Kurt Lewin's Planned Change Theory: Understanding Change Dynamics

Kurt Lewin's Theory of Planned Change By: Yamithsu Coriolan Yetunde Ojo

“If you want truly to understand something, try to change it” -Kurt Lewin

Background of Theorist Kurt Lewin was born on September 9th,1890 in Moglino, Germany (now part of Poland). Lewin originally began studying medicine but switched disciplines to natural sciences. While pursuing his doctorate Lewin developed an interest in the philosophy of science and psychology and earned his doctorate in Psychology in 1916. Lewin later served as a soldier in the German army during World War I and conducted psychological research related to soldiers’ experiences during the war. After the war, Lewin worked at the Psychological Institute in Berlin, where he conducted pioneering research in social psychology and group dynamics. Lewin, who was a Jewish refugee, escaped Nazi Germany and immigrated to the United States in 1933 to get away from the political controversy. He taught at Cornell and later joined the University of Iowa where he continued his influential work in social psychology, he also became a professor of Child Psychology at the latter's Child Research Station. (Burnes, 2004)

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Phenomenon of Concern • Kurt Lewin's change theory's major concern is the process of change itself, particularly in human behavior or systems. • The theory is focused on understanding how change occurs, what factors can help or impede change, and how to effectively manage change. • The theory was created to aid in the understanding and management of change in a variety of settings. - For example, in the context of nursing, changes in a patient's health behavior (such as diet, exercise, or medication adherence), and changes in a healthcare organization's practices or policies. (Burnes, 2004)

Problems Addresse d by the Theory The theory addresses the following problems: • Resistance to Change: One of the most difficult aspects of any change process is dealing with resistance from people who will be affected by the change. • Lack of Direction in Change: Without a clear plan, change efforts can become chaotic and ineffective. The theory provides a clear, three-step process (unfreezing, changing, refreezing) that can guide the change process. • Making Change Stick: Another prevalent issue is ensuring that changes are not only temporary but also sustained over time. • Understanding Change as a Process: The theory provides a psychological perspective on why and how change occurs, which can help in understanding and managing the change process more effectively. (Burnes, 2004)

Major Concepts of the Theory Unfreezing: The first step in the process is to look at the way things are now and admit that something needs to change. At this time, the individual has to fight the forces of habit and break down his or her old way of thinking. It could mean questioning the organization's current beliefs, values, attitudes, and behaviors and making people aware of how the current situation is getting in the way of growth. Changing: A lso referred to as the transition or mobility stage, the change itself takes place during this phase. It means making changes to your ideas, feelings, actions, or all three in a way that is more liberating or productive. Usually, this stage is a time of confusion and change. People don't know what the new ways are yet, but they know that the old ways are being tested. Refreezing: This is the last stage, where the new way of thinking solidifies, and the person's level of comfort returns to where it was before. After the changes are made, this refreezing stage needs to happen so that they can last for a long time. It includes using feedback and rewards to reinforce new habits and ways of doing things and making the changes part of the organization's culture.

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Diagram (Burnes, 2004 )

How are the concepts defined? Implicitly or Explicitly? • In Kurt Lewin's Theory of Planned Change, the concepts are defined explicitly. The theory is based on three clear stages: Unfreezing, Changing, and Refreezing. Each of these stages is clearly defined and distinct, making the concepts explicit. • However, the process of moving through these stages can be complex and may involve implicit factors such as individual attitudes, group dynamics, and organizational culture. (Peterson & Bredow, 2009)

Examining the Relationships (Propositions) among the Major Concepts Unfreezing to Changing: The change process begins with Unfreezing, which entails acknowledging the need for change and overcoming resistance. This stage has a direct connection to the Changing stage since it lays the groundwork for the change to take place. In the Unfreezing stage, the recognition of the need for change and the lowering of resistance enables for the implementation of new behaviors, attitudes, or tactics in the Changing stage. Changing to Refreezing: The Changing stage is directly tied to the Refreezing stage, where the actual change happens. In the Refreezing stage, the new behaviors, attitudes, or techniques introduced in the Changing stage must be cemented and integrated into standard practice or lifestyle. The effectiveness of the adjustments performed in the Changing stage determines the success of the Refreezing step. Unfreezing to Refreezing: The Unfreezing and Refreezing processes are also connected. In the Unfreezing stage, the recognition of the need for change and the lowering of resistance pave the way for the changes to be accepted and made permanent in the Refreezing stage. (Burnes, 2004 )

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Implicit and Explicit Assumptions Explicit Assumptions: 1. Change is a Process: Lewin's theory explicitly assumes that change is not an event, but a process that occurs over time and involves several stages. 2. Resistance to Change: The theory assumes that there is always resistance to change, which needs to be overcome in the unfreezing stage. 3. Need for Reinforcement: The theory explicitly assumes that changes need to be reinforced in order to be sustained, which is the purpose of the refreezing stage. Implicit Assumptions: 1. Motivation for Change: Implicit in Lewin's theory is the belief that individuals or groups must be motivated to change, whether by internal or external forces. 2. Support During Change: The theory implicitly assumes that support is necessary during the change process, particularly during the uncertain transition phase. 3. Capacity for Change: The theory also implicitly assumes that individuals or groups have the capacity to change. This includes the ability to learn new behaviors and adapt to new circumstances. (Burnes, 2004 )

Applying the Four Metaparadigms Concepts • Person: The person is perceived to be changeable. The individual realizes the necessity for change during the unfreezing phase. Throughout the stage of change, an individual acquires new behaviors or attitudes. The individual incorporates these newly acquired behaviors or attitudes into their daily existence during the refreezing phase. • Health: The theory can be used to promote health by facilitating behavior change. Unfreezing could mean acknowledging the necessity for improved health management. A new treatment regimen or the adoption of healthful behaviors may constitute change. Refreezing guarantees the integration of these new behaviors or interventions into the routine of health management. • Environment: The environment has the potential to either support or impede change. The recognition of the necessity for a more supportive environment may occur during the unfreezing phase. During the phase of transformation, measures are implemented to modify the surroundings. During the phase of refreezing, these modifications become frozen. • Nursing: The theory can guide nursing practice by providing a framework for implementing and managing change. Potentially, unfreezing requires identifying obsolete practices. Changing requires acquiring and applying new methodologies. Refreezing guarantees that these new processes become standard practice. (Peterson & Bredow, 2009 )

Clarity of the Theory Kurt Lewin's change theory is generally considered to be clear and easy to understand. The theory is based on a simple three- stage model of change - Unfreezing, Changing, and Refreezing - which is straightforward and intuitive. • Lucidness: The theory is lucid as it uses simple language and concepts. Each stage of the model is clearly defined. Unfreezing involves preparing for change, Changing involves implementing the change, and Refreezing involves making the change permanent. • Consistency: The theory is consistent in its approach to change. It consistently emphasizes that change is a process, not an event, and that this process involves moving from one state to another through a series of stages. The theory also consistently highlights the importance of each stage in the change process and the need for each stage to be successfully completed before moving on to the next. (Peterson & Bredow, 2009 )

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How the Theory Guides Nursing Actions Kurt Lewin's change theory can help nurses in various ways: • Managing Patient Lifestyle Changes: Nurses are frequently called upon to assist patients in making lifestyle changes such as eating a healthier diet or increasing physical exercise. This process can be guided by Lewin's theory. The unfreezing stage entails assisting the patient in understanding the need for change. Implementing the new behavior is part of the transitioning stage. Reinforcing the new behavior until it becomes a habit is what the refreezing stage entails. • Implementing New Nursing Practices: When new practices or procedures are introduced, Lewin's theory can be used to assist the implementation process. Unfreezing entails comprehending why the new practice is required. Learning and applying new practices are required for change. Reinforcing the new habit until it becomes standard is refreezing. • Research: The theory can also be used in nursing research to study behavior change. For example, a researcher could use the theory to design a study investigating the effectiveness of different strategies for promoting smoking cessation. (Cummings et al., 2016)

Limitations Although Kurt Lewin's change theory is extensively utilized and recognized, it has major limitations: Oversimplification: The idea divides the process of change into three different stages. In actuality, change can be much more complex and nonlinear. There may be overlapping stages, or stages may need to be revisited. Individual Differences Are Not Considered: The theory does not take individual differences in responsiveness to change into consideration. People have diverse attitudes, experiences, and change capacities, which can have a big impact on the change process. Resistance to Change: While the theory recognizes resistance to change, it does not provide explicit techniques for overcoming this opposition. Time component: The hypothesis does not take into account the time component required in change. Depending on the setting and individuals involved, the duration of each stage can vary substantially. External elements: The theory does not adequately address the impact of external elements on the change process, such as sociological, economic, or political pressures. (Cummings et al., 2016)

Evaluating the Theory Using Fawcett’s Criteria Significance: The theory of planned change is significant because it provides a framework for understanding how and why individuals or groups change their behavior. Internal Consistency: The theory is internally consistent as it posits that behavior change is influenced by attitudes, subjective norms, and perceived behavioral control, which are all interrelated. Parsimony: The theory is parsimonious as it simplifies the complex process of behavior change into a few key constructs. However, some critics argue that it oversimplifies the process and doesn't account for all possible influencing factors. Testability: The theory is testable as its constructs (attitudes, subjective norms, and perceived behavioral control) can be measured and their relationships tested. Empirical Adequacy: The theory has shown empirical adequacy as it has been supported by numerous studies across different contexts and behaviors. Pragmatic Adequacy: The theory is pragmatically adequate as it has been used to develop interventions to change behavior.

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Case Study #1 Background: John Smith, 68-year-old male, has been diagnosed with heart failure (NYHA Class II). He has also a history of hypertension, type 2 diabetes, and obesity. He lives with his wife, is retired, and has a modest financial situation. Shortness of breath, weariness, and swelling in his legs and ankles have been his symptoms for the past three days, which brought him to the Emergency Room (ER). Symptoms worsened in the ER, and John went into cardiogenic shock and had to be admitted to the Cardiac ICU for closer monitoring. Stage 1: Unfreezing Mr. Smith's heart problem is the result of a sedentary lifestyle and poor food habits. The first step is to assist Mr. Smith in recognizing the importance of change. I will teach him about heart failure and the significance of making lifestyle changes such as eating a healthy diet, exercising regularly, adhering to medication, and getting frequent check-ups. This level entails dismantling Mr. Smith's current ideas and practices and preparing him for change. Stage 2: Changing When Mr. Smith recognizes the need for change, I’ll assist him in putting it into action. This could include developing a personalized nutrition plan, establishing a tolerable exercise program, and developing a medication schedule. I can offer Mr. Smith with information to help him learn more about managing his disease. This stage is difficult because Mr. Smith must unlearn old behaviors and learn new ones. Stage 3: Refreezing After Mr. Smith has begun his new lifestyle routine, I will try to ensure that these adjustments become ingrained in his life. This could include regular check-ins to monitor his progress, offering continuous support and inspiration, and adjusting his plan as needed to ensure it remains successful and achievable. The idea is for Mr. Smith's new habits to 'stick,' becoming his new norm.

Case Study #2 Mr. Jones a 52-year-old male arrives to the emergency room at 0745 presenting with an infected diabetic foot ulcer. Mr. Jones was seen by the triage nurse at 0807. His initial vitals at triage were 38.1C, HR 112, Bp 92/60, and O2 saturation of 91% on room air. He stated that he has been feeling “sick” for the past 3 days and has been more tired. Mr. Jones’s vitals automatically tripped the SIRS criteria and he has been triaged as an ESI level 2. The doctors’ change of shift began at 8 am. Mr. Jones was first seen by a provider at 0945. At this time orders for blood work including CBC, BMP, lactate, and blood cultures were ordered. Mr. Jones lactate came back elevated at 2.04. He was started on lactated ringers and Tylenol for the fever. His fever was reassessed at 10:52 and afebrile. The doctor initiated a repeat lactate order to assess the effects of the fluids. Broad-spectrum antibiotics were ordered and Mr. Jones was admitted to the hospital. Identify how Lewin’s theory can be applied to the patient. . Identify how Lewin’s theory can be applied to the clinical staff.

Discussio n Questions How can we apply the Theory of Planned Change in a real-world healthcare setting? Can you provide a specific example? What are some potential challenges in applying the Theory of Planned Change to our nursing practice, and how might we overcome them?

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References Burnes, B. (2004). Kurt Lewin and the Planned Approach to Change: A Re‐appraisal. Journal of Management Studies , 41(6), 977-1002. Cummings, S., Bridgman, T., & Brown, K. G. (2016). Unfreezing change as three steps: Rethinking Kurt Lewin’s legacy for change management. Human Relations , 69(1), 33-60. Peterson, S. J., & Bredow, T. S. (2009). Middle-Range Theories Application to Nursing Research: Application to Nursing Research . Wolters Kluwer Health.

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