Order 1121761: The Impact of Change of Management in Healthcare

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Introduction

Change management is one of the pressing issues every organization is confronted with especially in an environment where change is associated with success or failure. The healthcare organizations are not left out in this change frenzy as they also seek to succeed through successful change implementation. Rapid change is being recorded in the health care organizations, mostly as they try to adopt new technologies and improve the quality of patient care, as well as manage the performance of the healthcare personnel. The best way to deal with the change, as literature reveals, is helping the employees adopt new ways of doing things (Campbell, 2008).

By definition, change management entails the process leading to the realization of the ideal state of the organization. In other words, change management in an organization entails overseeing the transition from the current state to the desired state. The process of change begins with the creation of a vision for the change. This is then followed by empowering the people responsible with the change to act as agents of the change and help attain the change. The change management process often involves many participants with roles that are clearly defined. These may include the owners of the change, the managers of the change, and the owners of the processes among others.

Change management often impacts on various people differently. The stakeholders in a change management are varied and this includes the participants to the change and other groups that affected directly and indirectly by the change. In the healthcare organizations, these impacts will be felt depending on the type of change and the result of change. For example, the change might be concerned with the introduction of new technologies, and this will mean new skills for the personnel and possibly a new structure for the entire organization. Change management in healthcare organizations, therefore, requires that the managers fully understand change and its impacts before making efforts to implement the change.

Problem statement

The changes in the organizational environment in the healthcare can force the organizations to adopt new structures, strategies and business models and requirements among other core aspects. The environment in the healthcare sector cannot be said to be stable, but one characterized by a high rate of volatility. The change management in these organizations has not always been successful – the success rate of the implementation of new changes is quite low. This can be partly because the people responsible do not fully understand the nature of the change and its impacts on the various stakeholders. The low rates of success in change implementation call for some deliberate efforts to examine what changes take place in the healthcare organizations, the people responsible for the change, and the impacts of these changes on the various stakeholders. More so, managing change will include managing the resistance to change, and this presents another reason for understanding change and its impact on the stakeholders

Objectives

The primary objective of this research is to present an understanding of the change management in healthcare organizations. The focus in on the impact of change management practices on stakeholders such as nurses, physicians, and doctors among others. The specific objectives are as outlined below:

· To establish the key types of change experienced in the healthcare organizations.

· To establish the people involved in the change management process in the healthcare organizations.

· To establish the impact of change management in healthcare organizations.

· To establish the role of management and leadership in change management in healthcare organizations.

· Establish the implications of change management on nurses and other professionals.

Research questions

The research questions are derived from the research objectives presented above. As such, the primary research question is what is the impact of change management in healthcare organizations? The research questions are as follows?

· What are the key types of change experienced in the healthcare organizations?

· What groups of people involved in the change management process in the healthcare organizations?

· What is the impact of change management in healthcare organizations?

· What is the role of management and leadership in change management in healthcare organizations?

· What are the implications of change management on nurses and other professionals?

Literature review

There are several major types of changes explained in the literature that are experienced in the healthcare industry. In this case, literature has revealed that technological changes, strategic changes and innovations in pursuit of better patient care are among the most influential ones. Change management, it has been hypothesized, will entail managing the change process itself and the people who most likely to resist the change.

It is acknowledged that the healthcare managers today tend to occupy an extremely challenging position requiring them to maintain a competitive edge in a healthcare market while leading the organization through a constant change (Campbell, 2008). Organizations today, regardless of the industry or sector, are experiencing rapid technological change. The healthcare organizations are also subject to this phenomenon whereby technology is the key driver of change. The healthcare organizations are adopting new technologies as they try to implement quality improvement initiatives and performance management initiatives such as pay-for-performance (Campbell, 2008). Technology can be disruptive in that it can completely change the face and operations of the organizations, and the change management in healthcare will need to take into account that new models and structures might result. In such a case, the biggest challenge is often preparing the nurses to cope with such changes which could have huge impacts in the nature of their careers. For example, they could not be required to have IT skills for them to handle the new IT systems being implemented.

Besides the technology changes, the change management in healthcare is also concerned with the shifts in the environment which tend to compel the healthcare organizations to change their strategies (Caldwell, Chatman, O'Reilly III, Ormiston, & Lapiz, 2008). Research in change management in healthcare has revealed that strategic change often fails owing to the inability of the individuals to adopt the necessary behaviors for the successful implementation of the new strategy. The healthcare management and leadership, therefore, are seen to be deficient in terms of proper change implementation. A change in strategy is something that would require a change in behavior, meaning that the behavioral change should be the first thing to implement. The behavioral change should lay the foundation for the strategy change whereby everyone is brought on board.

Literature has established that this form of change requires a unique approach. The hypotheses set out by Caldwell, Chatman, O'Reilly III, Ormiston, & Lapiz (2008) include that the management and leadership should gain support for the strategic change and introduce norms for change readiness. According to Klein, Conn, and Sorra (2001), a successful change implementation will require an ‘implementation climate’, a term defined as support for the specific change. Their study was concerned with the application of advanced computerized manufacturing technology, but the principle applies to all organizational contexts. An implementation climate in a healthcare organization would probably be that climate where the organizational members are not only ready for the change, but also support the change entirely.

Teamwork in change management in healthcare has also been found to facilitate a successful change implementation. Researchers like Markóczy (2001) have established that when the members of the management team are in agreement or have a consensus on the change direction, there is a greater likelihood of success. This leads to another hypothesis that there will be greater performance improvements where the members agree on the nature of the new strategy. The healthcare management is, therefore, presented with a challenge of achieving this unity that will drive the speed and effectiveness of the change process. Team leadership becomes a necessity because, as research has established, the senior leaders may have a critical role in the identification and implementation of the new strategy, the middle managers leading the various groups have the ability to enhance or undermine this implementation (House & Aditya, 1997). This means that the middle managers and the nurses collectively and individually have an influence on the success of change implementation. Each individual must be brought on board, a challenge for the managers who need to overcome the resistance to change. According to Kodama & Fukahori (2017), the nurse managers are the first-line managers who are responsible for inducing change in the clinical environment.

According to Al- Abri (2007, p. 9), the change management in healthcare has to contend with the fact that the healthcare professionals, including nurses, are obligated to acquire and maintain the expertise requisite for their tasks as they will only be given tasks falling within their individual competencies. With the change occurring frequently, all these professionals may be required to update continuously their expertise in order to remain relevant to this sector. This is why researchers like Al- Abri (2007, p. 9) argue that change management entails managing the complexity of the processes – that is, planning, evaluating, and implementing operations, strategies and tactics that ensure that the change is relevant and worthwhile. Managing resistance is especially important at the lower levels where professionals like the nurses could face and resist a change in the nature of their careers.

The pursuit of patient safety initiatives is another reason why the healthcare organizations have to be worried about change management. There are often some unintended consequences when these organizations pursue patient safety without undertaking effective change management (Ramanujam, Keyser, & Sirio, 2005, p. 455). Herein, the management and leadership in the healthcare organizations need to understand the inputs shaping the strategy (both internal and external) before developing strategies to achieve specified outcomes. According to these researchers, the senior management and leadership has an active role in the change initiation, and are also responsible for energizing the process of change. This leadership must also make sure that on board are senior administrators, clinicians, nurses, and opinion leaders among others. In other words, all members of the organization have to participate in the change process.

The improvement of patient care has been a top priority in almost all healthcare organizations and this exerts a lot of pressure. Ducharme, Buckley, Alder, and Pelletier (2009, p. 70) establish that among the challenges facing Ontario healthcare organizations include overcrowding and long wait times that degrade the quality of care. Innovative and timely solutions to such challenges are a priority. A literature review presented by Antwi and Kale (2014, p. 1) also indicates that the Canadian healthcare organizations were in need for solutions to problems such as long wait hour and timely access to care. This literature review reveals that the patient care is a critical factor affecting the changes in the healthcare. The pursuit of better patient care means pursuing innovations in both systems, structures, technologies, etc. These researchers express the need for the managers and decision makers to understand how change occurs in order for them to create a conducive environment for the innovations.

Theoretical framework

Today, several theories have been developed in the field of change management. Models have also been developed by several of the world’s renowned thinkers like John Kotter and William Bridges. Kotter, for example, developed a model expressing eight steps of managing change:

· Increasing urgency

· Building guiding teams

· Getting the vision right

· Communicating for buy-in

· Enabling action

· Creating short term wins

· Making sure not to let up

· Making the change stick

Lippitt, Watson, and Westley (1958) present a change management theory focusing on the role and responsibilities of the change agents. There are seven steps in this theory – 1) diagnosing the problem; 2) assessing the motivation and capacity for the change; 3) assessing the resources and motivation for the agent of change; 4) choosing progressive change objects, strategies and plans for action; 5) clarifying the roles and expectations of all parties; 6) maintaining change through actions such as feedback, communication, and coordination; and 7) withdrawal from the change agent. This theory is basically a collective development of behavioral change setting up the change environment.

Significance to nursing

Nursing profession is particularly affected by the various types of changes highlighted herein. They are faced with a situation whereby their occupation is subjected to change and where the changes often result into new structures, perspectives, and even environments. This research will be particularly important to the nurses as they learn how the changes affect them and their careers. This will help them to appreciate the fact that the change is necessary and that they need to facilitate it through creating a conducing implementation environment. They will learn to anticipate the change and get ready for it.

Research design and method

Introduction

The research methods, by definition, entail the tools and techniques used in doing the research (Willian, 2011, p. 1). They are a range of tools used for the various types of inquiry, reasoning that a research is basically an inquiry or search of knowledge (Kothari, 2004). This section of the proposal presents an overview of these tools and how they will be methodically used to answer the research questions presented earlier on. It is important to emphasize on the nature of the research – it will involve an inquiry into the change management practices in the healthcare sector to establish its impacts, types of change, stakeholders, and implications among other aspects.

A qualitative approach will be used for this study owing to the fact that it will involve collection and analysis of qualitative data. A qualitative research has been hailed as the best way to explore various dimensions of social life, including the weave and texture of the everyday life of the society (Mason, 2002, p. 1). The qualitative research can be defined as a systematic and empirical inquiry into meaning (Ospina, 2004). Since the qualitative research involves both naturalistic and interpretive settings, it can be said that qualitative researchers are concerned with studying the subjects in their natural settings as they try to make sense of or interpret phenomena.

An institutional ethnographic design will be adopted for this research. The ethnographic research is indeed a genre of qualitative research developed out the anthropological methodology (Shagrir, 2017). This type of research often seeks to investigate cultures and societies through the examination of the human, social ad interpersonal aspects. It is closely associated with the core qualitative methods of observation and interviewing. It is important to notice that ethnography emerged and developed as a social science tool. The researcher in an ethnographic research is a social scientific observer. Other participants in an ethnography are the observed and the audience to whom the reports (in the form of text) are made (Naidoo, 2012, p. 1).

The institutional ethnography can simply be described as ethnographic practices in specific institutional contexts. According to Gerhard (2011), institutional ethnography is an inquiry method describing the institutional situations in detail and analysing the actions and interpretations of the people make these situations recognizable institutional contexts. As an institutional ethnography, this research will involve the researcher (or the scientific observer) interacting with the healthcare organizations or institutions to learn about the change management practices.

Research participants

The research participants, besides the researcher, will be the two organizations selected and their employees and management/leadership. The people with whom the researcher interacts with will be selected on the convenience criteria, the rationale being that an organization with very many employees might not be easy to make contacts and spend adequate time with each employee. The researcher’s interest is on the change management practices and their impacts on the various stakeholders, a select few of which the researcher will interact with to learn all that is necessary.

The targeted sample for this research will be 100 participants from the various levels of the organization. The nurses, being the greater focus of the research, will be allocated 40% of this figure. The physicians and line managers will be allocated another 40%, and the remaining 20% will go to the executives and top management. Stratified random sampling method will be used whereby the participants will be selected as per the three groups, and randomly selected until the desired figures are reached. Taking into account the voluntary nature of the research, rejected requests will be replaced by other requests until the researcher obtains a full 100 research participants.

Protection of participants

The protection of the participant will be facilitated through the researcher observing the various ethical principles in a research. The researcher will make sure not to harm in any way the research participants, physically, mentally, or otherwise. The anonymity of the responses will be maintained and the researcher shall not link any employee or participant with any observation or interview response. The personal information shall not be disclosed to protect the privacy of the participants. Lastly, the researcher will make sure to obtain consent of the participants before engaging them in any research activity.

Data collection

Two methods of data collection will be used for this research – observations and interviews. Much of the data collection this design is collected through observation. In this method, a checklist of the researcher’s expectations and hypotheses will be used as the framework for data collection. The researcher will make the relevant notes to keep record of all observations related to the research. However, there are cases where it is not easy to observe what is being done, especially during secluded boardroom executive meetings where much of the change management decisions will be made. This means that the interview method will be of equal importance to the researcher.

The interviews will be conducted on face-to-face basis where the institutional ethnographer will prepare a set of questions for the interviews. Open-ended questions are preferred because they allow the respondents to freely express themselves and provide as much information as possible. There are more than one occupations in a healthcare institution, and this means that the researcher will have to prepare a different set of questions for each occupation or level in the organizational hierarchy. These questions will be aligned with the primary theme of the research – that is, the change management practices and their implications. The interviews will be tape-recorded for reference.

Credibility

Credibility entails the truth of the data and/or the participant views, their interpretations and representation. The researcher will adopt various techniques to improve the research rigor. Firstly, the research will adhere to the research guidelines and ethics as prescribed. The researcher will also ensure that the findings are valid and reliable, and this will mean overcoming various challenges like consistency. The researcher will give the research adequate time and resources, seek feedback where necessary, and work within a specified framework that keeps the study focused on achieving the research objectives. The credibility of the research will be achieved through demonstrating engagement, audit of trails and the methods of observation. Sections of the recorded interviews and original field notes will feature occasionally in the report as proof of the information collected.

Dissemination of findings

The dissemination of the findings will follow a simple procedure. The researcher will first understand the audience of the findings and select the best tools and techniques for analysis and presentation that yields results understandable by the audience. The dissemination will be in the form of a research report addressed to these audiences that will highlight the aim of the research, the methods and procedures, and the results of the research.

References Al-Abri, R. (2007). Managing Change in Healthcare. Oman Medical Journal, 9-10. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3294155/ Antwi, M., & Kale, M. (2014). Change Management in Healthcare: Literature Review. Retrieved from https://smith.queensu.ca/centres/monieson/knowledge_articles/files/Change%20Management%20in%20Healthcare%20-%20Lit%20Review%20-%20AP%20FINAL.pdf Caldwell, D., Chatman, J., O'Reilly III, C., Ormiston, M., & Lapiz, M. (2008). Implementing Strategic Change in Health Care System: The Importance of Leadership and Change Readiness. Health Care Management Review, 124-133. Retrieved from http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.462.6697&rep=rep1&type=pdf Campbell, J. (2008). Change Management in Health Care. The Health Care Manager, 23-35. Retrieved from https://pdfs.semanticscholar.org/fd5c/f11e42ff1adf514014f75e65764b38207b66.pdf Ducharme, J., Buckley, J., Alder, R., & Pelletier, C. (2009). The Application of Change Management Principles to facilitate the Introduction of Nurse Practitioners and Physician Assistants into Six Ontario Emergency Departments. Healthcare Quarterly, 70-77. Retrieved from https://pdfs.semanticscholar.org/0ad7/985633b9e47ee8dc5609aa2e307f7343990d.pdf Gerhard, M. (2011). Institutional Ethnography. In C. Chapelle, & L. Harklau, The blackwell encyclopedia of applied linguistics (pp. 1-5). Malden, MA: Wiley Blackwell. Retrieved from https://people.umass.edu/~mgebhard/Gebhard%20Publication%20PDFs/2012%20-%20Institutional%20Ethnography%20-%20Ency.pdf House, R., & Aditya, R. (1997). The Social Scientific Study of Leadership: Quo Vadis? Journal of Management, 409-473. Retrieved from http://psgleadership.scripts.mit.edu/2012IAP/pdf/1_required_reading/Scientific%20views%20on%20Leadership.pdf Klein, K., Conn, A., & Sorra, J. (2001). Implementing Computerized Technology: An Organizational Analysis. Journal of Applied Psychology, 811-824. Kodama, Y., & Fukahori, H. (2017). Nurse Managers’ Attributes to Promote Change in their Wards: A Qualitative Study. Nursing Open. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/nop2.87 Kothari, C. (2004). Research Methodology: Methods and Techniques. New Delhi: New Age International (P) Ltd. Retrieved from http://www.modares.ac.ir/uploads/Agr.Oth.Lib.17.pdf Lippitt, R., Watson, J. and Westley, B. (1958). The Dynamics of Planned Change. New York: Harcourt, Brace and World. Markóczy, L. (2001). Consensus Formation During Strategic Change. Strategic Management Journal, 1013-1031. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/smj.193 Mason, J. (2002). Qualitative Researching. London: Sage. Retrieved from http://www.sxf.uevora.pt/wp-content/uploads/2013/03/Mason_2002.pdf Naidoo, L. (2012). Ethnography: An Introduction to Definition and Method. In L. Naidoo, An Ethnography of Global Landscapes and Corridors (pp. 1-8). InTech. Retrieved from http://cdn.intechopen.com/pdfs/31534/InTech-Ethnography_an_introduction_to_definition_and_method.pdf Ospina, S. (2004). Qualitative Research. In G. Goethals, G. Sorenson, & J. MacGregor, Encyclopedia of Leadership. London: Sage. Retrieved from https://ualr.edu/interdisciplinary/files/2010/03/Qualitative_Research.pdf Ramanujam, R., Keyser, D., & Sirio, C. (2005). Making a Case for Organizational Change in Patient Safety Initiatives. Advances in Patient Safety, 455-465. Retrieved from https://www.ahrq.gov/downloads/pub/advances/vol2/Ramanujam.pdf Shagrir, L. (2017). Journey to Ethnographic Research. Willian, N. (2011). Research Methods: The Basics. New York: Routledge. Retrieved from https://edisciplinas.usp.br/pluginfile.php/2317618/mod_resource/content/1/BLOCO%202_Research%20Methods%20The%20Basics.pdf