NR 718 Week 6 Change Model Application Example

Applying Lewin's Three-Step Model to Kilograms-Only Pediatric Weights, With the Weight on Unfreezing and the Later Steps Marked as Plans

Student Name

College of Nursing, Chamberlain University

NR 718: Topics in Advanced Practice Leadership I

Instructor Name

Month Day, Year

Applying Lewin's Three-Step Model to Kilograms-Only Pediatric Weights, With the Weight on Unfreezing and the Later Steps Marked as Plans

The Change, and Why a Model

Here the change means that no child in our 26-bed department receives a weight-based dose until a scale fixed in kilograms has weighed them and the figure sits in a field that cannot hold pounds. The model is Lewin's three-step account of planned change: loosening the present pattern, shifting to another and then fixing the new pattern in place (Lewin, 1947). The steps are applied to this change only; nothing below has happened yet except the audit and the readiness work.

Why This Model

Lewin's model is chosen because of the shape of this change. It is small, on one unit, with one behavior at its center, and it fails in a particular way on this unit: past changes have moved and then slid back, as the 2023 weighing campaign did when measured weights rose to 71% and fell to 55% within four months. Lewin's model puts refreezing on the same level as moving, which speaks directly to that history. Kotter's eight steps would suit a larger, organization-wide change, but building a guiding coalition and a broad vision is more machinery than one triage routine needs (Kotter, 2012). Lewin's original work was also about group norms, the forces that hold a group's behavior at its current level, and the triage norm of asking parents for weights is exactly that kind of force (Burnes, 2004).

The Forces, Weighed

Lewin's model rests on the idea that current behavior is kept where it is by opposing pressures in balance, so the first task is to list them and judge their strength. The table weighs each force from 1, weak, to 5, strong, using the readiness survey, the audit and conversations with the charge nurses.

Table 1

Forces Holding and Driving the Current Weighing Pattern

Note. Note. Strength is the writer's judgment from the evidence shown, not a measured score.

The holding forces outweigh the driving ones, and the single strongest is the posted time. That is why the unfreezing plan removes it before asking anyone to change, rather than adding more reasons to change on top of an unchanged pressure.

Unfreezing: What Will Be Shown, Where and by Whom

Unfreezing means weakening the forces that hold the current pattern in place and strengthening those that push against it. On this unit the holding forces are time pressure, the posted door-to-provider number and the belief that parent estimates are close enough. The driving forces are patient safety and the pharmacists' frustration. Four concrete actions carry this step.

First, the data. At the November staff meeting, the night charge nurse, not the educator, will present two figures from the department's own audit: 61 of 400 children weighed in pounds and converted by hand, nine of them off by more than 10%, and 88 weights stated by a parent. A third figure will come from published work: in three emergency departments, a third of the weight errors found led to a medication dosing error (Hirata et al., 2019).

Second, the near miss. The fluid bolus that ran to 2.2 times the intended volume, already reviewed and de-identified, will be described by the nurse who caught it, in two minutes, as the story the numbers stand for.

Third, the time question. The one-week trial on two locked scales will measure how long kilogram weighing adds to triage, so the meeting argues about a measured figure, perhaps 90 seconds, instead of a feared one.

Fourth, the metric. The manager will announce at the same meeting that weighing time will be reported separately from door-to-provider time for three months, which removes the strongest holding force before anyone is asked to change.

Moving: Planned, Not Done

The moving step is written as intention. In January, the biomedical technician locks the two standing scales and the infant scale to kilograms, and the chair scale is replaced. On the same date, if the field has been built, the record accepts only kilograms. Over two weeks, every shift opens with a ten-minute huddle on the new routine, run by the night and day charge nurses with the educator present; travel nurses receive the one-page card at orientation. Parents hear one sentence: "We weigh children in kilograms because medicine doses are calculated that way." Paramedic crews are told through the regional coordinator to report weights in kilograms.

Refreezing: Planned, Not Done

Refreezing is where this unit has failed before, so it carries the most specific plans. The locked scales and field are the main refreezing tools, because they hold the new pattern without anyone's memory. Beyond them, the educator will audit 50 pediatric triage records a month for six months and post the measured-in-kilograms rate beside the door-to-provider time; the day charge nurse will recognize nurses on the board; and the physician champion who replaces the retiring medical director will report the rate at the monthly operations meeting. The new routine will count as frozen when the measured rate stays above 90% for three consecutive months with weighing time no longer reported separately.

What the Model Misses

Lewin's model treats change as a passage between two steady states, and this department is rarely stable. Travel nurses rotate every 13 weeks, so the group whose norms were unfrozen in November will be partly replaced by March; refreezing has to be built into orientation, not only into the current staff. The model also says little about technical owners outside the group, such as the analyst whose queue decides when the field is built, or about losing a sponsor partway through. Critics have also argued that the three steps are often taught as a simple sequence Lewin never intended (Burnes, 2004), and treating them as a calendar would be a mistake here: if the field is not built by January, moving should wait rather than proceed on schedule.

References

Burnes, B. (2004). Kurt Lewin and the planned approach to change: A re-appraisal. Journal of Management Studies, 41(6), 977-1002. https://doi.org/10.1111/j.1467-6486.2004.00463.x

Hirata, K. M., Kang, A. H., Ramirez, G. V., Kimata, C., & Yamamoto, L. G. (2019). Pediatric weight errors and resultant medication dosing errors in the emergency department. Pediatric Emergency Care, 35(9), 637-642. https://doi.org/10.1097/PEC.0000000000001277

Kotter, J. P. (2012). Leading change. Harvard Business Review Press.

Lewin, K. (1947). Frontiers in group dynamics: Concept, method and reality in social science; social equilibria and social change. Human Relations, 1(1), 5-41. https://doi.org/10.1177/001872674700100103