Theoretical Premise in Healthcare Delivery Paper

Theoretical Premise in Healthcare Delivery Paper


The Lewin’s change model is a theoretical premise that is popularly used in healthcare practice to effect change of policy or practice. This essay explores the three steps of Lewin’s change model (Unfreeze, Change, and Freeze) and their application in healthcare practice. The author will reimagine the concept of Lewin’s change model. As such, the essay will present a modified version of the model and how it can be used to address a health issue that needs to be disrupted in the sense of planning the disruption process, implementing the disruption process, reorganizing the disrupted process, and presenting it.


Kurt Lewin’s Change Model

The change model proposed by Kurt Lewin presents in three major stages namely: Unfreezing, changing, and refreezing (Abd El-Shafy et al, 2019). Lewin’s introduction of this model has been termed by some commentators, among them Lv & Zhang (2017), as rudimentary process of initiating change in the corporate sector.

The unfreezing step involves the identification of the necessary change. It is one of the most important steps of change management implementation because it involves improving the willingness and the readiness of employees to embrace change by helping them to realize the need to move from the current situation to a transformed new situation (Lin et al., 2017). therefore, according to ChePa et al. (2017), this step involves informing employees of the need for the proposed change and motivating them to accept the new ways of doing things for the purpose of getting better results. Ouma (2017) argues that one of the most important elements of this stage is effective communication, because the change agent must effectively inform and convince their followers of the existing practice gap.

The change step is also regarded as a transition or actual implementation stage of the change. According to Baye et al. (2019), it involves the acceptance and practice of new ways of doing things. Therefore, it is characterized by all the activities that can demonstrate an ‘unfrozen’ staff, with the actual change being fully implemented. Furthermore, according to Lv & Zhang (2017 Theoretical Premise in Healthcare Delivery Paper), it is necessary for the change agents to plan effectively, communicate effectively and encourage employee’s involvement in the change process. However, according to ChePa et al. (2017), this stage is usually regarded as not easy because change may bring some uncertainties and thus people may be fearful of the consequences that might result from the proposed change.

Lastly, the refreezing step entails the solidification of the initiated change and integrating into the organization’s systems through organizational buy-in and continuous learning of the new process. Abd El-Shafy et al. (2019) observed that during this step, employees move from the transition to a more stable situation, which can also be referred to as a state of equilibrium. It is the ultimate step in which people have internalized or accepted the change or new way of doing things. They have integrated the change as part of their lives. Lv & Zhang, (2017) argued that to reinforce and strengthen the new behavior, employees should be recognized, rewarded, and given positive reinforcements. This can be done through supportive policies, structures, and cultures.

Adaption of Lewin’s Change model into a different Conceptual Model

In health organizations, sometimes it is necessary to audit the current practice and how it impacts on the delivery of quality, safe and satisfactory services to patients. In case the audit reveals an issue that prevents the delivery of safe and quality care, a plan is established to fix the issue by implementing the necessary practice changes (Abd El-Shafy et al., 2019). for example, an audit reveals an increased amount of call offs a day after the payday, causing a critically short fall in hospital staff and consequently an increase in patient falls as well as an escalation of patients’ condition in the acute psychiatric care setting.

An Evaluation Of The Issue

Based on Lewin’s conceptual model, the first step is to evaluate the issue that needs to be disrupted. For instance, the audit revealed that staffs demanded a lot of call offs a day after the payday, 50% higher rates than when pay was given after the commencement of every shift. The current practice is that pay is given after every two weeks. Therefore, the main contributor to the problem is the biweekly payments that cause workers to ask for too much day-offs. The call-offs contribute to a critical staffing shortage that leads to the delivery of unsafe and poor-quality care.


The plan is to develop a new paying timetable and inform the workers of the new paying timetable through email. Each worker will receive the mail on their personal organizational mail. The message will read as follows:

Notice to all facility employees please be informed that as from the immediate next payment, all payments will be done daily as opposed to the current biweekly basis. The payment will be credited to your debit card as soon as you begin your shift. Please feel free to contact the HR department in case you have any questions concerning this. Thank you.


The next step will be to disrupt the payment schedule, which will involve the actual discontinuing of the biweekly payment schedule and reinstating the daily payment schedule.


The next step after the disruption is the reorganization. This step will be executed by changing the payment cycle into a daily occurrence, whereby money is wired to each beneficiary’s account daily as they begin their shifts. Ideally, this change will also act as an incentive for improving the workers’ attendance. If a worker attends all the shifts in a month, they shall receive a bonus deposit of $50 into their accounts. Furthermore, if an employee goes for 90 days without calling for an off, they will receive additional $100. This incentivization will greatly contribute to a change of behavior among the employees. They will therefore develop a habit of attending their shifts and minimizing day-offs. By reducing the day-offs, the hospital’s use of agency staff will reduce, leading to a decrease in human resource cost.   The following figure illustrates the modified version of the conceptual model:

The three adapted stages can be explained further in depth. Upon conducting an audit of the organization, it has been revealed that a radical change was needed to foster safe and quality care. However, the change agent needs to initiate change with minimum resistance by informing the employees of the issue, how it affected the delivery of quality care and why there needed to be a change of practice. Therefore, through the modified change model, the change agent managed to implement that change by maintaining effective communication and reinforcing the desired behavior. The change agent introduced two sets of change namely a daily-based payment and an incentivization program that would see the employees take as less day-offs as possible.

This facilitated the employees to change and sustain their behavior patterns at the workplace. The modified change model was implemented in three main ways namely: changing the employees’ behavior, skills, and attitudes; changing the existing organizational structures, process, or system, and changing the organizational climate, interpersonal style, and culture. The change in behavior was exemplified by the employees not being able to take much day-offs after payday, while the change in organization’s systems was exemplified by changing payment from biweekly to daily. Lastly, the interpersonal style change was exemplified by a reduced need for employees to take day-off after payday.

The modified model stresses on the interdependence of different units of the organization. The assumption was that the organization functioned under a static condition and that it could move from one state of stability to the other as planned. However, this plan would not work in other different healthcare organization because most organizations operate in a turbulent fashion, as well as in a more uncertain environment (Abd El-Shafy et al., 2019 Theoretical Premise in Healthcare Delivery Paper).

The theoretical premise of Lewin’s change model can also be viewed in two major sides. One side represents the factors that promote change while the other side represent the factors that restrain change. According to ChePa et al. (2017), the driving forces push the organization towards new state while the restraining forces resist the change and are regarded as employee behaviors that create a barrier to change. Stability can be achieved when both change restraining and driving forces are at an equilibrium, which is relatively the equal strength between the change enabling and change restraining forces.

In the above scenario, effective change could only happen by disrupting the current situation, reorganizing into the desired situation, and then presenting the change to the employees to make it relatively permanent. During the disruption step, the driving forces of change should be encouraged to motivate employees’ change of working or behavior, while discouraging or removing the restraining forces. in this scenario, the driving forces were the need for adequate staff who could see the delivery of safe and quality care to patients, coupled with faster and timely payroll processing daily. Apart from this, the change driving forces would originate from within the organization leadership.

All employees should be informed of any change at the beginning of the change initiation process. According to ChePa et al. (2017 Theoretical Premise in Healthcare Delivery Paper), the employees should be informed about the external factors such as trends, change of regulation and customer demands; as well as internal factors such as cost reduction and the need to increase service quality. Nonetheless, a considerable step in implementing the change is to remove or reduce the restraining forces. Employee’s resistance can be reduced or eliminated by communicating or involving them I the change process, training them on the various ways of coping with the stressors accompanying the change and negotiating for compliance. Coercing the employees towards change should be the last resort if all the other non-coercive methods have failed, and if the change is urgently needed.


The Kurt Lewin change model is one of the most popular theoretical premises applied in healthcare. It is useful in introducing new changes that are aimed at improving quality and safety of care by modifying to suit the organization’s change needs. The simple framework provides an effective guidance to healthcare managers on how to plan, introduce and manage change within their respective organizations so that new and most effective practices can easily and quickly implemented within practice.

Theoretical Premise in Healthcare Delivery Paper References

Abd El-Shafy, I., Zapke, J., Sargeant, D., Prince, J. M., & Christopherson, N. A. (2019). Decreased pediatric trauma length of stay and improved disposition with implementation of Lewin’s change model. Journal of Trauma Nursing| JTN, 26(2), 84-88. doi: 10.1097/JTN.0000000000000426

Bayes, S., Juggins, E., Whitehead, L., & De Leo, A. (2019). Australian midwives’ experiences of implementing practice change. Midwifery, 70, 38-45.

ChePa, N., Jasin, N. M., & Bakar, N. A. A. (2017, October). How change management can prevent the failure of information systems implementation among Malaysian government hospitals?. In AIP Conference Proceedings (Vol. 1891, No. 1, p. 020037). AIP Publishing LLC. doi/abs/10.1063/1.5005370

Lin, H., Chen, M., & Su, J. (2017). How management innovations are successfully implemented? An organizational routines’ perspective. Journal of Organizational Change Management. 10.1007/978-3-030-15409-7_24

Lv, C. M., & Zhang, L. (2017). How can collective leadership influence the implementation of change in health care?. Chinese Nursing Research, 4(4), 182-185.

Ouma, C. A. (2017). Planning for organizational change and the role of leadership in implementing change. United States International University – Africa.