Institutional Change Management Strategy Designed for Adoption by Public Hospital - Case Study Example

Running Head: Change Management Student’s Name: Instructor’s Name: Course Code and Name: University: Date Submitted: Change Management Introduction This paper details a culmination of the knowledge acquired so far in the area of advanced leadership and organisation management. The paper entails an institutional change management strategy that is designed for adoption by public hospital in European urban settings. There are three changes that the hospital referred to in this case has to adopt urgently if it is to fulfil its purpose and mandate. The paper begins with a discussion of the case study hospital and its need for change. This section discusses the changes that should be adopted in the hospital and the rationale behind such changes being adopted (evidence base for change). This forms the background from which the paper then details relevant change management principles as postulated my current literature on the area of organisation change, it conception, planning, implementation and evaluation. The third section then details the change strategy ideal for the hospital in view of the evidence base for change detailed in the earlier section. This change is then accompanied by the most appropriate implementation process of the institutional change strategy recommended for the hospital. As in the actual implementation processes, the paper then proceeds to recommend an informed evaluation strategy that should accrue after the institutional change has been implemented. The evaluation strategy is what will ensure that the recommended change strategy is appropriate, well implemented and effective in attaining the desired goals. If that is not the case, the evaluation strategy will recommend a strategy that can be used to recommend the scenario accordingly. As well as a strategy to boost the attainments of the change process Finally the paper will also discuss ways by which the management of the hospital can communicate the change strategy throughout the process to ensure success. Communication of the change strategy will be discussed in terms of its role, advantages and challenges. This done, the paper will then terminate with a viable conclusion on the institutional change adoption at the hospital. The Need for Institutional Change In the age of globalisation where information is available to everyone and from numerous sources and when technology has invaded every aspect of human life, these two changes have impacted on hospitals just as much as they have any other organisation in the world today (Uhl-Bien, Marion & McKelvey, 2007; Bazzoli, Dynan, Burns & Yap, 2004). To begin with, the information age has created an informed clientele for most organisations, in the hospital’s case an informed patient base. Hospitals are no longer the kind of institutions they were a decade ago, when there was minimal interaction between patients and the care givers and other medical staff employed at a hospital (Bazzoli, Dynan, Burns & Yap, 2004). Then, a patient neither wanted to know anything about the choices their doctors and nurses made during treatment nor needed an interaction with the medical team attending them at a personal level. Currently however, patients have become more involved in their treatment (Bazzoli, Dynan, Burns & Yap, 2004). They are more informed to a point of demanding to know the alternative treatments available, and the most viable alternative for them. They demand to make the choices themselves based on the advice given (Bazzoli, Dynan, Burns & Yap, 2004). Secondly, organisations have had to adopt modern technology in their equipments and communication. Of particular concern is the adoption of computer technology and all the technologies accruing from the computer platform such as the internet. Hospitals have had to learn how to communicate with their patients via the internet using emails and in their websites (Bazzoli, Dynan, Burns & Yap, 2004). Hospitals have to build an online presence as well as reply to numerous enquiries and comments sent to them by their patients or prospective patients in emails (Bazzoli, Dynan, Burns & Yap, 2004). The hospital under analysis was established between 1938 and 1945, in pre-world war II Europe. The hospital has survived with protocols and policies established then to offer services to patients until today. Most of their staff members are from a generation when the internet was a myth, and communication between them and patients discouraged. The hospital thus surfers criticism from patients due to their traditional stance in maintaining low communication between the medical team and their patients, failing to include patients in the decision making of their treatment options and mostly so, for not being open to communication especially using modern means of communication. Organisations are having to change by the day, modifying their approaches, changing their culture, redefining their purpose and objectives and entering new markets (MCNamara, 2009). Examples of contemporary organization-wide changes include modification of strategies, alteration of mission and purpose, restructuring of operations, resizing, adoption of new technologies, engaging in mergers and similar inter-organisation collaborations, transforming concerns for environmental pollution and degradation, change of marketing and customer service approaches, re-engineering quality management systems etc (MCNamara, 2009). Evaluated from a close range, most of these changes have been wrought by the need to assume a global perspective in their operations (MCNamara, 2009). Currently, institutional change mostly results from the existence of pressure to change. This pressure might originate from the external or internal environment of the organisation (Senior & Swailes, 2005). In external pressures, probable themes include the pressure to adopt contemporary technology as is the case for the hospital under discussion or change that is imposed by deteriorating reputation and credibility such as clientele dissatisfaction (Palmer, Dunfold & Akin, 2008). In internal pressures, organisations may be coerced to change be several reasons such as the need for growth in profitability or market share, need for collaboration and integration, need to establish organisation identity or need to refocus and become more efficient (Palmer, Dunfold & Akin, 2008). While external pressures originate from the environment, internal pressures originate from management politics and power motivations (Torbert, 2004; Palmer, Dunfold & Akin, 2008). This paper concentrates on the internal and external pressures that solicit for and mitigate change occurrences from within the hospital, where the management feels that it requires to adopt better practices, spelt out by the social environment/context they are in (Palmer, Dunfold & Akin, 2008). Institutional changes are in most cases mandatory, forced onto an institution as their only chance of survival (Senior & Swailes, 2005). This hospital for instance and its employee base if asked will prefer to maintain the status quo with which they are comfortable, familiar and secure (Armenakis, Achilles & Bedeian, 1999). Yet it is mandatory that they adopt these changes or else they fail in their mandate since patients will seek other hospitals able to change and move with the times. Nonetheless, the necessity of change does not make change a negative occurrence since it is through change that organisations evolve to better institutions, able to face challenges and serve their purposes better in the changing environment in which they find themselves (Armenakis, Achilles & Bedeian, 1999). Through change organisations become bigger, better and more useful to their social niche. All that is necessary is for an organisation to learn how to implement necessary changes effectively and in a timely manner instead of fighting the changes (Armenakis, Achilles & Bedeian, 1999) . What the argument thus postulates is that the hospital needs to change in its policies and practices especially in the way its staff communicates and interacts with patients and in using modern communication strategies. Secondly, that it is important, urgent and even mandatory for the hospital to adopt these changes if it is to remain an essential health care provider in the region. Finally the argument then agrees that the change desired is achievable if well implemented and if focused on the right goals. The goals of adopting these two changes will be to offer better and more satisfactory services to their modern breed of patients and to remain relevant with the society they serve. Change Management Principles Granted that the hospital needs to change, the question now is how it can achieve these changes successfully and become the better for it. Institutional change management approaches being employed today mainly focus on a strategic, planned and large-scale overhaul and transformation of the institution towards a predetermined objective. In this perspective, theorists and managers make a common assumption the change is intentional and that its outcomes are achievable through a planned implementation process (Weber & Manning, 2001; Palmer, Dunfold & Akin, 2008). Available approaches usually vary when it comes to the number of steps and the type of actions they outline (Palmer, Dunfold & Akin, 2008). There has been a noted rise in populace of change management approaches, which has caused a debate among proponents of change management and the supporters of organizational development approaches (Burke, 2007, pp. 201 -223). Change management is mostly criticized for being a fashion trend, a fad, thus only focusing on management needs rather than the humanistic organizational values (Palmer, Dunfold & Akin, 2008). Organisation development is on the other hand criticized for lacking relevance, more so when it comes to strategic and large-scale transformations (Palmer, Dunfold & Akin, 2008). This paper prefers to recommend a change management approach since the change desired here is urgent and far reaching to every facet of the hospital’s operations. There are two change management approaches, namely contingency approaches and processual approaches (Burke, 2007, pp. 201 -223). Contingency change management approaches include processes of change that are implemented to elevate the organisation to a higher leverage (Burke, 2007, pp. 201 -223). Once the change outcomes are achieved in this case, depending on the context of that change and its scale, it is halted until the next time that the management will feel it necessary to change further (Burke, 2007, pp. 201 -223). Contingency approaches usually adopt a perspective that there is one ‘best way’ to deal with change exhaustively and get done with it (Palmer, Dunfold & Akin, 2008). On the other hand, processual approach approaches change as a perpetual process (Palmer, Dunfold & Akin, 2008). The change unfolds in a contextual manner and its outcomes result from interplay of different internal and external interests. This perspective to change provides detailed understanding and analysis of change in retrospective and does not get to a time where change itself becomes the agenda perse (Burke, 2007, pp. 201 -223). Processual approaches are where the objective is approximated through a series of gradual steps, one at a time towards the desired end (Scharmer, 2007). Change here is viewed as a continuous process unfolding differently as the circumstances of context and time unfolds; a process that must be accepted by the organisation members collaboratively (Palmer, Dunfold & Akin, 2008). These approaches constitute a set of procedural actions that are perpetually maintained by the organisation to ensure that every member of the organisation adopts desirable change if and when the situation warrants (Palmer, Dunfold & Akin, 2008). Contingency approaches are less common change management approaches mainly because their achieving of the one ‘best way’ is difficult and not always possible in varying circumstances (Neves & Caetano, 2009). These instantaneous approaches are fully dependent on the management to succeed unlike the processual approaches, which are maintained by the entire institution’s membership. The reliance on managers for the contingency approaches sometimes gives rise to situations in which junior employees and support staff question the credibility and intention of the senior management commissioning the change process (Kouzes & Posner, 2003; Palmer, Dunfold & Akin, 2008). As noted in an earlier section, the change desired and or necessary in the hospital is rather urgent since it is already overdue. But the most recommended approach here is an integration of contingency and processual change approaches where some aspects of change are adopted instantaneously and others strived for through a process of growth. Such an integration of two dominant change management approaches will require that the hospital’s management be committed to facilitate, fund and motivate the change process greatly (Neves & Caetano, 2009). Adopting the appropriate model of sustainable organizational change is itself a highly challenging as detailed by Quinn, Spreitzer, & Brown, renown organizational scholars in their article, “Changing Others through Changing Ourselves” (Quinn, Spreitzer, & Brown, 2000). They say that for the management, “The process usually requires the surrender of personal control, the toleration of uncertainty, and the development of a new culture at the collective level and a new self at the individual level. In adaptive change, traditional change strategies are “not likely to be effective” (p. 147). As such, “changing others requires changing ourselves first” (p 148). Implementing the Institution Change Implementing a change process is thus demanding as argued in the preceding paragraph, requiring absolute commitment of the management (Kegan, 1982). Indeed, it is the management that conceives the need for change, accepts it as ideal, plans for its adoption towards achieving a particular goal, pioneers and motivates the change adoption, evaluates success of the adoption and maintains the process of change (Kegan, 1982). Simply, the management of any institution is the vehicle that drives a change process (Kegan, 1982). To implement the changes in the hospital, its management must play these roles impeccably if at all success is to be attained. The requirement here for a successful change program is that it must be strategic such that it envisions on what it wants to achieve as the end result. The implementation specifics and process/mechanism must also be planned as the path towards attainment of the vision (Neves & Caetano, 2009). That plan must intentionally seek to fuel and support the implementation on a large scale, and systematically (Quinn, Spreitzer and Brown, 2000, pp. 147-164). In essence therefore the change implementation at the hospital must be systematically planned for and implemented based on steps that are prescribed by the model of change employed (Quinn, Spreitzer & Brown, 2000, pp. 147-164). Another important thing to note is that for a change program to be successful, the management and employees of that organisation must have a strong belief that the change is possible to achieve, that the approach used to adopt and implement that change program is ideal and that the change will result to benefits (Quinn, Spreitzer & Brown, 2000, pp. 147-164). At the hospital, the change process has two objectives namely, amplify patient/staff interaction and enhance communication channels with modern technology. To begin with therefore, the employees dealing with patients during treatment including medical staff and support staff must be educated and convinced on the need to involve patients in the treatment process decision making. The employees must then be motivated to adopt the new approaches to treatment based on increased patient knowledge of their condition and treatment alternatives. First the staff must understand the need for a new approach and then be taught how to adopt that approach, before being motivated or required to adopt the change. Secondly, the employees must be retrained systematically on new aspects of communication such as the internet. Training in computer use and internet communication is of prime importance before requiring the employees to communicate using the same. The hospital should ideally begin an Information technology Department, staffed and equipped to computerise all the processes and documents in the hospital such that the records and data can be accessed remotely from a mainframe database. Secondly, the department should be tasked to establish an online presence for the hospital such as building a website where patients can get all necessary information about the hospital and also communicate their views, opinions and enquiries via that website. There thus should be staff to respond to these streams of patient communication promptly and satisfactorily. It is important to let the entire hospital and its employees participate in the process of going online, by soliciting their content and idea contributions for the site and also involving different departments to initiate projects online as way of becoming globalised in health service provision. As already noted, the process of implementing this change process must be both instantaneous and processual. Buying equipments, hiring IT staff and setting up the IT department is an instantaneous requirement. Training the current employee base on IT and participatory patient relations is also instantaneous. However, a continued training process for existing and new employees, a change of recruitment requirements to include IT skills and a continued purchase and installation of additional high-tech equipment is a processual change implementation, which must both be planned for and executed simultaneously. In implementing a change program, one of the most applicable strategies is one developed by Kotter (Armenakis and Bedeian, 1999, pp. 293-315). Kotter developed an eight-step model including, establishing the need for urgent change and ensuring that the organisation has an influential change group entrusted with the responsibility to guide a change process (Armenakis & Bedeian, 1999, pp. 293-315). Fourthly, the organisation develops a vision; then communicates that vision to all the publics in contact with the organisation before empowering the employees to implement that vision (Armenakis & Bedeian, 1999, pp. 293-315). Kotter then suggests that the organisation has to ensure the short term goals are achieved and finally that it consolidates its gains to a point that the change is embedded in the organisation culture (Armenakis & Bedeian, 1999, pp. 293-315). This is exactly what is required at the hospital. A team that can be entruysrted with the planning and execution of the change process should be created to work alongside the management in ensuring that the planned for change process gets underway through a set of logical steps. Evaluating the Change Implementation Process Once the strategies conceived of implementing the change process are underway and the entire institution is going through the transition, it is important that the management and the team entrusted with the change program to constantly review the progress and suggest mechanisms suitable to amplify the gains of the change process ((Daft, & Weick, 1984). A good example would be conducting regular surveys of patients to determine their views on how the staff who attended them interacted with them. The number of communications received and sent out online will also be indicative of success of failure in the adoption process (Collins, 2001). The employees themselves must constantly be monitored and surveyed for feedback about the change process so that their fears, worries and concerns are attended to in time before they affect the change process (Elias, 2009; Grunberg, Moore, Greenberg, & Sikora, 2008). Finally the last way in which the change process can be evaluated during implementation is in the attainment of short term goals such as staff training and equipment installation, encourse to the main objectives (Whelan-Berry, Gordon & Hinings, 2003). Communicating the Change Effectively Change can as well be conceived and supported by the management and then entrusted to a select committee for planning and implementation, but the people who actually realise the change are the employees themselves. The most important element of institutional change is the communication of the need for change, the contents of the change, the benefits of that change, the implementation of that change and the requirements for that implementation (Schraeder, Swamidass & Morrison, 2006; Collins, 2001). The hospital must thus conceive and employ a clear communication strategy to communicate the vision of change within and without the institution. The biggest challenge to achieving a change process at any organisation is attaining effective communication with their employees (Schraeder, Swamidass & Morrison, 2006). This means that if the employees do not support and facilitate the change process as the management would wish done, that change process is doomed. Palmer, Dunfold & Akin (2008) suggest a possible solution to this scenario with their theoretical strategies for communicating change. The communication strategy should focus on first and foremost, ensuring that every employee in the organisation shares the values of that change (Palmer, Dunfold & Akin, 2008). Not only should employees understand the change clearly, but they should also view it as beneficial and necessary (Armenakis & Bedeian, 1999, pp. 293-315). This will help initiate proper actions among the employees to propel the change programs towards effective implementation and maintenance (Armenakis & Bedeian, 1999, pp. 293-315). The management of the hospital should in this case adopt an internal initiative that aims at getting all employees to share in the values of the change process, to own the change program and to accept it as beneficial and or necessary (Saksvik & Hetland, 2009; Palmer, Dunfold & Akin, 2008). This can easily be done through cultivation of positive emotions in memos, internal publications, regular meetings, posters displayed on strategic points etc. The way that the change program is communicated to employees determines how receptive they are (Palmer, Dunfold & Akin, 2008). At the hospital, employees and the management should engage in positive dialogue and exploration interactions about the change program so that the need for change and its benefits may be shared across the board. Such direct interactions will ensure that the change communication process is not subject to distortion, ambiguity and message overload (Palmer, Dunfold & Akin, 2008). Again, direct interactions will create avenues for feedback on which the management can act accordingly (Palmer, Dunfold & Akin, 2008). Conclusion This paper has detailed an institutional change management strategy that is designed for adoption by public hospital. Two changes have been established as necessary and urgently needed in the hospital namely, adoption of new relationships with an informed patient base requiring participatory involvement in treatment decision making and the need for modern communication means, especially the internet. The paper has then gone on to discuss relevant change management principles as postulated my current literature on the area of organisation change, it conception, planning, implementation and evaluation. Based on these principles, the paper has recommended a change strategy ideal for the hospital in adopting new staff/patient interactions and adopting modern communication means such as training and equipment installation. These have been recommended for implementation in a process that simultaneously combines instantaneous and processual change implementation approaches. Evaluating this implementation through patient and employee feedback as well as accumulative attainment of short term goals has been recommended. Finally, the paper has recommended adoption of an effective approach to address potential resistance to the change, by increasing and sustaining employee communication and education as regards the change essentials (Saksvik & Hetland, 2009). The paper concludes that that communication must be structured in such a way that it explains the need for change, explains how the change will be effected, identify the benefits to accrue from implementing the change and spell out the responsibilities of implementing that change for each individual (Bordia, Jones, Gallois, Callan & DiFonzo, 2006). References Armenakis, Achilles & Bedeian, A. (1999). Organizational Change: A Review of Theory and Research in the 1990's. Journal of Management, Vol. 25 (3), pp. 293-315. Lazuli, G., Dylan, L., Burns, L. & Yap, C. (2004). Two Decades of Organizational Change in Health Care: What Have we Learned? Medical Care Resource Review. Vol. 61 (3). pp. 247 - 331. Bordia, P., Jones, E., Gallois, C., Callan, J. & DiFonzo, N. (2006). Management Are Aliens!: Rumors and Stress during Organizational Change. Group Organization Management. Vol. 31 (5). pp. 601 - 621. Burke, W. (2007). Organization Change: Theory and Practice, London: Sage Publications. Collins, J. (2001). Good to great: why some companies make the leap... And others don't. New York: Collins Business. Daft, R. & Weick, K. (1984). "Toward a Model of Organizations as Interpretation Systems." Academy of Management Review, Vol. 9 (3). pp. 284-295. Elias, S. (2009).Employee Commitment in Times of Change: Assessing the Importance of Attitudes Toward Organizational Change. Journal of Management. Vol. 35 (1). pp. 37 - 55. Grunberg, L., Moore, S., Greenberg, E. & Sikora, P. (2008). The Changing Workplace and Its Effects: A Longitudinal Examination of Employee Responses at a Large Company. Journal of Applied Behavioral Science. Vol. 44 (2). pp. 215 - 236. Kegan, R. (1982). The evolving self: problem and process in human development. Cambridge: Harvard University Press. Kouzes, J. & Posner, B. (2003). Credibility: How leaders gain and lose it, why people demand it. San Francisco: Jossey-Bass. MCNamara, C. (2009). Basic Context for Organizational Change. Free Management Library. Retrieved May 21, 2010. From http://managementhelp.org/mgmnt/orgchnge.htm Milliken, F. (2002). Understanding Organizational Adaptation to Change: The Case of Work-Family Issues. New York: EBSCO Publishing. Neves, P. & Caetano, A. (2009). Commitment to Change: Contributions to Trust in the Supervisor and Work Outcomes. Group Organization Management, Vol. 34 (6). pp. 623 - 644. Poole, M. (2000). Organizational change and innovation processes: theory and methods for research. New York: Oxford University Press. Palmer, I., Dunford, R. & Akin, G. (2008). Managing organizational change: a multiple perspectives approach. New York: McGraw-Hill Irwin. Saksvik, B. & Hetland, H. (2009). Exploring Dispositional Resistance to Change. Journal of Leadership and Organizational Studies. Vol. 16 (2). pp. 175 - 183. Scharmer, C.O. (2007). Theory U: Leading from the future as it emerges. Cambridge, MA: The Society for Organizational Learning. Schraeder, M., Swamidass, P. & Morrison, R. (2006). Employee Involvement, Attitudes and Reactions to Technology Changes. Journal of Leadership and Organizational Studies. Vol. 12 (3). pp. 85 - 100. Senior, B & Swailes, S. (2005). Organizational Change. Ottawa: Pearson Education Canada. Torbert, W. (2004). Action inquiry: The secret of timely and transforming leadership. San Francisco: Berrett-Koehler. Quinn, R. (2004). Building the bridge as you walk on it: A guide for leading change. San Francisco: Jossey-Bass. Quinn, R., Spreitzer, G. & Brown, M. (2000). Changing others through changing ourselves, Journal of Management Inquiry, Vol. 9 (2), pp. 147-164. Uhl-Bien, M., Marion, R. & McKelvey, B. (2007). Complexity leadership theory: Shifting leadership from the industrial age to the knowledge era. Leadership Quarterly, Vol. 18 (4). pp. 298-318. Weber, P. & Manning, M. (2001). Cause Maps, Sensemaking, and Planned Organizational Change. Journal of Applied Behavioral Science. Vol. 37 (2).pp. 227 - 251. Whelan-Berry, K., Gordon, J. & Hinings, C. (2003). Strengthening Organizational Change Processes: Recommendations and Implications from a Multilevel Analysis. Journal of Applied Behavioral Science. Vol. 39 (2). pp. 186 - 207. Read More