NU803 Unit 1 Change Model Application, Lippitt Example

Phase Two Pointed at Lunchtime: Applying Lippitt's Seven Phases of Planned Change to a Steroid Hyperglycemia Bundle Already Moving on Two Composite Medical Units

[Student Name]

Purdue University Global

NU803: Change Management and Clinical Data Analysis

Unit 1 Change Model Application

[Instructor Name]

[Date]

The units, staff and figures are composite and continue the project begun in the proposal course; numbers are bracketed.

Why a Change Model at This Stage

The bundle, which ties afternoon glucose checks to high-dose steroid orders and adds a paging rule, a taper reminder and a discharge check, was approved in the proposal course and is now in its education weeks on 4 North and 4 South. A change model is useful at this point because approval is not adoption. Lippitt, Watson and Westley described planned change as a process moving through seven phases, from diagnosing the problem to ending the helping relationship, with a change agent guiding a client system through each (Lippitt et al., 1958). The model suits this project because its phases include an explicit assessment of the system's capacity to change and a phase devoted to maintaining the change, both of which the bundle needs.

Phase 1: Diagnose the Problem

The problem was diagnosed in the proposal: patients started on high-dose glucocorticoids are checked, if at all, at 0600, when a morning steroid has barely begun to act, and roughly [31] in every 100 monitored steroid days reach 250 mg/dL or more. Lippitt's first phase asks who shares the diagnosis. On 4 North and 4 South, nurses and hospitalists largely agreed once they saw the glucose curve, but patient care technicians, who do most checks, had not been part of the diagnosis at all.

Phase 2: Assess Motivation and Capacity for Change

This phase asks whether the system wants to change and whether it can. Motivation was high among nurses, who had seen patients thirsty and unwell by late afternoon. Capacity was a different matter. Mapping the day hour by hour showed that pre-lunch checks, due between [1100] and [1130], coincide with the first lunch break wave, when each unit runs with [two] fewer staff. On both units, covering for a colleague at lunch has always meant answering call bells, and scheduled work waits. The same analysis showed that pre-dinner checks, due near [1600], fall at shift overlap for technicians, when capacity is higher.

The model's question about capacity found the problem that motivation could not solve: the people who would do the pre-lunch checks are at lunch.

The framework analysis in the proposal had named this social opportunity barrier as the thin row; Lippitt's second phase turned it into a scheduling fact that could be acted on.

What an Hour on 4 North Looked Like

To test the capacity finding, the change agent spent the hour from [1100] to [1200] on 4 North on three weekdays. On each day, lunch trays began arriving at [1130], both technicians went to lunch in turn between [1115] and [1215], and the nurses who covered them were also passing noon medications. On the first day, [four] patients on qualifying steroids were due pre-lunch checks; [one] was checked before the tray arrived, [two] after the patient had begun eating, and [one] not at all. On the other two days the pattern was similar. Nobody was ignoring the checks. The hour simply held more scheduled work than people, and the checks, being new, were the task that slipped. That observation, more than any survey, persuaded the nurse managers that break timing had to change if the pre-lunch target was to be reached.

Phase 3: Assess the Change Agent's Motivation and Resources

The change agent is the DNP student, a nurse practitioner on the hospitalist team who knows both units well, with the two nurse managers as sponsors. Resources include two protected hours a week, the pharmacist's help with the order set, and informatics support already approved. The limit is authority: the change agent cannot change break schedules, which belong to the nurse managers.

Phase 4: Select Progressive Change Objectives

The objectives were staged: first, the order-set trigger live and staff trained; second, pre-dinner checks at [80] percent, the easier target; third, pre-lunch checks at [80] percent, which depends on the break schedule; and fourth, a shift in hyperglycemic days. Staging the check targets separately follows directly from phase two's finding. It also gives the units an early success on pre-dinner checks while the harder lunchtime problem is worked out, which matters for morale in the first weeks of a change that staff did not ask for.

Phase 5: Choose the Change Agent's Role

Lippitt's model asks the change agent to choose a role, such as expert, facilitator or catalyst. For this project the role is mostly facilitator: bringing the nurse managers the lunchtime data, helping them decide on a solution, and supporting technicians rather than instructing them. For the order set and NPH suggestion, the role is closer to expert.

Phase 6: Maintain the Change

Maintenance is planned from the start, not left to the end of the project. The weekly run chart will be shown at huddles, and the break-coverage list will be rewritten into the technicians' assignment sheet, not posted as a separate reminder, because a previous attempt on these units to add afternoon checks by memo reverted within weeks when the assignment sheet was left unchanged. Kotter warned that change is lost when it is not anchored in how an organization routinely works (Kotter, 1995).

Phase 7: Terminate the Helping Relationship

The final phase transfers ownership to the units. The plan is to hand the routine to a diabetes resource nurse and fold the weekly report into the point-of-care testing coordinator's existing monthly report, so the routine survives the change agent's departure.

What the Model Does Not Do

Lippitt's model describes the change agent's work well, but it says little about the emotional side of change for staff, or about power and politics among groups. It does not explain why technicians, who gain nothing from the change, should take it on. Those questions are taken up in the stakeholder analysis and in the readiness assessment, which draws on a theory that treats readiness as shared commitment and shared belief in collective capability (Weiner, 2009).

Conclusion

Applied to a change already moving, Lippitt's phases were most useful for what phase two revealed: a capacity gap at lunchtime that motivation alone could not close. That finding changed the objectives, staging pre-lunch and pre-dinner targets separately, and pointed the maintenance plan toward the assignment sheet.

References

Kotter, J. P. (1995). Leading change: Why transformation efforts fail. Harvard Business Review, 73(2), 59-67.

Lippitt, R., Watson, J., & Westley, B. (1958). The dynamics of planned change. Harcourt, Brace.

Weiner, B. J. (2009). A theory of organizational readiness for change. Implementation Science, 4, Article 67. https://doi.org/10.1186/1748-5908-4-67