Managing Change
Introduction
Organizational change has become a significant feature in today’s business environment. According to Burke (2008), the need for change and the demand for organizations to adapt and modify their operations have intensified. In fact, the most prevalent challenge in many organizations has been the need to cope with the rapid change. In a recent study conducted by leadershipIQ.com, a failure to manage the organizational change is one of the top reasons for termination of jobs for many managers (Murphy 2015, para 1). This failure is attributed to the managers’ inability to motivate employees, especially by not articulating effectively the need for change.
The need and pressure to manage the organizational change have been significantly manifested in the healthcare industry. Primarily, the industry has been characterized by increasing costs of pharmaceutical products and confluence of the healthcare profession, mainly the nurses, physicians, and pharmacist, each competing for desires and interests (Bamford & Daniel 2005, p. 393). Fundamentally, the overall health condition of the population, government investment strategies in primary care and prevention of diseases are also major factors that have led to increased pressures and demand for changes in the provision of health care.
This paper evaluates the internal and external pressures and demand in Loretto healthcare. The paper reviews some of the essential change management models and theories to apply to manage change in the healthcare organization. Also, the paper discusses some of the impacts of the proposed change management models on the healthcare organization and its staffs. Furthermore, the paper explains some of the expected resistance to change by the organization and its employees. The paper winds up by analyzing some of the recommendations and approaches that assist in tackling the issues of resistance to change.
The Internal and External Factors in the Healthcare Organization That Have Affected the Delivery of Quality Services
Loretto healthcare is an acute hospital that serves approximately 33, 000 patients yearly (Administrator 2015, p. Para 1). Located in the Chicago’s Austin, the hospital has been involved in a continuous process of transformation and change at every level of its operation. This change is driven by the pressures and demands including the increasing number of patients requiring treatment, external financial constraints, and the need for the healthcare organizations to retain high qualified staff.
Most importantly, the internal complexity of the healthcare composition such as organizational culture and structure has affected the delivery of services. In particular, the high number of the patients requiring treatment has made the healthcare organization record one of the largest numbers of patients waiting to receive medical treatment. Notably, patients have to wait for long hours for elective treatment. The small number of available beds has influenced the long waiting hours. Also, the healthcare has increased its healthcare spending and mismanagement.
Addressing these issues require a dramatic change in management, as well as efficient reforms by the healthcare system. Practical solutions should be implemented in improving the healthcare management and preventing these external and internal pressures. One of the key considerations is to introduce change management concepts and models. Some of the important change management concepts and models include Planned Model, Emergency Change Model, and Lukas et al.’s Organizational Theory for Transformational Change.
Change Management Concepts and Models
Planned Change Model
Formulated by Kurt Lewin, the model views organizational change as a series of transitional process that exists between fixed forms. According to the Kurt Lewin, the planned change model is composed of three main steps: unfreezing the status quo, moving to a new status quo, and refreezing the new status (Burnes 2004, p. 313). The unfreezing stage of the model involves destabilizing and relinquishing the status quo by creating a conducive environment for change and ensuring that the organization understands the need for change. In essence, the stage involves disconfirming the legality of the current situation, inducing survival anxiety, and enhancing a psychological safety.
Disconfirming the legality of the status quo articulates the reasons why the current situation is undesirable. Inducing survival anxiety aims to captivate the need for organizational change as an essential requirement for survival. Enhancing psychological safety mitigates the organization and employees’ concern towards change. The planned change approach proposes that for the organizations to adopt and manage new changes and behaviors, the old behaviors should be abandoned.
The second stage, moving to a new status quo, involves identifying the changes to be adopted and develops a clear implementation strategy that resounds with the new change targets (Burnes 2004, p. 979). It also entails the process of identifying and overcoming the complexity of forces that deter the change.
The refreezing stage aims to stabilize the new change at a new state of equilibrium. The new changes and behaviors adopted during the change process seek to harmonize with the organizations and its employees and conform to the norms, structure, and culture of the organization. The refreezing process ensures that the employees do not revert to the old behaviors.
Lewin affirms that these steps models are held steadily by equilibrium and opposing forces; the forces are regulated by driving and restraining forces. Driving forces create an increased demand and pressure for change. On the hand, restraining forces resist any organizational change. If the restraining forces (or forces maintaining status quo) are much stronger than the driving forces, the organization fails to adopt change. If the forces driving for changes become stronger than the restraining forces, the organization can advocate for change. Lewin suggests that organization should introduce an efficient information system that reveals the discrepancy that exists between desired change and the current behavior.
Emergent Change Model
The emergent change management concept involves the Hinings and Greenwood’s model of change dynamics. In line with the emergent change models, this model states that organizational change is a complex process that involves the interaction of the internal process of organization and the organizational context (Greenwood & Hinings 1988, p. 298). As per the model, a change exists as an unfolding series of unexpected circumstances and an action that results from an unanticipated impact. This model affirms that organizational changes occur as a result of an interaction of five factors: situational constraints, interpretive schemes, organizational capacity, and power dependence.
Situational constraints refer to the environmental, technological, and size-related factors. The interaction of these factors influences the likelihood and the ability of an organization to necessitate or prevent the adoption of successful change. The interpretive factors are ideas, values and beliefs that influence the organizational operations. It forms the basis to which the design structures and arrangements of the organization are built. The dependency of power stipulates the relations of power within an organization. The relations assess the organizational factors that have the ability to determine the outcomes and influence decisions. The organizational capacity to achieve a successful change depends on the knowledge and skills of its leadership to encourage commitment on the change prospects (Greenwood & Hinings 1988, p. 299).
The Hinings and Greenwood’s model of change dynamics recognize the environmental complexity within which an organization operates. Therefore, for the organization to achieve a successful management change, its leadership must acknowledge the situational constraints. Also, the change must integrate the internal forces like beliefs, interests, values, and power relations. Furthermore, the transformational leadership must express its ability to promote a commitment and its capacity to structure and communicate its vision of change.
Lukas et al.’s Organizational Theory for Transformational Change
This theory for transformational change represents a conceptual model that can guide the healthcare organization in promoting a sustained and efficient patient care improvement (Lukas 2011. p. 311). The models define an organization in four components. The first component includes the mission, vision, and strategies, which set priorities and directions. Culture is the second component, and it determines the values and norms of the organization. The third element is operational functions and processes, and it stipulates the activities to done in promoting delivery of services. Infrastructure is the final element and entails the use of human resources, information technology, facility management that enhance service delivery.
According to Lukas theory, changes in these components can lead to a change in the healthcare system (Lukas 2011. p. 312). To promote the process of change, the model defines essential elements that guide the transformational change in the healthcare organizations.
• The impetus to transform – It involves the external forces that oblige an organization to adopt changes. Also, some internal factors can necessitate a change.
• Organization commitment to change – It refers to the involvement of the senior leadership management in promoting change in all the organizational levels.
• Improvement initiatives – They are initiatives that actively integrate the employee in meaningful and transparent problem solving.
• Alignment to enhance consistency of the broad goals of the organization – These are undertakings that have the potential to facilitate the efficiency to align change initiatives and create an opportunity to achieve the organization plans and goals.
• Integration across all traditional organization boundaries within the individual components – It provides an opportunity to incorporate staff and all internal components of the organization to disintegrate the boundaries between them and create a coherent organization unit.
Impacts of the Proposed Change Management Models on the Healthcare Organization and Its Employees
Organizational Structure
A structural change may manifest itself in the recruitment of more staffs that are instrumental in developing new ways to organize the employees in their areas of specialty. A structural change would create a planning method that allows the management to organize its staff accordingly, which would promote service delivery.
Organizational Culture
Though changing the organization culture is a difficult task, adopting a change management concept would help uncover and reflect on how the healthcare conducts its services (Schein 1999, p. 29). Thus, it would be able to identify undesirable culture and improve on it.
Management Practices
Change in management practice would help promote a democratic leadership by the managers. It would also inculcate a culture of responsibility for sustaining the welfare of the nurses and physicians.
Systems Change
Systems change involves a change in procedures that help achieve the duties of the organization. Service planning, patient information systems, and human resource management systems are some of the crucial system changes that can improve the delivery of services. Such systems would improve both the individual and team performance.
Working Environment
Implementation of change management concepts and models can help create a conducive environment for the staff. Also, it creates a positive perception that their contribution is valued, which boosts their morale and productivity.
Job skills and Task Requirements
Concept change models would contribute to creating congruence between employees’ competencies and their individual requirements.
Motivation
Motivation is an intrinsic aspect that links values and needs of the employees. Motivating the employees is likely to enrich their role by creating autonomy, involvement in the process of making the decision, recognition, and rewarding. This would help improve the delivery of services.
Assessing the performance of the employees and organization is crucial in promoting patient satisfaction and efficiency in resource allocation. Change concept models create a patient-based process and planning improvement system that aims at driving the organization assessment process (Chow et al., 1998, p. 278). This approach would help to identify areas that need improvements.
The Expected Resistance to Change by the Organization and its Employees
The implementation of the change management concepts and models is characterized by an intense resistance to change. According to Burke (2008, p.93), resistance is a human expression and a crucial aspect in adopting change. It is a strong restraining force that tends to be caused by reasonable and predictable reasons. Resistance is characterized by varying magnitude for acceptance and restraining including passionate acceptance, indifference, passive acceptance, and open opposition.
Arthur Bedeian (2004, p. 532) explains some of the reasons why Lorreto healthcare stakeholders or its employees may resist change
• Parochial self-interest - It exists where employee and stakeholders expect to lose after change implementation. It entails factors caused by fear of power loss, reduction in income, additional workload, and job insecurity.
• Resentment - Resentment occurs mainly as a result of the increased in the presence of authority that flows inevitably from the management in implementing the change.
• Low acceptance for change - Low acceptance to change occurs as a result of fear of inability to learn the new skills and change behavior.
• Different perceptions of change - The difference in change perception depends on the positions of the employees regarding the change.
• Lack of trust - Lack of trust may create a misunderstanding and result to change resistance.
Recommendations and Approaches That Assist Tackle the Issues of Resistance to Change
Working with Resistance
Resistant to change is an irrational, negative and counter-productive behavior that organization should overcome. Loretto healthcare management can develop an organizational development approach to resistance that encourages the stakeholders and staff to consider change as a healthy and a self-regulating undertaking. Also, a multifaceted tailored approach can be effective at changing the healthcare negative culture and attitudes toward change (Grol & Grimshaw 2003, p. 1229). Other approaches for minimizing resistance may include involving the staffs and other stakeholders in the planning for change, allowing the staffs to express their concerns or objections, captivating a trusting environment, provide efficient motivation, and adoption of problem-solving approaches.
Some of the problem-solving approaches include providing information on the change, exploring situations of resistance, and persuading the staffs to commit themselves to change. Other approaches include encouraging negotiation to clarify on areas of resistance and applying explicit or implicit coercion for staffs who fails to comply (Kotter & Schlesinger 1979, p. 108).
Recommendations
The healthcare should handle any aspects of resistance wisely. Mainly, they should listen to the complaints of the staff and its stakeholders, understand them, and try to resolve them.
The healthcare should develop a clear strategy for change that is explicitly continuous across all levels of the organizations. In particular, the management should develop and invest in a change improvement team that is mandated at implementing a specific model for change to facilitate a continuous improvement in all healthcare levels.
Fundamentally, the healthcare management can create a physician Engagement Program that aims to optimize the involvement of all the physicians in the changing efforts. Some of the important elements of the program may emphasize on duties of physicians in advocating for change.
Conclusion
The external and internal pressures and demands to improve quality and efficiency in healthcare organizations continue to grow. Though managing these forces is not an easy task, there is great need to develop an effective way to respond to such pressures and change from within. Addressing these issues require a dramatic change in management, as well as efficient reforms by the healthcare system, government interventions, and a stronger cooperation among the healthcare professionals. Practical solutions should be implemented in improving the healthcare organization and preventing these external and internal pressures.
Ideally, essential change management concepts and theories provide remarkable solutions for efficient implementation of changes in organizations. While no theories and frameworks of managing change are unique and specific to the healthcare organizations, these theoretical models can be applied in promoting change in the healthcare organizations. Due to the complexity of adopting and managing change, resistance from the organization stakeholders and employees will always occur, which may not only affect the implementation of this change; it can also affect its productivity. Nevertheless, developing effective approaches can help address the resistance to change.
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