Theory is an important component of robust nursing informatics knowledge, a fact that is sometimes overlooked in both education and practice.
Kurt Lewin’s Change Management Theory, is a time-tested, easily applied field theory that is often considered the epitome of change models, suitable for personal, group and organizational change. The first stage involves finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. Unfreezing the present Forces that maintain current behavior are reduced through analysis of the current situation.
The second stage involves a process of change–in thoughts, feelings, behavior, or all three, that is in some way more liberating or more productive than doing things the old way. Having analyzed the present situation, new structures and processes are put in place to achieve the desired improvements. Lewin extended his theory by including “force field analysis” which offers direction for diagnosing situations and managing change within organizations and communities. Driving forces are forces that influence a situation, pushing in a particular direction: they tend to initiate a change and keep it going.
Restraining forces are forces that act to restrain or decrease the driving forces – they make it difficult to move a change forward. Equilibrium is the status quo or the present level of productivity, and can be disrupted or fortified by changes in the relationship between the driving and the restraining forces. So before a change occurs, the force field is in equilibrium between forces favourable to change and those resisting it.
For change to happen the status quo, or equilibrium must be upset – either by adding conditions favorable to the change or by reducing resisting forces. Kurt Lewin proposed that whenever driving forces are stronger than restraining forces, the status quo or equilibrium will change. The force field analysis integrates with Lewin’s three stage theory of change as one works towards unfreezing the existing equilibrium, moving towards the desired change, and then freezing the change at the new level so that a new equilibrium exists that resists further change.

The goal of the change agent(s) is to support the driving forces to move beyond equilibrium and outweigh the impact of any restraining forces. Figure 2 illustrates a model adapted from Keller (2005) that applies Lewin’s change theory stages to the process of implementing information systems and technologies. The novice to expert model was featured in my editorial in our last issue, Volume 5, Number 4. Kurt Lewin, (1890 – 1947) a Gestalt social psychologist, has been acknowledged as the “father of social change theories” since several contemporary models are at least loosely based on Lewin’s work.
This is the stage where the desire to change occurs, or at least the recognition that change is needed. Imperatives for change are realized through dialogue and re-educational activities such as team building, personal development, and brain-storming.
During this stage, the people involved (change target group) are convinced that the new way is better than the old. This is the most time-consuming, costly, yet productive stage as far as tangible results go. Without some process of refreezing, it is easy to backslide into the old ways of doing things.
This is done by establishing supportive mechanisms such as policies, rewards, ongoing support, and a solid orientation to the new system for incoming personnel. Lewin assumed that in any situation there are both driving and restraining forces that influence any change that may occur.
In terms of improving productivity in a work group, pressure from a supervisor, incentives, frustration with the current way of doing things (such as paper documentation) and competitive or social demands are examples of potential driving forces.
Apathy, prohibitive cost, hostility, technology illiteracy and poor maintenance of equipment are examples of restraining forces which can inhibit change and may restrict productivity. Equilibrium is reached when the sum of the driving forces equals the sum of the restraining forces.

Lewin spoke about the existence of a quasi-stationary social equilibrium, which needed to be shifted during the change process, but then reestablished at a new level once the change had been refrozen. Successful change is achieved by either strengthening the driving forces or weakening the restraining forces.
This provides support in moving through the unfreezing – changing – refreezing stages of change. Although Lewin’s change management theory was developed decades ago, it continues to offer a reliable and viable model for informatics-related changes. A theory focus continues in this issue with a look at the oldest, simplest, yet robust and applicable change management theory, Kurt Lewin’s Change Theory. He is also lauded as the originator of social psychology, action research, as well as organizational development.
An example is moving from a paper based documentation system to an electronic system, in an organization where paper trails have become unmanageable and archaic. The more transparent and inclusive the process is, the more readily people move through the unfreezing stage.
Rewards, support, and champion leadership continue to be important through this stage, which is essentially ongoing until the next major change is needed. These forces can be positive, urging us toward a behavior, or negative, propelling us away from a beneficial behavior as illustrated in Figure 1.

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