Change Management In Healthcare Environment Policies

Question 2: Develop policies and systems for involving others in the process of change

Describe how you would involve stakeholders in the introduction of this change into the healthcare organisation viz. Mercer Medical Centers.

Analyze and evaluate the effectiveness of systems in promoting change in Mercer Medical Centers.

(Word Count :1500 words)

Question 3: Implement models for ensuring change in which risks are managed

3.1 Develop models for change that take account of risks in the context of case study

3.2 Plan the implementation of the model of change developed for Mercer Medical Centers

3.3 Evaluate the outcome of change in Mercer Medical Centers

(Word Count :1500 words)

Question 1: Explore the background to change affecting the healthcare organisation in the case study viz. Mercer Medical Centers

Assess the background to change that faces Mercer Medical Centers. .

At first change is awkward but it is something that presses us out of our comfort zone. Changing from one state to the next upsets our control over outcomes and is uncomfortable.

Change changes the speed of time. Time is so slow for the reluctant, and yet it is a whirlwind for those who embrace it. Change doesn’t look for a resting-place; just the next launching point. For those who don’t learn from it they perceived it only as a waste, Institute of Industrial Engineers (IIE, 2010).

Change management is all about people and processes that work for people. It is about how you take an organisation from Position A to Position B, in the fulfilment or implementation of a vision and a strategy and the whole art is to how to carry your people with you, so that the envisaged benefits of the vision and strategy are actually realised (Warrilow, 2010).

Organisational Change Management seeks to understand the sentiments of the target population and work with them to promote efficient delivery of the change and enthusiastic support for its results (Wallace, 2007).

Pressures that triggered for the need of change in Mercer Medical Centre can be seen. Competition in the market is the primary motive. The pressure has been relentless to constantly update expensive systems and equipment in order to be on the top of the business. Managed care penetration is increasing, and Mercer has bought up small private clinics as well as having its own managed care insurance plan. In order to stay competitive in the market, contracts from high technology firms such as Syntel, the company which manufactures computer chips whose function is to apply the Physician Order Entry (POE) system was sought after by Mercer Medical Centre. Plans from other competitors to implement same physician order entry (POE) system pushed Mercer to implement its system earlier than what has been planned (Ash et al, 2000).

Second reason is the public relations. The latest lawsuit has a negative impact to the corporation and could damage its reputation in the market and its managed care contracts. As stated by Anderson, having a state of the art POE system will be a good promotional tool in negotiation of contracts (Ash et al, 2000).

Resistance to change is normal. Lack of communication, minimal top management involvement and forced change processes are among barriers to change. Initially, the target population sees the change as a bad or threatening thing. The Project Manager should expect to encounter it and deal with it. The worst time to encounter resistance is during the cutover to the new solution. Transition is usually a busy, critical, high-risk period when the last thing you need is a lack of co-operation from the target population. A significant project will require a cascade of sponsorship, such that all affected parts of the organisation hear strong support from their leadership. If the message is delivered from the top and reinforced by the immediate management, staffs are far more likely to believe in the case for change and to act in support of the changes (Wallace, 2007).

1.2 Evaluate the strengths and weaknesses of bureaucratic health organizations

Bureaucracy is a form of structure in many large scale organisations. It is based on specialisation of tasks, hierarchy of authority and decision making, systems of rules and regulations and an impersonal orientation from officials (Mullins, 2007).

Bureaucracy is the division of labour applied to administration. ‘Bureau’, is a French word meaning desk, or by extension, an office; thus, ‘Bureaucracy’ is rule through a desk or office, that is, a form of organization built on the preparation and dispatch of written documents. In contrast to the commonly held view of bureaucracies, they do not ‘rule’ in their own right but are the means by which a monarchy, aristocracy, democracy, or other form of authority, rules (VectorStudy, 2008).

Moreover, bureaucracies provide a safe haven where managers can hide from responsibility and avoid being held accountable for errors of judgement or problems they crated or failed to solve. In return, managers are able to use bureaucratic rules to stifle self-management and compel employees to follow their direction (Mullins, 2007).

According to Weber, bureaucracy is a particular type of administrative structure developed through rational-legal authority. Bureaucratic structures evolved from traditional structures with the following changes

In addition, the ideal bureaucracy was characterized by impersonality, efficiency and rationality. The key feature of the organization was that the authority of officials was subject to published rules and codes of practice; all rules, decisions and actions were recorded in writing.

The structure of the organization is a continuous hierarchy where each level is subject to control by the level above it. Each position in the hierarchy exists in its own right and job holders have no rights to a particular position. Responsibilities within each level are clearly delineated and each level has its own sphere of competence. An appointment to an office, and the levels of authority that go with it, are based solely on the grounds of technical competence (VectorStudy, 2008).

The term “red tape” is often used by customer to call an organisation when it has rigid policies and procedures. In addition, an organisation is described as “bureaucratic” when it seems to be inflexible and unresponsive to a customer’s individual situation. Top managers are dangerously ill-informed and insulated from what is happening on the front lines or in “the field.” Decisions are made based on the perceived desires of superiors, rather than concern for mission achievement.

Bureaucratic management promises control and consistency, an up-focused mission promised that governmental agencies would serve the stockholders, represented by the board of directors, rather than the people within the organisation.

Moreover, “Bureaucracy” as defined by customers and employees is an array of negative forces, attitudes or actions that are damaging to customer and employee satisfaction. It is damaging to organizational effectiveness. It weakens employee morale and commitment. It divides people within the organization against each other, and misdirects their energy into conflict or competition with each other instead of mission achievement (Visionary Publications, 2010).

Compare and contrast different forms of organisational development.

Organisational development (OD) can play a vital part in harnessing the collective talent of an organisation, bringing about change and improving performance. It involves taking planned steps to create an environment that will enable staff to understand and deliver organisation’s objectives, People Development Team (PDT), 2010.

These steps include developing appropriate skills, behaviours and attitudes, culture and a style of leadership that will enable the organisation to achieve optimum performance. A clear sense of direction, strong leadership and a focus on people management issues including the management of performance and the promotion of learning, development, creativity and innovation are essential (PDT, 2010).

A team building could be a group of people who improve their individual and collective performances through a process designed to bring this about. The definition needs to further state that the group of people need to have shared or common goals, which are usually the goals of the company they work for and it starts with good leadership, Team Building Online (TBO), 2010.

Four stages of team building had been identified. First is the forming stage wherein people tend to be polite, cautious, trying to get organized and sense of belongingness in a group is being asked. Second is the storming stage wherein issues, irritations, and problems surface, infighting develops. Third is the norming stage wherein issues and problems are discussed openly to set new ground rules, processes and procedures to resolve them. Last is the performing stage wherein members of the organization are working together to meet the high standards of performance

Some of the team building tips are valuing each member of your team, be the kind of company that a team member wants to be part of, give team members a reason to feel motivated to achieving the company goals, a strong leader committed to his or her work and make certain that there is always good communication between members and their management.

While coaching is typically applied to one-on-one situations or to teams, most effective leaders are in truth coaches for their entire organisations. Coaching at its core about enabling others to succeed; toward that end coaches converse, cajole, confront and sometimes challenge individuals to do their best and then support them in that effort. Just as when you coach one on one, communications is all the more critical when coaching across an entire organisation. It can only be successful if it is based upon trust. One way you build trust is to listen to your people (Baldoni, 2005).

Organisational coaching spreads the leader’s message throughout the rank and file and in return it gives them ownership in the enterprise. It communicates that you care about individuals and you want them to succeed. It also gives them a voice in the process because listening to their ideas is essential. From the listening comes the learning so together leader and followers enrich a culture of sharing that builds a sense of pride as well as a more determined effort to succeed (Baldoni, 2005).

A strategy is an overall approach and plan. So, strategic planning is the overall planning that facilitates the good management of a process. Strategic planning takes you outside the day-to-day activities of your organisation or project. It provides you with the big picture of what you are doing and where you are going. Strategic planning gives you clarity about what you actually want to achieve and how to go about achieving it, rather than a plan of action for day-to-day operations (Shapiro, n.d.).

Word count = 1584 words

Question 2: Develop policies and systems for involving others in the process of change

2.1 Describe how you would involve stakeholders in the introduction of this change into the healthcare organisation viz. Mercer Medical Centers

Stakeholder is any individual, group or business with interest (a stake) in the success of an organisation. They typically concerned with an organization delivering intended results and meeting its financial objectives. A stakeholder may contribute directly or indirectly to an organization’s business activities. Other than traditional business, a stakeholder may also be concerned with the outcome of a specific project, effort or activity, such as a community development project or the delivery of local health services. A stakeholder usually stands to gain or lose depending on the decisions taken or policies implemented (Investor Glossary, 2010).

There are two important reasons in involving stakeholders in all phases of a project. Firstly, their involvement in a project significantly increases your chances of success by building in a self-correcting feedback loop; secondly, their involvement in a project builds confidence in a product and will greatly ease its acceptance in your target audience. Different types of stakeholders should be handled differently (Alexandrou, 2010)

In approaching any businesses that require change clarity in all areas should be specified. A constant two-way communication that explains clearly the reason what and why there is a need for change. Active communications is important and demonstrate to people that you have thought the impacts of change on them, and that you are prepared to work with them to achieve their support and commitment to the change – by making it work for them. Be consistent in leading the change. Constantly pay attention to the management of the tasks, activities, projects and initiatives that are delivering the capabilities into organisations that will deliver the benefits that you are seeking. Ensuring that your people have the full resources and capabilities they need to support them thro the change (Warrilow, 2010).

The reason is so important is because people are stressed, tired and generally fed up with change initiatives. They need careful and detailed explanation of what are change management – why the proposed change is necessary, and the direct effects on them and the benefits to them. They need help and practical support (Warrilow, 2010).

There are two types of stakeholders in a company. First is the internal stakeholder that includes employees, managers and owners. Second is the external stakeholder that includes the suppliers, society, government, creditors, shareholders and customers.

Mapping of stakeholders in change can be a useful tool to understand the support and opposition you will get for a planned change.

Construct the map by first analyzing your stakeholders and then plotting them in the map below, writing their names in the relevant box. In doing this in a team one should write the names down of the stakeholders on Post-It Notes and stick them up on a chart on the wall.

• Opposition
• Support
• Stakeholder Power
• High
• Active opponents
• Passive opponents
• Fence-sitters
• Passive supporters
• Active supporters
• Medium
• Low

Stakeholders all have authority, whether it is the formal power invested or it is social power of being able to persuade others to support or oppose the change. Those with higher power are likely to be your most useful supporters or most dangerous opponents — thus power analysis helps you prioritize your focus on stakeholders. Some people will actively support the change, putting their necks on the line and working long hours to help it be successful. Others will work the other way, determinedly seeking to ruin your efforts (Straker, 2010).

These active people are where much focus often happens. However, there is often a silent majority who are more difficult to classify. These may be in gatekeeper positions, where rather than taking positive action, they can subtly support or oppose the change by allowing things to happen or quietly blocking and hindering progress (Straker, 2010).

A Stakeholder Analysis and Map is a useful and necessary process for identifying and planning the necessary communications process for a programme. It lists each of the stakeholders against their particular interest area in the programme. It also lists known or anticipated issues associated with any person or group (Warrilow, 2010).

Each of these people and groups will have a specific interest area, such as financial, technical, regulatory etc so when you are identifying them it is important to recognise their specific interest areas in order to ensure that their expectations can be managed effectively. There clearly will be individuals or groups who will be worse off as a result of the programme and who are therefore potential ‘blockers’ to the progress of the programme. Both the positive and negative viewpoints should be considered as part of stakeholder management (Warrilow, 2010).

Moreover, the Pre Programme Review and Planning will have identified issues associated with these individuals or groups and determined potential solutions and strategies for resolving the issues. Information dissemination and two-way communications are critical for managing expectations effectively (Warrilow, 2010).

2.2 Analyze and evaluate the effectiveness of systems in promoting change in Mercer Medical Centers.

A system is an organized collection of parts that are highly integrated in order to accomplish an overall goal. The system has various inputs which are processed to produce certain outputs, which together, accomplish the overall goal desired by the organization. To explain, inputs to the system include resources such as raw materials, money, technologies and people. These inputs go through a process where they’re aligned, moved along and carefully coordinated, ultimately to achieve the goals set for the system. Outputs are tangible results produced by processes in the system, such as products or services for consumers. Another kind of result is outcomes, or benefits for consumers, e.g., jobs for workers, enhanced quality of life for customers, etc. Systems can be the entire organization, or its departments, groups, processes, etc (McNamara, 2010).

Decision Conferencing is a proven method of achieving more effective decisions. The process involves groups of people in a transparent decision-making process and is ideally suited to resolving complex issues fast (Catalyze Ltd, 2008).

All parties involved in the decision making process are gathered together in a series of workshops where options and issues are identified and discussed. These discussions are typically aided by modelling the problem, a process that documents the discussions and allows the best value options to be identified and different scenarios to be analysed. It is a remarkably powerful communication tool, allowing the group to openly discuss their organisation, values, issues and beliefs. The results are also ideal for educating and informing people not present at the workshops (Catalyze Ltd, 2008).

Systems engineering integrates all the disciplines and specialty groups into a team effort forming a structured development process that proceeds from concept to production to operation. Systems engineering considers both the business and the technical needs of all customers with the goal of providing a quality product that meets the user needs (Incose.org, n.d.).

Evaluation, in the context of management activities, is carefully collecting information about something in order to make necessary decisions about it. There are a large number and wide variety of evaluations that can occur in businesses, whether for-profit or non-profit. Evaluation is closely related to performance management (whether about organizations, groups, processes or individuals), which includes identifying measures to indicate results. Evaluation often includes collecting information around these measures to conclude the extent of performance, Free Management Library (FMP), 2010.

Several systems has been tried to implement in Mercer Medical Centre in order to improve its services to its user. A system called Physician has been attempted to implement two years ago and it failed in great proportions. Opposition from the medical staff was identified from the time they previewed the system. The implementation was carried out without consideration to physicians’ opinions. It was abandoned after two days of implementation due to technical problems. This was not a successful system because it resulted to great loss of money, the CIO nearly lost his job and the image of the information services department was severely tarnished (Ash, et al., 2000)

Another system, CareReviewer was tried to be implemented but end up being unsuccessful because of its unwelcomed technology as perceived by the challenged medical staff. They thought that the system add to their workload rather than making their jobs easier. Being pushed to see more patients in less time and with less compensation, physicians see this as a cause for them to receive less salary and working for the top executives to make more money and they lost their autonomy (Ash, et al., 2000)

Recently, the hospital is trying to implement a new system, the Physician Order Entry (POE). Instead of implementing the system for a longer period of time, the top management wants to implement it within nine months time. The change in the time frame was caused by competition by Mercer Medical Centre with the other health care provider around the area and public relations (Ash, et al., 2000)

Reed was aware of the existing resistance to the organisation and she is willing to win back the trust of the medical staff by being available to them 24-hour and giving support by visiting them to their home personally in order to build rapport. Involving influential people and making sure that the system provides immediate benefit to the users increases the use of the POE. Fast, easy to use, being accessible anytime, consistent, accurate and reliable and a system that positively affect the patient care is the system that physicians wants. (Ash, et al., 2000).

Word count = 1525 words

Question 3: Implement models for ensuring change in which risks are managed

3.1 Develop models for change that take account of risks in the context of case study.

There are many causes of organisational change such as economic downturns, changes in strategy, government legislation, labour market pressure, technological changes and natural evolvement. It is crucial that organisations manage this change from within and understand and plan for the effects it may have on their employees (Snaith, 2010).

Introducing change to an organisation can be difficult and managers need to gain the support and commitment of their colleagues and employees to ensure that change is managed effectively and business continues as usual with as little disruption as possible. Failure to do this can result in a loss of talented employees, a loss of credibility and a loss of the organisation market position (Snaith, 2010).

It is usual for organisations to encounter resistance to change. Employees may be concerned for their job, be sensitive to change, dislike the change that is taking place, or dislike the process in which it is taking place. To combat this employer need to ensure that they communicate with their employees on a continuous basis, provide any training that may be required for new roles or changes to current roles, and ensure that the reasons for the change are communicated from the offset (Snaith, 2010).

When change is imposed to people they feel little ownership with their decision and it leads them to feel out of control. Some people will go through the process quickly and others slowly (RapidBi, 2008).

Kotter listed reasons why change fails, these includes allowing too much complexity, failure to build substantial coalition, understanding the need for a clear vision, failure to communicate and permitting the roadblocks against the vision, not planning and getting short term wins, declaring victory too soon and not anchoring changes in corporate culture (RapidBi, 2008).

There are many change management models; the most common is the Kubler Ross transition (Grief) cycle which is well grounded in academic research within clinical environments. Another model is the ADKAR model for individual management which was developed by Prosci. It describes the five required building blocks for change to be realized successfully on an individual level. The building blocks include awareness, desire, knowledge, ability and reinforcement. (RapidBi, 2008).

Business process Reengineering aims to increase performance by radically re-designing the organization’s structures and processes, including by starting over from the ground up (McNamara, 2010).

Kaizen is a model that has incremental self-improvement that has been applied to business and management. Use only for improvement to existing processes. It is not a methodology for introducing new processes or large scale change. It works well where there is a long-term requirement. It focuses on the people aspects of improvement, requiring some discipline and acceptance of change for improvement but can be easier to implement than other business process re-engineering methodologies where more radical changes are required in the short term which can give rise to more resistance and require more robust change management skills (JISC Advance, 2009).

People have different perception on change therefore it should not and cannot force on people; instead as a change manager we should encourage people to make a choice or decision.

3.2 Plan the implementation of the model of change developed for Mercer Medical Centers

Business Process reengineering is a technology-oriented approach that enables radical change however requires considerable management skills. According to Davenport (1992), business process reengineering has 5 steps approach. First is to develop the business vision and process objectives. Second is to identify the business process to be redesigned. Third is to understand the existing processes. Fourth is to identify the IT levers and last is to design and build a prototype of the new process, The Executive Fast Track, (TEFT), 2010.

Change is a fundamental component of continuous quality improvement. Any improvement methodology involves introducing change and measuring its impact. In health care there has been recognition of the need for system change to support the delivery of safe, quality care, Victorian Quality Council (VQC), 2006.

It is not enough to provide the tools and strategies with which to improve safety and quality of health care and expect success. There is a need to be aware of what to expect when introducing change, how to engage staff and to make change sustainable. Knowledge or awareness of change processes may assist in ensuring success of a project (VQC, 2006).

Successful implementation of system change is essential in the provision of safe, quality care to consumers. Implementation of improvement projects and sustaining the resulting change can be a difficult process. It has been stated all too often that quality improvement projects fail on a regular basis. The individual or the teams introducing change have a challenging task. Change management is one component of a successful project; the need for project planning and the use of quality improvement tools are also critical (VQC, 2006).

People are generally the most critical resource, supporter, barrier and risk when managing change. The uncertainty of change can provoke strong emotions, with most people experiencing some sense of grief and loss as they let go of the old and move towards the new (VQC, 2006).

Awareness of the range of reactions to change will help the leader of the change process respond appropriately to concerns that are expressed. Understanding why these emotions occur may assist the leader to introduce change in a manner that anticipates, acknowledges and responds to concerns (VQC, 2006).

Since improvement depends on the actions of people, ultimately it comes down to winning hearts and minds. Staff will not respond well to just being told to change, nor can the project leader stand over staff to ensure compliance. To be successful, a change management process must include an effective communication strategy. All stakeholders must have opportunities to express their views and attitudes as part of the planning process. A lot of improvement is about changing mindsets. It is about having the tools, techniques and confidence to work with colleagues to try something that is different. It is about understanding the possibilities of thinking differently and aiming to make practical improvements for patients and staff (VQC, 2006).

Evaluation is an important component of any change process. As part of the project planning a decision needs to be made about measures that will be used to determine if the planned change leads to an improvement (VQC, 2006).

Dissemination of the evaluation is important and consideration of the audience, the method and format of communicating the feedback should be undertaken. Present the final package containing all the planning, data, outcomes and learning to staff and stakeholders. If this evaluation is shared, and the emphasis is on learning in a non-punitive environment, then it can become a benchmark (or standard) for implementing change (VQC, 2006).

The key to implementing change and continuous improvement is the effective exchange of information between people and process, a combination of business and human dimensions towards a shared objective (VQC, 2006).

3.3 Evaluate the outcome of change in Mercer Medical Centres

Competition and public relations are the wrong driving forces for change mentioned in the case of Mercer Medical Centre. These forces for change lead to resistance by its medical staff.

In any successful change initiative 3 broad areas should be included: leadership that directly addresses the transitions and emotional dimension of those impacted by the change, and provides inspirational motivation, a change model and methodology that cover the multiple factors that must be addressed and action management that shows and assists people with the specifics of exactly what is required of them (Warrilow, 2010).

Fast implementation of the POE system was pressed to Dr. Reed and she knows that the corporation is not ready for this change. They need time to implement such change and that what she does not have (Ash, et al., 2000). Mercer Medical Centre experiences almost the same environmental influences that put pressures to organisations. Two-way communication is very important thing that has been recommended by different stakeholder groups. They must come together, engage in constructive problem solving, create a common strategy, and actively take charge of the change.

There can never be any general formulas for organizational success. Each organization has its own constraints and pressures however there is a large number of theories which can be used as a guide for success. Each theory has its own drawbacks and tends to be situation-specific. Managers and organizations need to treat theories with degree of skepticism. If managers can identify the theories for planning and changing organizations and they can understand it then they are in a position to identify choices and make changes (Brunes, 2004).

Sometimes mangers may choose or be required by circumstances to change their organizations radically and quickly; sometimes they may choose to influence the context to promote or reduce the need for such changes. In some instances, change may take place more slowly and over a long period, as both organization and context are shaped and changed. The key factor for this is to make conscious decisions rather than rely on untested assumptions. This will require those who manage and lead organizations to question and challenge their own and other people’s assumptions. This will also require them to gather and be open to a wide variety of information. Learning should be an organization-wide and continuous process, rather than one limited to a few like-minded individuals at one point in time (Brunes, 2004).

Officials face many challenges and choices. Some organizations will find that their role for planning is very limited. Others will find that there is considerable scope for discretion. It is the role of managers and leaders to ensure that all available options and choices are identified, and that the choices made take account of both the short-and long-term interest of all their stakeholders – whether these be shareholders, employees, the managers themselves or the community at large. The worst managers may not be those who make poor choices; it may be those who fail to recognize that there are choices to be made (Brunes, 2004).

Word count = 1643 words

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