Strategic Change Management in Larnaca General Hospital - Assignment Example

Strategic Change Management in Larnaca General Hospital Larnaca General Hospital The Larnaca General Hospital is renowned health care unit of Cyprus. The hospital was established in the year 1984 (Larnaca General Hospital, 2012). The hospital has been built upon the land which belongs to the “Church Committee of the Monastery of St. George Kontos”. Church committee donated the land to hospital authority during early 1980’s. Ministry of Health provided donation to hospital authority in order to build the health care unit. The hospital was opened on 24th April 1985 by Spyros Kyprianou (former president of Cyprus during that time). Funding Situation Various non profit organizations such as Anti-Cancer Society of Cyprus and Cyprus Association of Cancer Patients and Ministry of Health will provide fund for breast health centre of Larnaca general hospital. There will not be any other stakeholders except mentioned non profit organizations. Mission Statement In accordance with the Directorate of Nursing Services the hospital strives for improving nursing care continuously. According to directorate they need constructive cooperation as well as participation from nurses during difficult and complex healthcare situation in order to achieve the mission objective. Change Situation Breast Health Center Breast cancer has emerged as pernicious disease for women in last fifteen years and statistics show that in the country of Cyprus number of women affected by breast cancer has been increased sharply in recent times. There are three major cancer prevention initiatives such as Anti-Cancer society, Cyprus Association of Cancer Patients and Friends are present in the country. In the district of Larnaca there are no special centres for observing initial symptoms of breast cancer although it is a way to prevent the disease in early stages. It is very hard to find accurate and valid health care data of the Cypriot population due to strict government rules. Report published by CYSTAT or Statistical Service of Cyprus shows that number of women death due to breast cancer is relatively high in contrast to other diseases. Statistical report shows that more than 32% of women are suffering from breast cancers. The following diagram can be used in order to understand severity of breast cancer in the country. (Source: Golna et al., 2004) The Larnaca General Hospital needs to establish breast health centre in order to reduce stress and nervousness associated with preliminary stages of breast cancer. Study shows that 1109 Cypriot women were diagnosed with breast cancer during the time period of 1999-2005. Study also shows that yearly 400 cases of breast cancer are reported by women while 90% of cases get registered by hospital officials. Although cancer patients receive treatment from Bank of Cyprus Oncology Centre of Nicosia but very few people in Larnaca district have the access to such facilities. Statistical study of propensity of breast cancer among women can be summarized in the following manner. (Source: Hadjisavvas et al., 2010) Larnaca General Hospital needs to establish following specifications in order to bring the change in existing healthcare system. Mammogram facility for women will help them go to next phase of radiology without much complexity. Genetic Advisory Services can be created in order to communicate genetics of cancer to public. A separate laboratory part will be created for various issues such as genetic analysis, controlling surveillance programmes and therapeutic interventions in terms of specific genetic carriers (Ministry of Health, 2009). Professional cancer consultant will be there in order to explain risk factors associated with breast cancer to women while recruiting psychologist will help women to stay mentally strong during the operation period. Special committee will be formed in order to report women with breast problems. Area for the breast health centre should be more than 2000 square foot in order to create a spacious environment for patients. Larnaca General Hospital needs to create various strategic blocks such as patient consultation rooms, radiology reading room, mammography test room, operation theatre and waiting cubicles for family members of patient as a part of the change process. The hospital authority needs to connect various services in order to ease the process of breast cancer detection and treatment. In this situation hospital authority needs to appoint at least one navigator staff who will help patients to walk through the process. Change Statement Larnaca General Hospital will offer only breast cancer surgery but not prevention or observation of other breast problems. Long term targets of the change can be mentioned in the following manner. Targets Developing Palliative Care service for patients Developing the nursing community services in order to provide palliative medicine support to cancer patients on the basis of pancyprian scale Establishing infrastructural support for cancer patients’ re-integration Setting up quality control indicator for Re-integration, Diagnosis, Prevention and Therapy Creating integrated surveillance facility such as Bio-monitoring Nature of Change Required TROPICS Test TROPICS test can be used to analyze the nature of change required by Larnaca General Hospital in order to open breast health centre (Paton, and McCalman, 2008, p. 26). TROPIC can be done in the following manner. Consideration Hard, well defined issues Soft, people focused issues Timescale Although the need of creating breast health centre is important but there is no emergency to create it immediately. Recourses The hospital lacks in technical equipments required to provide healthcare service to breast cancer operation. Objectives Diversifying service portfolio and providing health care solution to women suffering from breast cancer. Perception Transparent communication is needed among personnel concerned in the project. Interest Improving social relevance in front of non-profit organizations and get financial aid. Control Overall project needs to be definite and clear with project management team. Source Report published by CYSTAT shows that breast cancer among women is a major health concern for the country. Conclusions from the Test The project is necessary for management Significant opportunities exist for management to explore into new segment Further work is needed in order to synchronize individual objectives with project team Although the need for establishing breast healthcare unit is not urgent but the project should be started within next 18months Further work is needed to sell the concept to change agents such as doctors, nurses and Healthcare supervisors Force Field Analysis An arbitrary scale of five has been taken by the report to do force field analysis. Force field analysis will help the study to move further (Daft, and Marcic, 2010, pp. 277-278). Strength Scale Driving Forces Restraining Forces Strength Scale Breast health centre will increase efficiency of the hospital manifold hence strength is as high as 4 out of 5. Increasing efficiency Capital Investment Larnaca General Hospital already has radiology department hence at the initial phase capital investment is low. Hence strength is low as 3 out of 5. Statistical data shows that demand for breast centre is high in the district of Larnaca hence strength is high as 4 out of 5. Customer Demand Fear for Change Fear factor is low among staffs because establishment of new breast health division will not affect their job security. Hence strength is low as 2 out of 5. Individual supervisors will be assigned for the project in order to build trust factor hence strength is as low as 3 out of 5. Trust in Supervisor Lack of Training Change agents might think that they will not be provided sufficient training in order to deal with breast cancer related issues. Proper training program can resolve such issues regarding change. Hence strength is significant as 4 out of 5. Total 11 9 Above analysis shows that total points assigned on driving forces exceeds points assigned to restraining forces. This means proposed change can be passed in general circumstances. Leavitt Model In 1973, Leavitt et al proposed a model for change management. The model can be used in order to understand focus of the change management process (Burke, 2010, pp. 193-195). Structure of the Organization Larnaca General Hospital follows layered management structure for maintaining daily activities. Careful observations show that mix of authoritarian style and democratic style is characteristics of management. Authoritarian approach will prevent individual staff to take any change initiatives. The management has appointed project managers in order to evaluate potentiality of opening breast health centre. Democratic nature of management will help to form team of change agents to guide other staff of the hospital. Technology Although Larnaca General Hospital has radiology departments but they still need to purchase state of art technologies such as mammogram facility, external beam therapy, Brach therapy and others to achieve potential functionality. People Certain changes in terms of value, attitude and motives are needed for nurses, doctors and staffs in order to satisfy requirement of women suffering from breast related problems. Task Special training is needed for staffs handling breast health centre. Task regarding handling technical equipments, conducting critical tests and others should be assigned to responsible staff. Designing Strategy In 1995, Nadler and Tushman have identified two different aspects of change management and those aspects are mentioned in the following diagram (Kotter, 1995). . (Source: Upetd, 2003) Problem of Larnaca General Hospital can be categorised in the subsystem of adaptation because they are basically adapting new technologies and ideas in response to external environment. The study will use four models of change management in order to satisfy all the requirements extensively. Perpetual Transition Management Model Trigger Layer Data published by CYSTAT or Statistical Service of Cyprus shows that cases of breast cancer are growing at significant number in recent years. Study also shows that in the district of Larnaca number of breast health centres is negligible. Larnaca General Hospital has the opportunity to achieve service diversification by opening breast health centre in near future. Threat of low return on investment in the initial phase must be considered by hospital authority. Vision Layer In future the hospital needs to communicate about their breast health centre to public with the help of print media. Public relationship activities can also be done to promote the breast health centre. The hospital authority needs to use state of art technologies such as mammogram facility, External Beam Therapy, Brach therapy in order to differentiate with competitors. Conversion Layer The hospital needs to build technical support team and panel of doctors specialize in breast cancer in order to decrease complexity of change management process. Maintenance and Renewal Layer Changing the attitude of staffs, nurses and doctors responsible for breast health division is needed in order to sustain the change. Project managers need to monitor change agent’s activity in periodic basis in order to control the process. (Source: Buchanen, and McCalman, 1989, p. 198) Organizational Development Model Unfreeze - Creation of Motivation to Change The following guidelines are needed to be followed in order to unfreeze organizational system of Larnaca General Hospital. Identifying problems regarding behaviour of staff, nurses and doctors which can create obstacle for change management process in future. Management needs to create anxiety among staffs in order to motivate them to participate in change management process. Knowledge session for employees needed to design in order to provide them information about breast cancer. Change - Adjusting the Equilibrium The following guidelines are needed to be followed in order to adjust equilibrium of organizational system of Larnaca General Hospital. Sense of urgency about creating breast health centre is needed to be established among staffs of the hospital A strong guiding team complemented by doctors, nurses, staffs, technical supervisors and breast cancer specialists are needed to be created Short term objectives such as building patient care unit in six months, learning various types of breast related diseases within three months are needed to be created in order to achieve long term results Empowerment of staffs to take decision by their own during contingency period is need to justify objective of change management Within a period of 18 months the breast health centre should start operation in order to give sufficient time for change institutionalization process Refreeze - Making Routine The company needs to include new rules, reward schemes and incentive plans to motivate doctors, staffs and nurses to perform periodically in order to sustain the effect of change management. The Interventionist Strategy Model (ISM) ISM or Interventionist Strategy Model can be used as a part of system theory in order to create step wise model of change management (Sharma, 2006, pp. 42-52). Steps are explained in the following piece of work. Problem Specification Larnaca General Hospital needs to open breast health centre in order to provide solution to women suffering from breast cancer Although the hospital has radiology departments but they need to install latest equipments to open breast health centre. The hospital needs to hire doctors having expertise in breast cancer and technical advisors for breast cancer tests in order to start operating. They need to change behaviour of staffs in accordance to requirement of breast cancer patients. Formulation The project needs to be completed within 18 months. In the first 12 months building blocks such as patient consultation rooms, radiology reading room, mammography test room, operation theatre and waiting cubicles are needed to be developed and in the next six months training regarding new equipments should be given to hospital staffs. Change management steps should be defined to stakeholders with the help of diagrammatic explanations. Performance Indicators Annual project cost in terms of return on investment, cost benefit analysis is needed to be measured financially Balance score card method will be applied to measure performance of nurses, staffs and doctors. Patient satisfaction rate should be used in order to measure individual performance. Generation of Options Weekly meeting between staffs and management is needed during the change management process in order to generate options for the hospital. Brainstorming can be a potential way to generate ideas for the management to increase delivery efficiency in near future. Weekly knowledge session regarding importance of breast health centre and cancer related issues of breast are needed to be discussed with staffs Appropriate Evaluation Technique Physical and computer simulation technique should be designed in order to examine ongoing change management function and their impact on overall system Network analysis is needed to be used in order to measure time scale and resource availability of the project Finally detailed financial analysis in terms of cash flow statement, sensitivity method, cost benefit method and ratio calculation is needed to identify appropriate strategy to accomplish the project successfully (Johann, 2008, pp. 16-18) Option Evaluation Balance scorecard should be used to evaluate financial and non financial options for the hospital. KPI model of option evaluation focuses on measuring performances critical to short term and long term business objectives for the organization (Parmenter, 2011, p. 3-15). The hospital management can use the tool in the following manner to evaluate options. Key Result Indicator (KRI)- 10 How the Larnaca General Hospital responded in previous problems Performance Indicator (PI)- 80 What should Larnaca General Hospital do to solve the current problem Key Performance Indicator (KPI)- 10 How to increase future performance of the breast health centre Implementation Phase The hospital should start breast health centre in pilot phase and based on the result of pilot phase they should decide future strategy. During the pilot phase authority of the hospital has the opportunity to review of the change management process. Proper training should be given to staffs for handling equipments and patient related issues during pilot phase. Pilot phase implementation should be done for only three months in order to prevent further delay of full project implementation. Consolidation It takes time for a new system to be well accepted among all the staffs. Project managers, management teams and change agents are needed to work for additional six months after the 18 months long change implementation process gets completed in order to achieve sustainability (Wilson, 1992, pp. 48-51). Total Project Management Project Definition This phase is similar to ISM hence management of hospital needs to define project objective among staffs. Team building guideline such as number of members required in steering committee, number of specialist doctors required in training process will be discussed in this phase. Planning Project team for developing breast health centre will be of twelve members among which three of them will be doctors having specialized knowledge about breast problems. Change agents will be divided in to three sub groups working under the supervision of project management team. Full project team will decide performance indicators for change agents in order to motivate them to perform well. Implementation Similar to ISM, this model should be implemented in pilot phase in the initial process. During the implementation phase each actors of change management should act together in order to make the event successful. Constant monitoring and correcting flaws are required during implementation phase to create a sustainable change management model. Creation of Support Team Following steps are needed in order to create strong cancer support team. Creation of the Committee A specialized committee will be created in order to report various issues. Those issues can be clarified in the following manner. Number of women diagnosed with breast cancer and examined by doctors every month Number of operations being done by doctors every month Total examination time for each patients A separate dashboard is needed to be created in order to monitor health condition of patient before the operation and health condition after operation The committee will send compiled report to Ministry of Health of the country for every month. They will send report on last working day of every month. Learning Organization-Resistance to Change Learning organization concept has been used by many management research scholars to distinguish between successful and failed organizations. In accordance to research scholars learning organizations can be classified as foundations giving importance on acquiring or creating and transferring information and knowledge among change agents (Garvin, 1993, p. 81). Systematic Learning- Senge Model Personal Mastery Hospital authority needs to motivate change agents to use personal mastery in order to achieve individual objectives. Creative tension between reality and vision statement is needed to be managed by hospital authority. Mental Models Top level management of the hospital needs to understand stringent perception of employees complemented by past experience. Building Shared Vision A common vision statement for change agents is needed to be created by hospital authority in order to fillip collective capability. Creating a common vision for all will trigger greater commitment and higher degree of ownership among change agents. Team Learning Hospital authority needs to focus on generating power of collective thinking by gathering likeminded change agents in a team. Likeminded group members will listen to each other without getting involved in confirmation bias. Conclusion and Recommendation It is evident from above study that the Project committee needs to supervise following issues. Determining specific initiatives to achieve target statement Detailed costing and budgeting of the project Supervisors need to evaluate the evaluation phase of the project Following recommendations are needed to be taken into account during change management for the Larnaca General hospital. They need to set regional oncology centre for patients within next five years The hospital needs to create health care facilities such as palliative care and monitoring after therapy (Knapp, Madden, and Kerry, 2012, p. 144) Incentives and scholarships should be provided to surgeons specialise in oncology surgery. References Buchanen, D. A. and McCalman, J., 1989. High Performance Work Systems: The Digital Experience. London: Routledge. Burke, W. W., 2010. Organization Change: Theory and Practice. Thousand Oaks, California: SAGE. Daft, R. L. and Marcic, D., 2010. Understanding Management. Stamford, Connecticut: Cengage Learning. Garvin, D. A., 1993. Building a Learning Organization. Harvard: Harvard Business Review. Golna, C. et al., 2004. Health Care Systems in Transition. [pdf] Available at: [Accessed 5 November 2012]. Hadjisavvas, A et al., 2010. An Investigation of Breast Cancer Risk Factors in Cyprus: A Case Control Study. [online] Available at: [Accessed 9 November 2012]. Johann, R., 2008. The Free Cash Flow Approach: Firm Valuation Using a DCF-Method and WACC. Munich: GRIN Verlag. Knapp, C., Madden, V. and Kerry, S. F., 2012. Pediatric Palliative Care: Global Perspectives. Berlin: Springer. Kotter, J. P., 1995. Leading Change: Why Transformation Efforts Fail. [pdf] Available at: [Accessed 5 November 2012]. Larnaca General Hospital., 2012. History. [online] Available at: [Accessed 12 November 2012]. Ministry of Health., 2009. National Cancer Control Strategy. [pdf] Available at: [Accessed 9 November 2012]. Parmenter, D., 2011. Key Performance Indicators: Developing, Implementing, and Using Winning KPIs. Hoboken, New Jersey: John Wiley & Sons. Paton, R. A. and McCalman, J., 2008. Change Management: A Guide to Effective Implementation. Thousand Oaks, California: SAGE. Sharma, R. R., 2006. Change Management. New York: McGraw-Hill Education. Upetd., 2003. A Changing Environment. Available at: [Accessed 5 November 2012]. Wilson, D. C., 1992. A Strategy of Change: Concepts and Controversies in the Management of Change. Stamford, Connecticut: Cengage Learning. Read More