Systems Theory and Behavioral Change in Nursing Practice

Systems Theory and Multidisciplinary Healthcare

Humans, like organizations, possess inherent complexities. In this context, systems theory can be especially valuable in finding solutions to a wide range of problems in the healthcare setting. A system is made up of a number of components that must be taken into consideration collectively, because it is the interconnection of these components that comprises the entire system (Ziegler, 2005). These components should not be considered in isolation but as parts of the whole. Systems theory has accordingly had a significant impact on the management and leadership of healthcare organizations, which are composed of structures, processes, and people — all of which are interconnected.

For healthcare leaders to not only initiate but also sustain change, they must be systematic thinkers. They need to recognize that the various specialties, departments, and related factors — such as multidisciplinary teams and multidirectional objectives — are all interconnected and may either conflict with or support one another. An effective healthcare leader should have management approaches that view the entire healthcare organization as a whole, while simultaneously seeking to optimize processes by promoting common goals, efficiently allocating resources, and fostering cohesiveness among disciplines for the benefit of individuals and groups receiving care.

Due to the nature of disease and illness, those who are ill may not be able to perform optimally. As a result, they are expected to assume certain roles, are exempt from some responsibilities, and are owed specific rights. This essentially means they are permitted to deviate from normal societal expectations. According to Parsons' sick role theory, a sick person may take advantage of this approved — and sometimes positively sanctioned — deviance and abdicate duties or obligations they could otherwise have fulfilled even in their current state. For this reason, some individuals may deliberately perpetuate their health situation by engaging in behaviors that worsen their illness.

Parsons' Sick Role Theory and Illness Behavior

In clinical experience, several patients have appeared not to take their health and well-being seriously — to the extent of nearly jeopardizing their full recovery. One such case involved a cancer patient who seemed to welcome the affection and concern her husband was showing her. Prior to her health deterioration, her family had been falling apart and her husband had been openly involved with another woman. She routinely refused treatment whenever she showed signs of improvement. Since a patient cannot be subjected to a treatment plan against her will, the appropriate course of action was to share these concerns with her closest family members, who then took it upon themselves to address the underlying situation. After reassurances from her husband that he would change and become more supportive, and following heartfelt pleas from her children, she began accepting clinical recommendations and was eventually on the path to full recovery.

The stages identified in Kurt Lewin's Change Theory are unfreezing, movement, and refreezing (Marquis and Huston, 2009). These are "the phases through which the change agent must proceed before a planned change becomes part of the system" (Marquis and Huston, 2009, p. 167). Unfreezing involves demonstrating to a group the need for change while challenging the status quo with evidence about the change process. Movement involves the adoption of new ways of doing things — it is at this stage that people begin embracing a new approach. Refreezing is characterized by the internalization and institutionalization of that change.

As a hypothetical example, nurses working in a hospital unit could be opposed to the implementation of new scheduling technology to manage their shifts. The unfreezing phase would involve demonstrating to staff the advantages of this new approach and how the change could be mutually beneficial — improving efficiency for the hospital and enhancing time management and productivity for nurses. The movement phase would involve nurses gradually becoming comfortable with the technology and letting go of their prior doubts. Finally, the refreezing phase would involve the full institutionalization of the new system, at which point it becomes a routine part of the unit and nurses embrace it as standard practice. This process of managing change effectively is essential to sustaining improvements in patient care environments.