Management of Health Services - Literature review Example

Management of Health Services Introduction Change management refers to the continuous process of reviewing an organization’s structure, capabilities, and direction in order to satisfy the ever-changing needs of consumers (Edwinah & Ahiauzu, 2013). Change is a feature that is present in all organizations and occurs throughout an organization’s life, both at strategic and operational levels. The manner in which an organization handles changes affects its performance, both in the short- and in the long-run. Essentially, the kind of approaches adopted in an organization influence the success of change process. Despite recommendations by contemporary theories to incorporate employees’ knowledge and experience in the change process, evidence shows that their knowledge and experience is rarely taken into account (Edwinah & Ahiauzu, 2013). As well, research shows that most organizations still rely on top-down approach to organizational change, which is based on traditional views of classical theories (Tuladhar et al, 2009). This approach has been shown to be ineffective mainly due to the fact that it does not take into account the opinion of lower-level personnel during implementation of change. The importance of learning in facilitating sustainable change in organizations has also been ignored (McMillan, 2008. As a result, most organizations have been unsuccessful in implementing large-scale changes. In this regard, this paper provides a critical review of change management in organizations in the contemporary world of business. Discussion The importance of knowledge, experience, and skills of workers in enhancing change within organizations is widely highlighted in the contemporary theory of change management (Goudge, 2006). However, research shows that the contribution of knowledge, skills, and experience of workers in the process of change is widely ignored (Brown & Cregan, 2008). During a conversation I had with a friend who works as a junior staff with a local bank, it was apparent the lower-level staff perceive senior managers as being more knowledgeable and thus, they recognize the suggestions and decisions of the managers as superior. He explained that the senior managers usually design change without incorporating the opinions of the lower-level staff. This notion, however, ignores the importance of employee involvement and acceptance to the success of change. As Edwinah and Ahiauzu (2013) explain, the lower-level personnel are always involved directly in the implementation of organizational goals. The workers gain essential knowledge, experience and skills while undertaking allocated tasks, both individually and in teams. Therefore, they are in a better position to understand the implications of change initiatives to their jobs. They can give vital recommendations that might make the change process to be more fruitful. Apart from capitalizing on the knowledge and experience of the workers, incorporating their suggestions in designing change helps to gain their loyalty, trust, and commitment (Morgan & Zeffane, 2003). The workers are going to be more active in facilitating change since they believe that they are part of the change process. Therefore, organizations miss such benefits by ignoring the knowledge, skills and experience of workers. On top of this, failure to incorporate the knowledge and skills of the workers negatively impacts on their trust, commitment, loyalty, and productivity (Morgan & Zeffane, 2003). In some cases, the workers respond by showing resistance to the change. In such circumstances, the change process faces hindrances and may not be successful. It is therefore essential for senior managers in organizations to utilize the knowledge, skills and experience of workers into the proposed change and where necessary, create change purely from the suggestions of the workers (Brown & Cregan, 2008). The senior management should take time to listen to the lower-level personnel and incorporate their opinions in decision-making process. Traditionally, changes within organizations are based on the top-down approach, rooted in the views of classical theorists. As Tuladhar et al (2009) assert, there has been resistance to change towards adopting more effective modern approaches to change management, with more emphasis being given to the traditional approach. In the top-down approach, senior managers initiate changes to achieve specific goals. In this paradigm, the lower-level personnel are not involved in the decision-making process and their opinions do not count in the process of setting up goals for change. In my conversation with my friend, it was apparent that in their organization, the lower-level personnel are just expected to follow and implement instructions given by the senior staff without questioning. He mentioned that senior managers provide a vision to be focused on and develop parameters by which the performance of the lower-level staff will be measured. In most organizations, a view is held that changes affecting the survival, such as acquisitions, mergers and structural changes can only be based on the decisions and opinions of senior managers since they have adequate knowledge and information regarding the causes and effects of such changes (Sharma, 2006). It is also held that since such large-scale changes involve big risks, require huge capitals and have profound implications, involving everybody in decision-making would take too much time. The senior managers justify this approach by stating that large-scale changes are too sensitive to be based on the decisions of the less-knowledgeable lower-level staff; effectiveness can only be achieved when they take charge and control of the process (Droese, 2003). Importantly, however, studies have shown that changes initiated solely from the top without regard to the opinions of workers are hardly successful. Tuladhar et al (2009) found that 70% of large-scale changes in American organizations where the top-down approach is adopted fail. According to Tuladhar et al (2009), only about 20% of European organizations reported success with the strategy. 63% of European firms reported ‘occasional success.’ Ineffectiveness in the top-down approach has largely been attributed to failure to actively involve lower-level staff in the decision-making process. In most cases, the workers perceive the senior managers as being insensitive to their needs. They feel the proposed changes to be odd to them. In extreme cases, the workers become resistant to the proposed change. As Nielsen & Randall, (2012) explain, change can only achieve success if it is supported by those who are going to implement it. The top-up paradigm contradicts the bottom-up approach whereby initiatives for change come from lower-level staff. In the bottom-up approach, the opinions of the lower-level staff count more than the opinions of the top managers in decision-making. This approach is based on the notion that changes can be more effectively implemented where lower-level staff are allowed and encouraged to use their job-knowledge and experience in facilitating change. While undertaking my attachment at Victoria Medicaid Nursing Home, I realized that senior managers consulted staff at all levels before making final decisions. As a result, staff at all levels supported change initiatives since they felt change to be part of them. They focused on benefits, rather than demerits of change. Generally, the bottom-up approach helps to build organizational capacity for sustainable change. However, studies have shown that the most successful approach is one that includes both top-up and bottom-up approach (Hiatt & Creasey. 2010). While the bottom-up approach is supportive to the change process, the top-down initiatives are needed to break traditional patterns and habits. In Victoria Medicaid Nursing Home, senior managers were relied upon to make sensitive and difficult economic adjustments. The importance of learning in facilitating organizational change and in enabling managers and staff to adapt to changes has been extensively documented. Despite this, the concept of learning organization is widely ignored (McMillan, 2008). The concept of learning organization is based on the notion that through learning, an organization is able to adapt to changes and to transform internal processes in order to meet its own needs as well as the needs of the workers (Rowden, 2001). According to the theory of learning, learning should be integrated in all processes within an organization and should be a rich, continuous process. With regard to change, the organizational learning theory sees learning as providing a link between individuals and teams in an organizational web that constantly reacts, responds and transforms itself. A learning organization focuses on ongoing movements and patterns of change, rather than relying on specific events to introduce change. This is quite different from the manner in which change and organizational learning are understood in many organizations. Approaches to learning in most organizations tend to be event driven and is undertaken to acquire specific skills or to accomplish specific tasks and processes (McMillan, 2008). After the targeted skills are acquired or knowledge is gained on how to accomplish a task or a process, learning is deemed to be over. During the conversation with my friend, he mentioned that workers and managers undergo through training sessions occasionally to gain specific skills. However, after the training is over, everything goes back to normal; learning is deemed over. Generally, learning in most organizations is not viewed as a continuous, enriching, stimulating, flow of experience. As Caluwé and Vermaak (2003) noted, more attention and energy should focus on stimulating capacity for continuous process of learning and value should be attached to accumulated learning within an organization. In a learning organization, both managers and workers develop and apply crucial skills of reflection and enquiry (Caluwé &Vermaak, 2003). They also learn to develop new mental models, to be creative and to be adaptive to change. As a result of maintaining traditional, controlling approaches, many organizations are unable to deal with unpredictable nature of the contemporary world. As Peter Senge (as cited in Steenekamp, Botha & Moloi, 2012) suggested, it is essential for organizations to facilitate life-long learning for both managers and staff through creation of shared visions, establishment of systems of thinking and facilitation of learning in teams. Steenekamp et al (2012) found that different organizations have applied Senge’s approach in varying degrees. However, according to Steenekamp et al (2012) Senge’s ideas are rarely implemented in organizations where internal frameworks are not supportive (such as bureaucratic and linear supervision models). Steenekamp et al (2012) propose that organizations should adapt an approach to strategic change that sees learning as important as other strategic goals set for achievement. Change should be seen as a continuous process with learning as an essential part of the process. Thus, in a learning organization, change occurs as a result of overall change that occurs in individuals and teams as they learn from different experiences. After individuals and groups learn from experiences, they influence organizational culture and behaviours. Schermerhorn (2009) argues that organizational change in most organizations today is influenced by external factors or perceived threats from external environment. In a learning organization, change starts from within, rather than as a response to pressure from the external - Conclusion Generally, approaches and strategies adopted within an organization determine the success of change process. As explained, the importance of employee’s knowledge and experience, organizational learning in enhancing successful change within organizations is widely ignored. Most organizations still rely on the views of the classical theorists with the result that they still adopt the traditional top-down approach to change. As a result, many change initiatives within organizations are unsuccessful. Change initiatives can be successful if recommendations of contemporary theories of change are taken into account. Precisely, the top-down approach should be replaced with or used simultaneously with the bottom-up approach. Secondly, employee’s knowledge and experience should be taken into account when designing change. Finally, a culture of life-long learning should be facilitated in organizations, whereby managers and staff learn from change and initiate change based on their knowledge. ` References Brown, M. & Cregan, C. (2008). Organizational change cynicism: The role of employee involvement. 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