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Journal of Organizational Culture, Communications and Conflict, Volume 18, Number 1, 2014

THE EMOTIONS AND COGNITIONS DURING ORGANIZATIONAL CHANGE: THE IMPORTANCE OF

THE EMOTIONAL WORK FOR LEADERS

Eleanor Lawrence, Nova Southeastern University Cynthia P. Ruppel, Nova Southeastern University Leslie C. Tworoger, Nova Southeastern University

ABSTRACT

This study looked longitudinally at both the emotional and cognitive reactions of the

hospital executive during organizational change. The study examined the cognitive and affective experiences of ten hospital executives leading and implementing organizational change initiatives over a twelve year period. Our study demonstrates that management is not a purely rational activity, and explores the emotional experience of the leader through rich empirical accounts in a change context. The results indicate that not only employees have feelings that must be expressed and not suppressed during change initiative, but also the top leaders. The findings illustrate how top leaders experience significant emotional reactions as a part of their role leading change.

This research answered a call to examine emotions during an organizational change process. This research illustrates the importance of recognizing and addressing the emotional work of the leader, particularly during times of organizational change. The research offers important considerations for those facing significant transformations. The study suggests that acknowledging and supporting the emotion work undertaken by leaders is important for the successful execution of the change initiatives. This study indicates that it is the leader who needs to be given support to express and acknowledge emotional reactions, both in terms of formal management development and organizational change training. The support is vital to retain long term commitment and motivation when implementing successive rounds of change initiatives

This study illustrates how emotion work is an integral part of the role at this level, and that the demands of performing emotion work are heightened during particular stages of the organizational change process. Understanding the impact of emotions can improve leadership during times of transition which translates into less resistance, quicker engagement, and higher commitment.

INTRODUCTION

In many arenas change is becoming a constant. McKinsey and Company reported that

approximately 70% of organizational change initiatives fail (Maurer, 2010). This suggests that due to the myriad of very public changes in the field of healthcare it provides a fertile setting for studying change efforts.

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Changes in healthcare are occurring both externally in the form of broad sweeping laws such as the Affordable Health Care Act, payment structures and focused public debate while internal pressures include budget constraints, new technologies, changing ownership and staffing issues. As one healthcare executive involved in this study stated, “Turbulence has been the norm rather than the exception over the years”. Hospital leaders today are in a unique predicament, responsible for designing, implementing, as well as, leading their employees through organizational change initiatives. The hospital industry has been struggling to keep up with the rapid-fire changes (CPP, Inc., 2004). It has been very difficult to lead a hospital and pressures on hospitals have worsened over time with no light at the end of the tunnel (2004). Legislative, demographic, and economic pressures have changed the way hospitals do business (2004). Altman and Gurvis (2006) of the Center for Creative Leadership suggested in the case of healthcare:

…leadership is the process by which groups, communities, and organizations accomplish three tasks: setting direction, creating alignment, and gaining commitment. The processes by which these leadership tasks are accomplished take many forms, ranging from individuals stepping into traditional leadership roles to leadership arising as a collective. (p. 21). William Bridges (1980), author of Managing Transitions, says, “It isn’t the changes that

do you in, it’s the transitions” (p. 3). While change is an event (a death, birth, merger, reorganization, new job, or downsizing), the human response to change is a process. Human reactions to change may include excitement, heightened emotions such as anxiety, fear and anger, as well as psychological trauma and confusion. The psychological response is a process of transition over time. People do not typically change their attitudes, beliefs, feelings and allegiances overnight; it happens gradually (Bridges, 1991).

For successful change management, emotions associated with organizational life during times of change must be emphasized rather that the “overly rational portrayal of both change management and managerial activity” (Clarke, Hope-Hailey, & Kelliher, 207, p. 92). The consequence of ignoring the emotions during change is a “one size fits all” management style that really does not facilitate effective change. Understanding the relationship between emotions and the transition can improve leadership during times of transition which translates into less resistance, quicker engagement, and higher commitment. “Implications for successful change management depend as much on the management of the transition period as its strategic formulation” (Clarke et al., 2007, p. 92).

The setting of this study is a hospital that has won many awards during this time period despite the fact that much of this time they were involved in a major change initiative while dealing with a turbulent external environment. This setting identifies the cognitions and emotions of the leaders throughout the change initiatives. Cognitions and emotions are studied through two levels of leaders, executives and directors. Their emotional perspectives during the change initiatives are very important to understand in terms of the impact on the change process and outcomes (Klarner, By, & Diefenbach, 2011). The study captures leader reactions and reflections regarding the organizational change process: beginning, midpoint, and at the twelve

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year point in time. This longitudinal view of data frames the change as a process “that unfolds repeatedly over time” (Klarner et al., 2011, p. 335). This phase analysis of organizational change may identify emotional patterns different from those obtained in response to a single change initiative (2011).

While significant literature exists on the level of the employees who are actually implementing the changes we were unable to locate a body of literature that deals with the emotions of the leaders of organizations during the change efforts. An over-rational view of both change management and leadership activity exists with little research on the emotional work of the leader within the change context (Clarke et al., 2007). This leads to the following research question:

Research Question: What were the emotions and cognitions that high level healthcare leaders experienced during repeated changes in a turbulent internal and external environment?

LITERATURE REVIEW

Brief History of the Human Aspects of Change

For many years, academics, management and organizational practitioners have hypothesized that organizational transitions follow a series of predictable patterns or stages, which, if understood, could enable leaders to more effectively and efficiently manage organizational change. There are striking similarities in the change models of the past half- century. Each model proposes predictable and sequential stages and phase and cognitive and emotional reactions. There is overlap among the theories regardless of the number of stages described. The stages in each of the models present a common and predictable pattern. Yet successful change management includes the human side, the feelings and emotions, not simply a series of linear and logical processes and activities (Clarke et al., 2007).

Lewin (1951) described the process of change as occurring in three stages: Unfreezing, Moving, and Refreezing, a sequential process through which existing systems are undone rearranged and reconstituted. Lewin’s model describes an individual’s cognitive and emotional response to change. Initially, individuals must recognize that the old system or “state” is history and reduce their attachment to doing things in a familiar way. This Unfreezing Stage challenges the status quo with different and possibly discomforting information. In the Moving Stage, new ideas, structures and systems are created, tested, and installed to replace those that existed previously. In the Refreezing Stage, new systems are accepted, refined, and operated to produce results. Elisabeth Kubler-Ross (1969), a Swiss born psychiatrist, published her seminal work on the topic, On Death and Dying, in which she outlined five commonly experienced stages for those facing death or experiencing the death of a loved one. Kubler-Ross’s grief model focuses on significant individual loss; it has been applied extensively to work-place losses. These stages include Denial and Isolation, Anger, Bargaining, Depression, and Acceptance. Denial involves activities and rituals that are reflective of life before the change occurred. People in denial refuse to believe what has happened. In Stage Two, anger, denial is replaced by feelings of anger, rage, envy, and resentment. A common question is: “Why me?” In the Bargaining stage, bargains are

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typically made with God and are attempts to postpone the inevitable. The fourth Stage, Depression, has two aspects; one related to losses in the past and one related to losses in the future. In the final stage of grief, people accept the inevitable. Kubler-Ross describes acceptance by a dying person not as a happy time, but as a time that is almost devoid of feeling. For a survivor, this is the stage in which they realize that life must go on; loss is accepted and attention is turned toward the future.

Table 1.1 LITERATURE REVIEW

Brief History of the Human-Side of Change 1947 1 Unfreezing 2 Moving 3 Refreezing

L ew

Triggered by social problem or conflict Anxiety Fear Unconscious behaviors

Changing values, attitudes, structure, feelings, behaviors Uncertainty Excitement

New support mechanisms New perspectives New status quo New identity

1969 1 Denial & Isolation 2 Anger 3 Bargaining 4 Depression 5 Acceptance

K u

b le

r- R

o ss

Believe life is as it was before loss Reenact rituals Flash-back to past experiences

Blame others or ourselves for our loss Easily agitated, emotional outbursts Making deals with ourselves or with God Feeling listless and tired Feeling guilty Feelings of being punished

For dying: Resignation, withdrawal, lack of emotion For survivors: Realization that life has to go on, acceptance of loss, new focus on future goals and activities, renewed energy

1980 1 Letting Go 2 Neutral Zone 3 New Beginnings

B ri

d g

Sadness Fright Depression Grief

High anxiety Lowered motivation Self-doubt Lowered energy Disorientation Polarization Confusion Uncertainty

New understanding New values New attitudes New identities Finality of past Risk Pressure Accountability Stress

2003

Stage 1 Acknowledging

Stage 2 Reacting

Stage 3 Investigating

Stage 4 Implementing

M u

ss el

w h

it e

& I

n g

ra m

Primarily a cognitive process. Denial, both cognitive and emotional. Show they are aware of the change, but demonstrate no emotional response.

Includes strong emotions such as anger, withdrawal, depression, and resistance. Active attempt to regain or retain past policies, duties and relationships.

Transition from a past to a future orientation Accept change on an emotional level and become more open to future possibilities. Willingness to consider future opportunities Mixture of emotions from excitement to anxiety and fear of the unknown.

Settle into a new routine Develop a level of comfort and familiarity with responsibilities. Begin the process of improvement and refinement. Transition from a more emotional orientation to a more cognitive orientation. Less emotion visible as people adjust to the change

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Bridges (1980) developed a three-stage transition model similar to Lewin’s change model. Bridges’ stages include Letting Go, the Neutral Zone, and New Beginning. Letting Go recognizes an ending and acknowledges the experience of loss. The Neutral Zone, is described as a “no man’s land” that exists between the old and new realities. The Neutral Zone is a broad category incorporating the negative emotions of resistance and the more positive emotions associated with exploration and new possibilities. People operating in this zone feel uncomfortable and emotionally awkward as they confront the unfamiliar and unknown. In this stage both danger and opportunity exist. Some people may persevere and others may abandon the situation. Only after organizations experience Letting Go and the Neutral Zone can they begin the third stage, New Beginnings. Leaders of change seem to forget that through the planning process they have already experienced their own denial and resistance and thus are ahead of the followers in the transition curve. Commitment to new beginnings comes only after they have traveled the transitory path from denial to confusion and resistance, and then to exploration and renewal.

More recently, Musselwhite and Ingram (2003) introduced a four stage model represented as: 1) Acknowledging, 2) Reacting, 3) Investigating, and 4) Implementing. Requirements for effective leadership change as people progress through the stages of transition. STAGE 1: ACKNOWLEDGING

People are shocked and feel threatened.

People deny that a change has happened.

People appear slower in their thinking, distracted, and forgetful. :

Productivity is low. STAGE 2: REACTING

People express various reactions - anger, depression, withdrawal, etc.

People try to “bargain” to do things the “old” way.

People believe they can “wait out” the change and everything will return to normal.

People recycle back to Stage 1 when their emotions are denied or ignored. STAGE 3: INVESTIGATING

People may express grief/sadness over loss, but they begin to explore the possibility of future options.

People may mix a willingness to explore new options with reservation.

Emotions can range from excitement to anxiety. STAGE 4: IMPLEMENTING

People appear ready to establish new routines, adapt to new systems, and help others learn new ways.

Comfort with the change engenders more flexibility, creativity, and risk taking on the job.

The change is not viewed as a “change” but “the way we do things around here.”

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To acknowledge change, people need information. Reacting to change, people need

support. Emotions should be acknowledged, accepted and respected. When people begin to enter the Investigative stage of transition, the leadership imperative becomes to provide information. As people enter the last stage of transition, Implementing, the leadership imperative becomes reinforcement. People are actively implementing new ideas, systems and projects and need reinforcement for their initiative and successes.t is common for leaders to expect people to jump in at the stages of investigating and implementing, and to avoid the emotional negative part of transition – reacting. Reacting is viewed as not accepting or supporting the change. In reality, change efforts are often disrupted and delayed by uninformed efforts to move right to the latter stages of transition. Leaders of change seem to forget that through the development and planning process they have already experienced their own denial and resistance and thus are ahead of the troops in the transition curve (Musselwhite & Ingram, 2003). To obtain commitment to new beginnings arrives after the journey through the stages from denial to confusion and resistance, and then to exploration and renewal.

Healthcare Change --Environmental Turbulence

Significant changes are occurring in the healthcare industry. Hospitals are clustering into multi-institutional groupings, the population is aging, and Americans are spending more on healthcare (Berman, Naik, & Winslow, 2006). Hospitals are experiencing dramatically increasing debt and expense at the same time that inpatient admissions and government and private insurance reimbursement are declining (2006). Healthcare leaders face major internal and external demands for change complicated by the structure of the healthcare industry itself (Fairfield & Wagner, 2004). Leadership in healthcare demands a response to these rapidly changing conditions. Society expects hospital executives to develop new strategies for growing admissions, achieving higher patient care standards, and reducing expenditures in the midst of financial and insurance coverage declines (Berman et al., 2006).

The U.S. health care delivery system is on the verge of reform yet again. Reimbursement and care delivery models are poised for significant overhaul with the goal of improving the quality, safety and efficiency of care. Healthcare organizations are preparing for changes under health care reform, meaningful use requirements and awaiting the decision of the Supreme Court regarding the Affordable Healthcare Act. Healthcare leaders know all about dealing with change, they must adapt on the individual, organizational, and industry levels just to survive. Is this becoming a class six rapid—one that is unnavigable?

Altman and Gurvis (2006) remark, “One does not have to be a medical expert to know that the healthcare system in the United States is unequivocally broken and broke” (p. 19). Issues of access and affordability place the industry directly in the midst of the current political debate. The healthcare system is likely to remain broken without leaders who are courageous, visionary, charismatic, and skilled in dealing with complex organizational change (2006). Altman and Gurvis (2006) suggest the following:

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The system will not be healed without excellent individual and collective leadership. Strong, capable individual leaders who are courageous, visionary, charismatic, and skilled will be needed. However, it will take a lot more than heroic individual efforts to make significant headway with this vexing and complex challenge. Our belief is that the development of leadership talent and of processes that support collective leadership is part of the solution. (p. 20) Healthcare organizations are experiencing a demand to transform to meet the

expectations of society, consumers, and governmental agencies, and to incorporate the latest advances in technology (Berman et al., 2006). Intense competition, reductions in reimbursement, mergers, and requirements to restructure and re-engineer for cost efficiency have exerted enormous pressure on healthcare organizations (Cunningham, 2002). As the magnitude and rate of change are predicted to accelerate, organizations must be able to successfully anticipate and manage their approach and process to change (Greiner, Cummings, & Bhambri, 2003). Attempting radical change is a complex endeavor as it involves the “transformation of the organization” (Greenwood & Hinings, 1996, p. 1023), much like the one undertaken in this study.

In the case of the hospital that is the subject of this longitudinal action research study, the CEO and his team was attempting a radical planned change by moving from private ownership to public then to investor owned and then returned to publicly owned during the twelve year period of this study. These changes were brought about by both internal forces and by external market conditions. As a part of an annual review process the management team participated in a survey which in part questioned their perception of the external environment. The tables below are the result of that survey with a 76% response rate of hospital executives and managers concerning the external healthcare environment. The results suggest that the executives feel the future holds increasing difficulty arising from the external environment. Over twice as many respondents expect the difficulty to be extreme in the next 5 years versus the page five years.

Over the past five years, the external healthcare market in your area has been:

Executive Level

Very Easy (1) Easy (2) Normal (3) Difficult (4) Very Difficult (5)

Senior leader 2 4 1

Physician 2 3

Director 3 11 3

Manager 1 2 5 4

Total 1 0 7 18 8

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Over the next five years, the external healthcare market in your areas will be:

Executive Level

Very easy (1) Easy (2) Normal (3) Difficult (4) Very Difficult (5)

Senior leader 2 5

Physician 4 1

Director 2 5 11

Manager 1 5 6

Total 0 0 2 13 19

METHODOLOGY Instruments

“Action research provides rich opportunity to bridge the gap between theory and practice”(Mathiassen, Chiasson, & Germonprez, 2012, p. 347). The data were collected from an open ended semi structured survey comprised of nine questions that was part of one of the researchers working with the organization to learn from the change experience. The questions were designed to solicit cognitive and emotional responses to sequential and continuous change at the beginning, midpoint, and ten year phases. Participation was voluntary and was solicited by and returned to one of the researchers.

A copy of the survey questions can be found in Appendix A. In addition, the Change Style Indicator (CSI) assessment results, identifying each participant’s preference for approaching change, were also made available to the researchers to further validate the findings. The Change Style Preferences of the executives studied can be found in Appendix B.

Sample

The survey was administered to ten hospital executives to obtain their perspective as stakeholders during a change initiative that occurring over a twelve year period.

Table 1.2.

METHODOLOGY Sample Demographics

Participants: 10 Gender: Male (4) Female (6) Education Level: Bachelors (3) Masters (5) Doctoral (2) Years of Service <5 (0) 6-10 (4) 11-20 (3) >20 (3)

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Data Analysis

Content analysis was used analyze the survey responses to identify the stages of change based on the affective and cognitive comments. Content analysis provides insight into complex models of human thought and language (Krippendorf, 1980). Content analysis is suited to describe attitudinal and behavioral response and to determine psychological or emotional state of persons or groups (1980). Musslewhite and Ingram’s (2003) Model of Change was the primary framework utilized to examine the affective and cognitive responses to the survey questions. Appendix D contains the content analysis for each participant. A frequency count was performed to further categorize the type of affective and cognitive responses contained in Appendix E.

Organizational change causes individuals to experience a reaction process consisting of four phases, namely: initial denial, resistance, gradual exploration, and eventual commitment. Resistance is a natural and normal response to change because change often involves going from the known to the unknown. Not only do individuals experience change in a different ways, they also differ in their ability and willingness to adapt to change (Bovey & Hede, 2001). The executives reflected on their expectations and fears when embarking on the change initiative 12 years before. This is the environment that the CEO walked into when he began his job which involved a massive change effort.

DISCUSSION

The model to code the survey responses of the participants demonstrates the range of emotional and cognitive reactions over the longitudinal study. Both the Musselewhite and Ingram 2003 model of change reactions as shown in Table 1.1 and the results of the coding of the numbered quotations below the table can be found in Table 1.3 which is shown below.

Table 1.3 RESULTS

Applying Musselewhite & Ingram Model (2003) Change Reactions 2003

Stage 1 Acknowledging

Stage 2 Reacting

Stage 3 Investigating

Stage 4 Implementing

M u

ss el

w h

it e

& I

n g

ra m

Primarily a cognitive process. Denial, both cognitive and emotional. Show they are aware of the change, but demonstrate no emotional response.

Includes strong emotions such as anger, withdrawal, depression, and resistance. Active attempt to regain or retain past policies, duties and relationships.

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B eh

av io

People are shocked and feel threatened. People deny that a change has happened. People appear slower in their thinking, distracted, and forgetful. Productivity is low.

People express various reactions - anger, depression, withdrawal, etc. People try to “bargain” to do things the “old” way. People believe they can “wait out” the change and everything will return to normal. People recycle back to Stage 1 when their emotions are denied or ignored.

People may express grief/sadness over loss, but they begin to explore the possibility of future options. People may mix a willingness to explore new options with reservation. Emotions may range from excitement to sadness

People appear ready to establish new routines, adapt to new systems, and help others learn new ways. Comfort with the change engenders more flexibility, creativity, and risk taking on the job. The change is not viewed as a “change” but “the way we do things around her

C o

d in

F re

q u

en cy

y V

er b

a ti

1 2 4 7

3 5 6 8 9 10 11

12 17 18 19 20

13 14 15 16 22 23 24 25

26 27 28 29 30 31

This survey qualitative data draws on a series of survey questions answered by the

leaders (Appendix A), which was carried out as part of an in-depth, longitudinal study of an organization undergoing major change. The data reflects the stages associated with organizational change. Research involving longitudinal data in the area of work emotion is not common, and we proffer that this aspect of our study is of great value. Executives were held accountable for the delivery of organizational change and performance outcomes at the same time expected to lead their teams through the psychological process of transitioning, and potentially experiencing the pain of personal change themselves (Clarke et al., 2007).

1. The change initiative actually goes back even longer than 10 years. The process started in 1997 when [the CEO came to the hospital]. The climate within the hospital was a chaotic one. There was a lot of nervousness among the management group. A consultant was brought in during the year prior to [CEO’s] arrival and had administered some kind of standardized tool with the leadership group to look at leadership effectiveness. Paranoia existed in that some individuals felt that this was an attempt at profiling and that the results would be used to determine who should stay and who should go.

Beginning his tenure at CEO with this environment would naturally raise the level of

emotion when embarking on these changes. As the CEO reflected upon the beginning of his tenure he recalls:

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2. There was a whole lot of personal second guessing. … I was concerned I would be embarrassed by my peers; boss, etc. that they would order me to stop, perhaps terminate me based on doing this. (CEO)

The emotions of the existing top management people reflected a mixture of the fears

expressed earlier as well as those that they experienced when the change initiative was announced as well as the team-based design of the change initiative. When asked what their greatest fears were they suggested the following:

3. I think at first we thought (CEO) was crazy. I was excited and felt empowered. I was afraid of anything new, and afraid of putting myself “out there” into new roles and responsibilities. (CNO)

4. I was overwhelmed. I was frustrated with my team mates and inability to drive decisions

and action. (Ethics and Compliance Officer)

5. That I might fail or be unable to meet the challenges ahead. The fact that my colleagues supported the change was motivating. (former COO promoted to corporate)

6. My biggest fear during this time was a fear of failure and a fear that I was not prepared.

Being new in my position and on a steep learning curve, my worries were more for my own performance than for changes on the horizon.

7. I was afraid to be directive, give feedback or consistently challenge dysfunctional behaviors. I wasn’t sure that our leaders were willing to invest the energy and time that would be necessary to achieve the vision. (AVP-Operations)

8. Actually I did not understand just how powerful this was going to be. I felt

uncomfortable with some of this but forged ahead and glad I did. I am so proud of what have accomplished thus far and looking forward to what we will accomplish in the future. (CFO)

9. Was told to join a team [and] that was the biggest stretch for me. Also would be working

with leaders that I didn't necessarily know very well. (AVP-Nursing)

10. I think my fear is that – and continues to be – that it is seen as a burden rather than an opportunity. I have those private thoughts and emotions sometimes too. (current COO)

11. My biggest fear during this time was a fear of failure and a fear that I was not prepared.

Being new in my position and on a steep learning curve, my worries were more for my own performance than for changes on the horizon. (Director-Rehab)

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These top executives were asked to reflect on their expectations and feelings five years into the change process and the executives recalled having the following thoughts and emotions. It appears they can reflect on the cognitive lessons learned more than their emotions at the time:

12. There were moments of immense pride, and certainly times are tremendous anxiety. Organization change could use a better PR firm! (CEO)

13. …my expectations changed. I understood more about the importance of culture, vision,

and values. Of always doing what is “right”. Experience is the greatest teacher and doing things wrong under the guidance of someone like our CEO is powerful. Getting it right is sweeter after you get it wrong. (CNO)

14. So my perspective changed a lot, and so too my expectations. I was pushing harder. In a

position where I could challenge my peers more. I felt a lot more personal responsibility for forward movement not only of the teams by of the functioning of the leadership team as a whole. (Ethics and Compliance Officer)

15. My expectations for the timing and progression changed. This would be a marathon, not

a sprint. We would need to learn how to train differently, pace differently and sustain differently. The expectations for end result remained the same. ((AVP Operations)

16. [CEO] could accurately perceive when the troops were not aligned and was very skilled

at getting the team back on track.

17. When we were stressed and quit talking about the vision, I was concerned that we would lose sight of the vision.

18. Taking two steps forward and one step back can be unsettling at best.

19. Team meetings and preparation for the Advance all seemed a little over kill to me and then after I saw some of the progress we were making that all went away. (AVP-Ops)

20. For me personally being on a team and especially in a leadership role was

empowering… Many have viewed (and some still do) team membership as a second job they don't have time for.(AVP- Nursing)

21. I have not had doubts of the success of the project but have had doubts about whether or

not “the right people are on the bus”.

22. Creating an atmosphere where people are not afraid to make mistakes, take risks, offer an honest opinion, or provide feedback.

Because of the constant change experienced by this organization, the leaders we asked to

discuss what sustained them during the process.

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23. It was incredibly lonely at times… helped me understand humility and truly challenged me to be someone that I am proud to be. I felt that the process was truly a gift for me…the feedback is a gift that has truly been special. To know that you can influence others in a positive way has been an incredible gift. (CEO)

24. I have always been given opportunities to learn something new, expand my horizons, take risks, and make a difference. I am proud of our hospital, our staff, our physicians, and the care we give to our community (CNO).

25. My sense of the community that is [the hospital] (employees, physicians, volunteers) is something that I value greatly. (Ethics and Compliance Officer)

26. I became emotional reading the M&V statement quoted in your article… I remember

sitting in the [name omitted] with [name omitted] when he wrote this on a napkin. It was the foundation for my actions every single day. (COO)

27. [The CEO’s] commitment, feedback and challenges along with his belief in me and my

potential for change personally and within the organization.(AVP-Ops) 28. One of the things that sustained me is that I believe in the organization and in our

mission and values. But I stay because I love the organization and what I do. I love to see the successes and truly believe that I am a contributor to those successes.(VPHR)

29. My values and that of my team were aligned---do the right thing for the patient…I could

not go anywhere else and do more for my patients (CFO) 30. Mostly there is great satisfaction when you perform well in the eyes of your customer

(AVP-Nursing) 31. The factors that have sustained me over time include: the support of the executive team

and the collegiality with medical staff and peer group, the culture, history and values of the institution, the emphasis on learning and improving performance, the focus on quality patient care, the idea that we will always take the high road, the opportunity to be creative, the opportunity to make a difference. (Director, Rehabilitation Services)

PROJECT SUCCESSES

We were able to validate the perception of success of the change effort we studied both internally and external validation includes recently being selected as one of the 25 best hospitals to work for by HealthCareExecutive.com as well as one of the top 100 hospitals by Thomson Reuters in 2010. In September 2012 the hospital was named as one of the nation’s top performers on key quality metrics in 2011 by The Joint Commission, a leading accreditor of healthcare organizations in the United States (www.jointcommision.org). This hospital is one of

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only 244 hospitals that achieved this distinction two years in a row. This accomplishment is impressive given that “The Joint Commission accredits and certifies more than 19,000 health care organizations and programs in the United States.” (http://www.jointcommission.org/about_us/about_the_joint_commission_main.aspx)

Internally we asked the top level leaders whether they perceived the project as a success. The CIO responded, There were some parts of the change that are continuing in ways I never dreamed of. Interestingly, another top level executive stated: I don’t think I pictured a “change project” at all. For a long time, it felt like it was just how things were done at [hospital name]. This suggests that it has been very successful in that it has changed the culture at this point. This building of a culture to support the hospital vision was echoed by another top executive. Two of the executives were proud of the improvement and the external recognition; however it appears the continuous improvement focus remains as they responded;

I do think it continues to be a work in progress because the definition of success is ever- changing and in some ways a moving target. This makes it hard to say that we have exceeded expectations because there is always something more to be done. Overall, I believe we have done a good job of holding to our vision and staying focused on the model that we believe will bring the success. Two of the remaining respondents indicated that the effort had exceeded expectations

while one reported that it had met expectations and again noted that the changes had now become part of the culture. This suggests that the refreezing step has been accomplished successfully by the top managers we studied. Therefore we consider this a successful project as measured both internally and externally and an appropriate setting in which to study this successful change initiative. Limitations

This research has limitations in that the data was collected at one point in time and we asked the respondents to reflect on how they felt at different points during the 12 year change process. There is the possibility that they are not remembering specific time points accurately. The results may not be generalizable beyond a similar service organization in that this highly educated leadership team recognized felt a higher calling and responsibility to the patient and their well-being. Given the limitations, it would still appear from this action research study that recognizing that not only employees have feeling that must be dealt with during change, but also the top leaders, who are designing and implementing the change, have emotions and cognitions that should be recognized and addressed.

FUTURE RESEARCH

Further, exploring a leader’s change style type and preference for approaching change

may contribute to a more precise understanding one’s natural approach in these circumstances.

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Further research could also include the ways that emotion work can add to the organizational toolbox in terms of facilitating change.

CONCLUSIONS

This research answered a call by Klarner, By, and Diefenbach (2011) to “examine the

unfolding and outcomes of emotions during an organizational change process” (p. 336). The reflections offered by the top management team about their cognitions and emotions during a 12 year change initiative demonstrated that though this team was charged with designing and leading a massive change effort, they had very real doubts and fears throughout. This change process felt, to at least one leader, like “a slog through the mud” at times and they found it was emotionally charged. Most respondents noted that the mission, vision and the higher calling of their profession, that of providing excellent care for their patients, sustained them and kept them moving forward. Many noted that the leadership from the top was critical in keeping the management team motivated and focused and that seeing real progress and improvement further fueled their efforts.

The research offers important considerations for those facing significant transformations. The study suggests that acknowledging and supporting the emotion work undertaken by leaders is important for the successful execution of the change initiatives. This study indicates that it is the leader who needs to be given support to express and acknowledge emotional reactions, both in terms of formal management development and organizational change training. The support is vital to retain long term commitment and motivation when implementing successive rounds of change initiatives.

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Appendix A

Relevant Survey Questions

1. As you remember, when you embarked on this change initiative 10 years ago, what were your expectations? What were your fears? Your hopes for the change? What were your private thoughts and emotions regarding the change?

2. Once again, thinking back to the midpoint in the process (5 years in to the change effort), had your expectations changed from those you started with? How? Why?

3. At any point in time did you have doubts or questions about the success of the project? When? Why? What issues arose? How were they resolved?

4. When you initially pictured a “successful change project”, have you fallen short of that picture? Met it? Or exceeded expectations? Why? What were key factors?

5. What personally sustained you during the change effort and facilitated your decision to stay in the organization?

Appendix B Change Style Indicator Type: Survey Participants

CSI -2008 Initials CSI TYPE

CONSERVER C

PRAGMATIST P ORIGINATOR O

KFA O Mod O

LWB P Slight

EFC C Slight C

IMD C Mod C

RCE C Slight C

CMF P Slight

JMG C Mod C

LJH C Mod C

SHI P Slight

BHJ O Slight

TOTAL 5 3 2

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