Change Management Plan - Integrated Maternity and Paediatric Care - Example

Table of Contents 1.0.Introduction 1 2.0.Change Management Plan 3 2.1.Collaborating with GP Plus Health Care Centres 3 2.2.Funding Clinicians to Work Together 4 2.3.Providing essential health care for an ageing population 5 2.3.1.Increased rehabilitation services 6 2.3.2.Better coordination of health care for the aged 7 2.4.Integrated Maternity and Paediatric Care 7 2.5.Re-train Current Workforce 8 2.6.Creating Health Learning Network 9 3.0.Reflection on the Change Management Plan and the Patient View 10 4.0.Conclusion 13 5.0.References 14 1.0. Introduction Managers confront many changes in healthcare sector. As a matter of fact, policy makers, stakeholders and decision makers describe the magnitude of changes that health care systems need as being more than large-scale transformation---a process of radical and profound that orients a given organisation into a new directions and gives it entirely different level of effectiveness. As a manager, the perception for a need of significant change is not only widespread but must be geared towards evidence based and scenarios at hand. Just like Kemp et al. (2013), note, as health care services grow in complexity and size, the number of technical and people factors that should be addressed must be done so based on the scenario so as such change(s) will be within the framework of funding and allow exponential growth. In face of the significant but innovative change management plan, theoretical underpinnings are necessary so as to reflect the fact that such plans must not only be embedded on the funding given but on workable management models. To underscore this statement, the proposal has goal oriented objective and scope; identification, with reference to the literature and theoretical frameworks, experience of decision makers from Australia and specific health related scenarios in the system, a suite of evidence-informed approaches to support transformation and or change in the health service so as it also moves away from acute care to a primary health care model (PHM). While the allocated funding should be structured to improve the health care facility, the proposal will be a good plan for quality and safety of healthcare that stretches beyond the limits of funding. That is, it articulates the vision as well as the system-wide priorities for quality and safety improvements and provides a focus for elaborated discussions, planning and evidence based actions at all levels of the health system. Consequently, as noted in Essue et al. (2013) strategic plan for health care services in Australia, the path to the highest levels of safe and high quality health care must be embedded on the views and opinion of people. It is from this perspective that the plan intends to critically reflect views of people in the change management plan(s). 2.0. Change Management Plan 2.1. Collaborating with GP Plus Health Care Centres Beginning from a wider perspective, General Practitioner (GP) Health Care Centres has been helping in taking control of the health care, stay health as well as stay out of hospital campaigns (Healy, 2011). Basing on the premise of GP Plus Health Care Centres, the current change requires the attention of the manager to ease the pressure on the available emergency sections and relieve the workload of the busy hospital-based nurses, doctors and the recently recruited allied health workers. To contextualise the essence of collaboration, Essue and Chapman (2013) describe that GP Plus Health Care Centres are the genesis of primary health care services as they have elaborative models and structures of providing assistance and advice on management of chronic diseases, support for more in-home care as well as giving guidance for health care facilities on how to keep people healthy. While collaborating with GP Plus Health Care Centres means easing the pressure on the available emergency departments within the health care, such an innovative change management plan reflects what Jan et al. (2011) term as planned and emergent change as example of change management models. Based on this model, planned change assume that, generally, the change targets within the health care will conform to management’s vision of change the structures laid to ascend to such change(s). On the other hand, emergent change looks at change as more analytical and less of prescriptive undertaking. Basically, it puts emphasis on projections of the organisation from one state to another by providing a range of alternatives for operations. The manager will be concerned with the second model as a platform; GP Plus Health Care Centres offers immediate solutions that the health care service requires. That is, the collaboration will ensure that the health care benefits from myriads of services such as; Allied health – physiotherapy, dental, occupational therapy and podiatry Chronic disease self-management programmes After-hours GP services Picking on chronic disease self-management programmes, the collaboration will ensure that the change management plan focus on a new role developed to provide assistance to patients with chronic diseases. 2.2. Funding Clinicians to Work Together Health managers have been sensitised through different programmes that introduce transformative changes in the areas managed which in turn help clinicians work together. According to Field Theory, analyzing situational change and plans to avert challenges facing an organisation or a firm must first consider the behaviours and working relationship of different behaviours with the organisation (Schofield, 2012). Therefore the changes that need to be introduced here should be premised on group dynamics which is actually a set of symbolic interactions affecting effective health care deliveries. Contextualising this theory, funding clinicians from the health care to work together with others is two-fold. First, the management will sponsor a series of Statewide Clinical Networks that are already underway in Australia. Secondly, the management will ensure that its clinicians are involved in the planning of health services with the facility. When these networks are well funded and linked, the facility will link its health service providers to other nurses, doctors, GPs, allied health professionals and community representatives which in turn will ensure that the sponsored or funded health care providers fully integrate service provision the health care sites as well as GP Plus Health Care Services. For instance, when well-funded, Cancer Clinical Network will train the facility’s clinicians on how people attending their facility can get most of cancer care near their homes. Going by the latest statistics, prevalence of chronic infections is not only affecting the health care but a problem to the all health care facilities in Australia (Australian Institute of Health and Welfare, 2012). In 2010-12, regions such as South Australia reported increased number of case of chronic infections that would otherwise be managed at home (Australian Bureau of statistics, 2012). While ABS attributed such increase on the lack of access to GP services, it remains to be understood that clinicians are not working together thus learning new ways of dealing with such infections outside the hospital. In conclusion, funding clinicians to work together has been identified as one of the critical scenario based change management plan that will improve quality and safety of the services besides reducing the length of hospital stays as it is currently witnessed to national benchmarks. Just like it has been suggested by Elshaug et al. (2012), bringing clinicians to work together will reduce challenges witnessed in the facility such as emergency department waiting periods. Taking managerial hegemony perspective to understand roles of managers in this situation, the manager has the duty of contributing towards strategy formulation of health facility in line with change management plans suggested above. 2.3. Providing essential health care for an ageing population One of the critical challenges the manager is facing is ageing population. As a matter of fact, it is a national challenge when it comes to health care service provision. Comparing the challenges with recent statistics, those with 70 years currently makes up 20-30% of the Australia with the population requiring particular health care needs (Australian Institute of Health and Welfare, 2012). In addition, this age group is responsible for about 72% of all replacements of hip as reported in most health care service, 68% of knee replacements and about 60% demand for palliative care as well as rehabilitation services (Australian Institute of Health and Welfare, 2012). Based on the statistics above and unique challenges and scenarios experienced in the health care facility, management’s plan of change will be focused on the provision of problem-based care for the older generation visiting the facility. Such focus will be funded according to the following priorities; 2.3.1. Increased rehabilitation services Australia is already having rehabilitation services like those at Hampstead Centre and RGH. According to Pettigrew’s context model of change in organization, it is impractical for managers to try and bring complete changes in their firms as witnessed elsewhere as such changes encompass incessancy and complexities that must be given considerations (Department of Human Services, 2013). Based on Pettigrew’s model of change management plan, the manager within this facility will recognized the impracticability of attempting to introduce rehabilitation centre such as Hampstead Centre and RGH with the funding available. Instead, increased rehabilitation services will increase the number of rehabilitation consultants which will also incorporate allied health staff. Also considered in the plan is to establish new training positions which in turn care for the aged recovering from conditions such major orthopaedic surgery or stroke. 2.3.2. Better coordination of health care for the aged The biggest challenge faced by the facility when dealing with the aged is that more and more aged patients have one or more chronic diseases and good number have an acute sickness of some sort. Therefore to deal with these challenges, the proposed change plan will be evidence based and refocused to implement problem oriented programmes that help the staff understand the special needs of the elderly. Secondly, better coordination of such health care will be to fund services such as those already practiced at Repatriation General Hospital (RGH), The Queen Elizabeth Hospital (TQEH) and at Lyell McEwin Hospital (LMH). That is, enhance palliative care services to make it accessible and okayfor the elderly to receive palliative care either at hospital or home. Finally, the plan expects to establish, for the first time, what has been termed as ‘Informed Choices Programme’ which will help the elderly make right care needs at the end of their life. 2.4. Integrated Maternity and Paediatric Care In the eve of modern management practices, it is required that managers put energies to ratify decisions and monitor resource utilization so as to reflect the tenets and demands of agency theory. Contextualising agency theory within this framework, there are situations where health related issues represent conditions, external to the system that compel it to initiate counter change (Schofield, 2012). At the moment, Australia has average obstetric health care as well as the lowest infant mortality (Australian Bureau of Statistics, 2012). This finding however does not reflect what the manager is currently facing at the health facility. The scenario at hand is the lack of high quality safe maternity. First, the funding should be channelled to have the health care centre adopt the working policies as practiced at Women and Children Hospital in Adelaide. Additionally, the manager intends to stock the centre with high-quality facilities as ones used at Flinders Medical Centre (FMC). The main aim of this management change plan is to cater for children with chronic illness or as often witnessed in the centre, children with non-life or short-term threatening illness. Every Chance for Every Child initiative that was introduced is the premise with which the change management plan will be based. 2.5. Re-train Current Workforce It has come to the realisation of the manager that vast majority of the acute care service providers lack the needed skills that can help it shift to the primary health care model. As it is the case on the ground, more than half the number of health workers in the centre does not have the needed skills that can help the Centre shift to primary health care model. Therefore change management plan will be tailored towards re-training its current workforce so as to confirm to modern requirements when as practiced in centres such as Repatriation General Hospital or Noarlunga Hospital. The two health facilities have been included to ascertain the fact that re-training of the workforce is based on evidence-informed change management plan. That is, workforce will be funded to train so as to understand the best and transformative practices that are needed as per the scenario as well as practices that are aligned within the context of change management theory (Schofield, 2012). Core aim of developing this change plan is to have workers who provide transformation support to primary health care practices so as to increase the number of health care deliveries within the centre. The re-training will seek to offer; Learning collaborative with other facilities such as Flinders Medical Centre Specific transformation goals and expectations Care management Monthly performance reporting and Practice reporting Beyond these outcomes, the manager will be expected to align the re-training with clinical quality improvement. According to Australian Commission on Safety and Quality in Health Care (2012) the current demand for hospital services/hospital admission has grown to about 11%. Therefore as the Centre moves from acute care to a Primary Health Care Model, the manager has the responsibility of ensuring that the re-training as a change plan result in increased capacity for care coordination, capacity for population management, a stronger sustainable infrastructure as well as larger community being served. According to David McClelland and his Acquired Needs Theory as one of the management principles, health service providers at one point will need to acquire different needs within a given period of time and this comes as a result of their life experiences (Schofield, 2012). This is one of the aspects that the manager should be aware of in the process of initiating change management plan for the Centre. That is, the manager should sensitize the workers on the need for change as such will conform to countries’ or ethics of practices as required by commissions such as the Australian Commission on Safety and Quality in Health Care (ACSQHC, 2012). 2.6. Creating Health Learning Network One of the critical impetuses that the Centre uses with regard to the available funding and specific needs of people is the report released on Western Australian Strategic Plan for Safety and Quality in Health Care 2013–2017 (Essue and Chapman, 2013). In such connectedness, creation of health learning network will be initiated as part of the innovation plan so as to improve collaboration existing between acute care, the primary care model and specialist providers. Currently, the Centre has basic infrastructure for networking but the change management plan needs to innovate a platform on which it will focus on increasing the abilities and skills of its already re-trained primary health care providers in areas such post-acute stroke management as well as management of depression which the Centre has identified as a co-morbid condition. The Centre anticipates, based on the current scenario that the learning network will form collaboration with other primary care providers. Additionally, with the network, there will be access to training programmes in specific areas as well as consultation with other providers and specialists on complicated matters thus increasing the ability of the Centre to deal with complex cases and increase access of patients to the best possible care. To underscore this statement, National Safety and Quality Health Service Standards as a Commission has recently introduced national quality accreditation and safety schemes for all health service centres and that from 1st January 2013, all centres have been required to be accredited to the Commission. It therefore remains that when such networks are formed and clearer and standardized practices are achieved, the manager will be able to acquire the accreditation. The network will also be based on the extension for community health care outcomes so as to connect specialist with community thus enhancing the ability of the Center to treat patient with chronic illness. 3.0. Reflection on the Change Management Plan and the Patient View It is certain, based on the change management plan above that Australians are worried about the out of pocket costs for health care services. For members of public affiliated with the Centre whose change management plan has been analysed or for those Australians committed to high quality, equitable and universal health systems, introduction of change management plans such as ‘Integrated Maternity and Paediatric Care’ will mean that they will have to stretch deeper so as to afford the very same services they were doing cheaply before the change management plan. To show evidence of this fear, in 2010-11 there were 735 public acute hospitals and relating the number with the 2011 National Health Reform Agreement, none of the hospitals managed to provide affordable health care to low income earners (Australian Bureau of Statistics, 2012). It there remains that the introduction of ‘Integrated Maternity and Paediatric Care’ will escalate cost of treatment owing to the fact that the Centre will be liaising with centres such as Repatriation General Hospital or Noarlunga Hospital. In respect to this, through the National Hospital Funding Authority, Australians enjoys up to 50% of the health care costs from “efficient” cost (percentage based on calculations made by Independent Hospital Pricing Authority) (Australian Bureau of Statistics, 2012). Therefore it is apparent that introduction of extended services will mean low income earners pay way beyond 50% entitled as it was before. Secondly, it is apparent, based on change management plans such as “providing essential health care for an ageing population” that older Australians are likely to pay even higher despite the fact that they could be having health insurance. The latest statistics by Australian Institute of Health and Welfare shows that older people under health insurance are likely to pay additional A$ 1,170 annually when there is reforms or introductions of policies that are likely to promote health care services they receive (Kemp et al. 2013). Additionally, Tanya Plibersek, health minister reiterated that introduction of reforms and changes in health care for the old escalate costs for the same due to high bulk billing rates of General Practitioners (GP) (Kemp et al.). This is compounded by the fact that most of care for the older individuals with long-term health conditions in Australia is taken care of by the families and relatives in as much as there is small amount of allowance to caregivers in some instance. One of the critical changes that the manager wants to introduce to the Centre as a management plan is the “Collaborating with GP Plus Health Care Centres.” This is one of the plans that will bring significant improvement to the Centre as well as providing quality health care services to the people. It is apparent that when the strategy is well explained to consumers/patients visiting, they will certainly link it to the already existing Home and Community Care (HACC) which that has been subsidizing for health related services supporting people in their homes. Additionally, Collaborating with GP Plus Health Care Centres is away through which patients see a way of budgeting in a manner that will tailor services to their specific needs. The plan has captured the need for palliative care services that will be affordable to patients. In connection to this, patients feel that the change management plans will benefit them in the sense that there is already existing programs such as National Palliative Care which funds facilities that have signed up with them who in turn benefit from palliative care access and quality. On a different note, the assessment of the change management plan as assessed is likely to make patients and consumers look at the initiative as a strategy to reduce health care disparities. Innovative plans such as health learning network is likely to give the manager and indigenous and marginalized communities closing gap when it comes to the existing health gaps. For instance, when there will be working links, there is going to be extensive training programs as well as outreach programs and services directed to people in marginalized and rural areas. In addition, integrated maternity and paediatric care is another change plan that consumers and patients will associate with low income people thus getting convinced that the change management plan has been ratified to ensure that low income families access extensive and high quality medical facilities at affordable rates. It has to be established that managers are now required by National Health Performance Authority to furnish relevant commissions and authorities with report concerning measure of access and equity including level of access of medical facilities of the indigenous and marginalized communities (Healy, 2011). It is from this basis that the study considers that people will certainly see it as a platform that brings quality and accessible medical facilities. 4.0. Conclusion This paper has succinctly elaborated a scenario based change management proposal that seeks to use the funding available with an understanding of shaping processes of changes that are likely to provide value and transformation of health services from acute care to a primary health care model. The proposals or change management plans as described above are the most promising evidence-based approaches for mobilizing and translating the available resources into the health centre that meets specific requirements of people as well as specific standard set for a primary health care model. In that regard, the plan provides an up-to-date as well as continually maintained inventory of health related approaches which is not only beyond the primary health care model but also creates a resource network that necessitate decision makers through the change management plan process. 5.0. References Australian Bureau of Statistics (2012). 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(2013) ‘impact of cost of medicines for chronic conditions on low income households in Australia’, Journal of Health Services Research and Policy 18(1):21-27. Schofield, M. (2012) ‘Quantifying the Productivity impacts of poor health and health interventions’. Medicines Australia Conference 2012: Living longer, living well. Session: Prolonging participation and promoting productivity: How do we quantify and better demonstrate the benefits of medicines for the longer term?, 24 October 2012, Sydney. Read More