The new year is a perfect time to reflect on your current practice habits and implement ways to better serve your patients. Maybe you’re feeling energized after attending one of the big winter dental meetings and excited to try something new that you’ve learned. Perhaps your boss is looking for ways to grow the practice this year. Whatever the catalyst, be a champion for change and use it as an opportunity to exhibit leadership among your team.
The science and practice of dentistry is always advancing. Research leads to new evidence-based practices and innovative technologies, and the philosophy of patient care is always evolving. As hygienists, we need to take continuing education requirements to stay current, and it is expected that our practices will progress accordingly. Additionally, the doctors we work for are continually learning and implementing change, and the organizations we work for regularly adopt new policies and procedures.
But change is often met with resistance. It’s difficult to abandon the comfort of routine and venture into the unknown, and learning a new system takes time.1 Whether you’re implementing change on your own or change is thrust upon you, using a framework to organize and direct the process can greatly increase the acceptance and sustainability of change. Lewin’s 3-stage Model of Change is a simple strategy that can guide you and your teammates to effective change (figure 1).
Lewin’s 3-stage Model of Change
Kurt Lewin, an American social psychologist, based his change model on the physical properties of water. He proposed that one must first “unfreeze” existing behaviors to engage in “movement” toward a desired behavior, then “refreeze” in a new shape, making the desired behavior into habit.2 An important element of Lewin’s model is his theory of force field analysis. Lewin described two opposing forces—driving forces and restraining forces—that either motivate or hinder change. When these forces are equal against each other, an equilibrium or status quo is maintained, but when driving forces increase to outweigh restraining forces, or restraining forces decrease below the influence of driving forces, change occurs.2
Lewin’s three-stage model has been applied to organizational changes for decades. Its strengths lie in its simplicity, collaborative approach, and how it addresses resistance. Everyone affected, the entire dental team, is invited to participate in the process, thereby sharing ownership of the change, allowing resistors to voice their concerns, and building trust in fellow teammates and the new system.1
Is it time for a change?
Hygienists can spearhead change initiatives by raising questions that encourage the team to think about areas that need improving. Start the process of unfreezing by asking your teammates to identify policies and procedures that can be improved,or best practices that could be implemented.1 How may your practice be lagging behind current technological trends? What are the latest evidence-based treatment recommendations that you are not following? What feedback has your team received from patients about the services that your office provides?
Once the need for change is identified, the unfreeze stage is an opportunity to loosen ties with old ways and foster positive attitudes toward the change to come. During this stage, communicate why the change is needed and discuss how the change will be beneficial.3 Highlight the advantages of the proposed change over the existing system. For example, if an office is transitioning from paper charts to computerized record keeping, advantages are less time spent filing, no more misplaced charts, and easy accessibility of patient records.
During the unfreeze stage, those resistant to change are given the opportunity to share their concerns, which identifies barriers and leads to solutions before implementation.1,3 For example, members of the team may be concerned that entering patient notes into the computer will take too much time and put them behind schedule. A solution could be that during initial implementation, extra time be blocked into the schedule to allow for the adjustment in record-keeping habits. Open communication during unfreezing will help uncover resistance among the team and troubleshoot potential barriers.
The unfreeze stage is also the time to train the team on the change. A well-prepared team will face change with more confidence and understanding the change will increase acceptance. Manufacturers’ representatives can do in-office training on new technology, and there are many opportunities for online continuing education. If, for example, your office is incorporating the new American Academy of Periodontology (AAP) staging and grading into your patient assessment, hygienists can take continuing education to learn the new classification guidelines. The entire team should then be brought up to speed on the rationale and benefits of the new guidelines, such as a more thorough patient assessment and more accurate documentation. Also, your office will have the system already in place should insurance companies begin using the AAP classifications. The goal during unfreezing is to build up the driving forces for change to overcome resistance.3
Then there is movement
“Movement” is when the change is implemented. A date should be set for implementation, and from that date, only the new way should be followed. If you’re switching to paperless, from the date of implementation no paper charts should be written up at all; rather, the staff should utilize the new computerized system all of the time. The less time the entire transition takes, the more quickly resistance can be replaced by acceptance. Team members will not have time to dwell on the fact that change is occurring but will have to engage fully with the change. During implementation, continually reinforce the driving forces behind the change to maintain positive momentum.
During the movement stage, team members are encouraged to share their experiences and concerns.4 Continuous feedback during implementation will identify problems as they arise so that swift adjustments can be made.3 To further counter resisting forces, a team member can be appointed as the resource person who others can go to for help. Lastly, triumphs should be recognized and celebrated throughout the movement stage to further reinforce favorable attitudes and acceptance.4
Now it’s time to set the new ways
“Refreezing” is the stage after initial implementation when the new way becomes ingrained into the practice as the new norm. A time frame for implementation should be set, at the end of which evaluation of the new system will occur as part of refreezing. Analyze the results of the change.1 Has production increased? Has patient care improved? Has workflow become more efficient? By analyzing the positive results, team members can appreciate the fruits of their efforts, which will solidify their acceptance. This is also a time for celebration. All team members should be rewarded for their part in the successful transition.
Lewin’s three-stage model can be adapted to implement individual change. Reflect on your personal practice. Have you been practicing the same way since you graduated? Are there new skills or technologies that would benefit your patients? What are the driving forces that could motivate your change? Why are you resistant to change?
When embarking on individual change, establish a timeline for the change to occur. Mark on your calendar the unfreeze preparation period, a date for implementation or movement to begin, and a few weeks later for your refreezing evaluation. During the unfreeze stage, learn all you can about the change. Tell your coworkers about the change even if it does not involve them. Brainstorm the barriers you may encounter and plan how you’ll overcome them.
Go into the movement phase feeling prepared and positive. During the movement phase, make notes on what works and what doesn’t. Refine your new practice as you go but avoid the temptation to backslide into old habits by committing yourself to the change. Remind yourself of all the reasons why you’re making the change. Focus on the benefits and advantages. After your initial implementation, celebrate your success! You deserve a reward for implementing successful change. This is the beginning of your refreezing stage, when you settle into your new norm. Finally, evaluate how you, your patients, and the practice are benefitting from the change you made.
Change is a necessary part of dental hygiene practice. Advancements in technology and evidence-based practices must be incorporated into patient care. As individuals we should always be engaging in professional growth, and as part of a dental team, we should be alert to ways the practice can improve workflow and patient outcomes. Change does not have to be stymied by resistance. Build up your driving forces. By following a strategy, identifying barriers, and communicating with teammates, sustainable change can be achieved.
References
1. Nucci D. Overcoming resistance to infection prevention best practices. AORN J. 2019;109(5):557-558.
2. Kennedy CL, Young W. Influencing practice with m-Health: Using Lewin’s change theory to implement the usage of cell phones in the delivery of health care. Can J Nurs Inform. 2013;8:1-2.
3. Manchester J, Gray-Miceli DL, Metcalf JA, et al. Facilitating Lewin’s change model with collaborative evaluation in promoting evidence-based practices of health professionals. Eval Prog Plan. 2013;47(12):82-90.
4. Tetef S. Successful implementation of new technology using an interdepartmental collaborative approach. J Perio Anes Nurs. 2017;32(3);225-230.
JULIE A. TRACY, MS, BS, RDH, CHES, received her dental hygiene degree from the State University of New York (SUNY) Broome in Binghamton, New York, where she is now a clinical instructor. She holds a bachelor of science in public health from SUNY Empire State College, a master of science in health science with a concentration in health education and promotion from the University of Central Arkansas, and she is a certified health education specialist. Tracy keeps her patient skills sharp by continuing in clinical practice.
