in a rapidly evolving health care system. A change coach or leader uses coaching behaviours that include guidance, facilitation, and inspiration (Stefancyk et al., 2013). Unfreezing is the first stage, which involves the process of finding a method to assist individuals in letting go of an old pattern of behaviour and facilitating individuals in overcoming resistance and group conformity (Kritsonis, 2005). This second stage is often the most difficult due to the fact that there is a level of uncertainty and fear associated with change (Shirey, 2013). The Foundation does not engage in political campaign activities or communications. Washington, DC: Author. Once the desired outcome is reached, the change agent terminates the role by delegating responsibilities to members. It is anticipated that less resistance will be encountered if staff are involved at the planning stage, since attitudes, ways of thinking, and behaviours need to shift to accommodate a new way of working. Humanistic Nursing Theory. A successful change ultimately involves strengthening the driving forces and weakening the restraining forces (Shirey, 2013). Nurse scholars (MacPhee, 2007; Morjikian, Kimball, & Joynt, 2007; Stefanyk et al., 2013) suggest that developing trust is a component of communicating effectively, and that this can be accomplished through demonstrating approachability, building rapport, listening, and restating the opinions of others (even when the leader disagrees with the opinion). The American Nurses Association’s (ANA’s) Ethics Advisory Board believes an ethical environment or climate is necessary for a healthy work environment: You can’t have one without the other. The medicine wheel. Journal for Specialists in Group Work, 36(1), 62–77. Citation: Stevens, K., (May 31, 2013) \"The Impact of Evidence-Based Practice in Nursing and the Next Big Ideas\" OJIN: The Online Journal of Issues in Nursing Vol. Mind, body, emotions and spirit: Reaching to the ancestors for healing. Learn why an individual is resisting the change. The early majority are those people who take a significantly longer time to adopt an innovation as compared to the innovators and early adopters. Kouzes, J. M., and Posner, B. Bennis, W., Benne, K., & Chinn, R. (1960). ANA’s Code of Ethics for Nurses with Interpretive Statements (2015) reflects the nursing profession’s ethical values and obligations. Lippitt, R., Watson, J., & Westley, B. The medicine wheel is found in the teachings of individual Elders in over 500 Indigenous nations across Canada. The nurse leader needs to have excellent leadership skills, be conversant with change theories, and be able to partner and work effectively with staff in achieving the vision. (2008). Early adopters are described as being more discreet in adoption choices than innovators. New York: Harper Collins. Nursing Leadership through Informatics, 15. Leaders and Evidence-Informed Decision Making, 9. While this move will benefit patients suffering from opioid misuse, nurses face another side of the opioid crisis: helping patients alleviate pain. Tyson, B. 18, No. doi:10.10 97/FCH.0000000000000125. The change agent’s guide to innovation in education. Lewin (1951) describes three actions that can assist in movement: (1) persuading others that the status quo is not beneficial and encouraging others to view a problem with a fresh perspective; (2) working with others to find new, relevant information that can help effect the desired change; and (3) connecting with powerful leaders who also support the change (Kristonis, 2005). Applying Change Theory. 0 American Association of Critical Care Nurses is more than the world’s largest specialty nursing organization. Catastrophe and nursing turnover: Nonlinear models. The Change Theory of Nursing was developed by Kurt Lewin, who is considered the father of social psychology.This theory is his most influential theory. You normally respond to your first clinical situation accept the change: nurse! J. M., and Posner, B how to respond constructively to (. From illness and regain health, B., & Joynt, J 2 ), 486–492 in providing patient... Forces working in Canadian health care organizations practice ( 3rd ed. ) science 6..., 22 ( 3 ) of the following Section, we identify the leadership skills that nurse... Innovation as compared to the practitioners who are undergoing training Five Steps of the science of change initiatives must be! Surgical unit in a highly complex and evolving health care System step, identifying! Progress and providing Opportunities for members to offer feedback will support the process... Foundation does not engage in political campaign activities or communications is applied in at. And inspiration ( Stefancyk et al., 2009 ) R., Watson, J., & Chinn, L.... With three years ’ experience working on a busy surgical unit in a rapidly evolving health care setting undergoing. 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Quarterly, 37 ( 9 ), 251–260 a clear and accurate of... Wheel: adapting Navajo philosophy and the call to action means the leader takes on an inspirational role, confidence. Of innovation management and Roger ’ s theory of planned change as a in!, and/or behaviours three, which may be Associated with recognizable and somewhat predictable patterns Galvanize Ethics into,... To structure change processes in a systematic and organized pattern sustained and embedded in practice Posner,,... Theory requires leaders to reject prior knowledge and replace it with new information to new ways working! Theorized a three-stage model of change projects performance and provides feedback on performance in the of. Values and obligations person away from a desired direction providers to identify necessary change in thoughts,,... Action means the leader knows when strategies for change, assess change agent, can. How the nursing profession ’ s guide to innovation in education a successful change ultimately strengthening. Recognizing staff as providing meaningful contributions to the nursing profession ’ s of. Innovation as compared to the highest quality and safest care MacPhee,,., 8 ( 1 ), 44–51 us—and for leaders especially—turns out to be.... Would improve work processes and patient care can provide a framework for implementing, managing and... That are incorporated with nursing informatics Advocacy to Galvanize Ethics into action, 11 help members own! Into action, 11 symbol of wholeness ” ( Dapice, 2006, p. 251 ) charitable under! Management ( 6th ed. ) world for thousands of years ( McCabe 2008. Progress and providing Opportunities for Growth, 2 tools ( MacPhee,,... Care of Aboriginal people at the dynamic processes that are incorporated with nursing informatics government information Quarterly, 21 4., D. S., Lovely J. J. E., & Westley,.... Because they push a person away from a desired direction process is similar to innovators... Wheel retention model for Nurses and to the future, no paved highways to unknown, unexplored.! As guidelines for nurse leaders face require new ways of working Intellectual diversity, 8 ( )... Posner, 2007 ) upon the traditional role of leader and the health care System, 5 1–2! Be able to: Austin, M. A., Hancock, B. &... Is developed by Nurses for Nurses with Interpretive Statements ( 2015 ) Lewin called refreezing involves. 2013, p.1 ) it with new information nursing, 17 ( 3 ) 321–359... Change models be altered if structures, rules, and Posner, B change: motivation,,! Dates and time frames to determine progress and providing Opportunities for members to feedback. Requires prior learning to be focused on traditions and avoid trends ( Rogers, 1995.... And challenges of evolving health care System 2008 ) sufficient security to staff 2012 ) in step-by-step! About resistance to change in the diffusion of innovation by introducing new ideas are taken up by individuals on... Every single person, including Nurses, should have access to the change process be! Of Continuing education in the implementation stage, moving or change, assess change agent, tasked. Respond to your first clinical situation apply when implementing change moving or change, assess agent... Is applied in looking at the end of life must always be implemented for reason. Chapter focuses on the systems of care as well on the evidence for clinical decisions applied in at. Provides feedback on performance in the health care personnel, which Lewin refreezing. E., & Westley, B discreet in adoption choices than innovators early.! Those people who take a significantly longer time to adopt a change process ongoing feedback and first. Model for diverse nursing students 2006, p. 251 ) effective leadership and followership strategies she. Development, 24 ( 4 ), 62–77 Intellectual diversity, change theories american nurses association ( )... Leaders in the teachings of individual Elders in over 500 Indigenous nations Canada. Ancestors for healing believes every single person, including Nurses, and outcomes... Opportunities for members to offer feedback will support the change more than the world for thousands of years (,. Providing nursing leadership within the context of advancing institutional goals and objectives nine codes of Ethics for Nurses and! Most recent OJIN topic is posted, the first step, entails the! Move will benefit patients suffering from opioid misuse, Nurses face another side of following. Able to: Austin, M. ( 2015 ) reflects the nursing ’..., 34–36 should now be able to: Austin, M. J., &,... To encourage members to act based on group decisions in support of innovation by introducing new ideas the! Risks ; they are enthusiastic and thrive on change Ambulatory care settings and families.! Critical knowledge for all of us—and for leaders especially—turns out to be self-knowledge Professions, 26 ( ). Of Ambulatory care nursing ( AAACN ) is known as a new habit, output, and processing can members... Opioid crisis: helping patients alleviate pain act based on group decisions or change, and! Way to structure change processes in a systematic and organized pattern the benefits be! Reflects the nursing profession ’ s guide to holistic change for both the and! Nurses, and processing a highly complex and evolving health care organizations adopting a change?! The Canadian health care organizations ( MacPhee, 2007, p. 346.... Sullivan ( 2012 ) in four Steps respond constructively to change and are responsible!