Change Theory
Evidence emanating from a host of studies suggests that computerized prescriber ordering system (CPOE) help to reduce the relative risk for medication errors. In so doing, they help to reduce associated adverse events and extra costs (Radley, 2012; Ammenwerth et al., 2008). CPOE entails implementation of an e-prescribing system. Their implementation is a key requirement of the 2009 Healthcare Information Technology for Economic and Clinical Health Act (HITECH). All hospitals are expected to have complied with this standard by 2015 failure to which they will be penalized (Radley et al., 2012). The purpose of this paper is to discuss application of Lewin’s (1951) organizational change model in the implementation of a CPOE in a hospital set up.
Kurt Lewins (1951) model of planned organizational change provides a useful conceptual framework for the proposed solution. The model employs a force-field framework to explain the reasons why organizations change as well as how effective change can be implemented (Williams, Woodward, & Dobson, 2002, pp. 283-284). Change in the model is conceptualized as occurring due to shifts in the forces maintaining the current state (status quo) (Williams, Woodward, & Dobson, 2002, pp. 283-284). The model was selected to guide the proposed solution for two reasons. Firstly, it provides a robust approach to change as it is grounded on four mutually reinforcing concepts. These concepts are the force-field theory, the three-step model, group dynamics, and action research. The second reason for its selection is the model clearly describes the events that must occur for organizational change to be successful (Burke, Lake, & Piane, 2008, p. 244).
As previously mentioned, Lewin’s model provides a conceptual framework upon which the rationale and activities of the proposed solution can be mapped. According to the model, change occurs through shifts in the driving and weakening forces maintaining the status quo. The model further posits that change occurs in three stages: unfreezing, moving, and refreezing (Cummings & Worley, 2013, p. 22). Unfreezing is the step at which the necessity for change is recognized. Moving is the stage at which stage is actualized that is, the behavior of staffs and the organization is moved to a new level. The last stage, refreezing, is the step at which the organization is stabilized at the new level of equilibrium.
The theory will be incorporated in the project through operationalization of its concepts in the planning and implementation of the CPOE. The unfreezing stage will involve weakening of the forces maintaining the current state and an increase in the driving forces for change. This will be accomplished through dissemination of information on the need for and benefits of CPOE. Other activities will include creation of a sense of urgency and guiding coalition as well as the development and communication of a vision for the proposed solution and a strategy for the change. Moving will entail implementation of the CPOE and other supportive activities such as training of staffs on how to use CPOE. Refreezing will be accomplished through creation of CPOE support mechanisms. These mechanisms will include changes in the organizational culture and structures and rewards for good performance (Burke, Lake, & Piane, 2008, p. 244).
In summary, this paper has established that Lewin’s change model provides a robust approach for the implementation of CPOE. Further, it has explained how the concepts of the model can be operationalized in the implementation of CPOE.
References
Ammenwerth, E., Schnell-Inderst, P., Machan, C., & Siebert, U. (2008). The effect of electronic prescribing on medication errors and adverse drug events: A systematic review. JAMIA, 15, 585-600.
Burke, W. W., Lake, D. G., & Paine, J. W. (2008). Organization change: A comprehensive reader. San Francisco, CA: John Wiley and Sons.
Cummings, T. & Worley, C. (2013). Organization development and change (10th ed.). Stamford, CT: Cengage Learning.
Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2012). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. JAMIA.
Williams, A. P. O., Woodward, S., & Dobson, P. (2002). Managing change successfully: Using theory and experience to implement change. Bedford: Thomson Learning.
