Managing Change in an Organization - Essay Example

Introduction Managing change in an organization can be an enormous challenge. The successful or failed integration of change in an organization depends on so many factors – factors that are found both on the management and on the rungs of the rank-and-file. In order for organizations to remain afloat or to remain competitive, they have to occasionally and sometimes radically integrate changes into their daily processes (Kotter & Schlesinger, 2007, p. 1). And these changes may not always be welcomed in the organization. Some members may prefer to preserve the status quo and stick to the traditional ways; others may be readily receptive to change, seeing these changes as welcome improvements needed by the organization. The role of the manager is to ease the members into the new processes of the organization. Successful implementation of change very much depends on the manager’s ability to handle and ease the employees and the members into the new processes in the organization. Managing change in healthcare organizations is essentially similar to managing change in economic or political organizations. The same concept of resistance among employees very much hinges on the organization’s and the manager’s ability to shake off its traditional practices. Throughout this change process, it is important for policies and structures to be altered for purposes of innovation and improved performance. Therefore, “individuals and groups have to be motivated to continue to perform in the face of major turbulence” (Nadler, as quoted by Mabey, et.al., 1993, p. 85). Given time, this major turbulence would not have as much devastating effects on the organization as originally perceived by its members. This paper shall discuss the concept of managing change in an organization. It shall present a case study of how change was managed in a healthcare organization. It shall then discuss the different concepts and issues involved in introducing and integrating change into different organizations while considering the events as they unfolded in the case study. A decision and analysis about the management of change shall be drawn from this discussion. Case Study I used to work in a governmental hospital with a 400 bed capacity. The hospital offered specialised, emergency and intensive care. Our intensive care was divided into 2 units, the intensive care unit and the step-down unit. The hospital opened in 2005 and I accompanied the progress development of the hospital. The total capacity of our ICU was 35 beds. The step-down ICU was for chronic patients under mechanical ventilator. The staff members were familiar with the patients because the chronic patients sometimes stayed in the unit for as long as 6 months. The head of the intensive care unit, Dr. Saeed, later came to notice that we did not have enough beds for patients in the ICU and SDU. Our department received many requests from other hospitals for transfer but most of them were refused because of insufficient beds. The head of the ICU started to think of a new approach of delivering services to chronic care patients. He met with the head of the nursing department and other intensive care physicians to discuss a new approach for delivering critical care to patients. They discussed whether they could open a palliative care unit for chronic care patients. Dr. Saeed argued that the hospital cannot open a palliative unit because the maximum capacity of the hospital was about to be reached; moreover, the human resource department would surely refuse to recruit more staff for the whole unit. Dr. Saeed wanted another way to reduce the patient costs without having to recruit more staff. Then, Dr. Assf suggested offering home care delivery for the chronic care patients. He said that by doing so, the hospital could decrease the number of chronic patients and still not have to recruit additional staff to implement the program. The first step that was taken in order to implement department change was to obtain the approval of the directors of the department. The merits of the project were explained to them. According to Dr. Saeed the project will help to minimize cost of service, at the same time, meet the needs of the family. Many meetings were set between senior levels to plan for this project. Many structural changes had to be made in order to achieve the goal of the project. The strategy for the department had to be changed because the department staff would monitor the patients in the ICU and in their homes after discharge. After the meeting, the head of the ICU announced to the staff (nurses, respiratory therapist, physicians) that the hospital was planning to provide home care services and as a result the staff had to undergo additional training to help them treat home-bound patients. Many employees had a negative impression about this project. Many of them did not want to change their tasks and routines because they were already accustomed to working inside hospitals. In addition, many of them thought that the work load of each staff would increase when the project would be implemented. They were also afraid that they would not be effective in the home care set-up. It was obvious that the turn-over of patients in our step-down ICU was very low because most of the beds were occupied by chronic patients requiring basic treatment while needing the mechanical ventilator. Most of the staff assigned to this area had an easier task in monitoring these patients. Moreover, most of the staff did not know why the hospital was now opting to offer home-based care. Their knowledge about the change to be implemented was insufficient. Many of the staff members were also not receptive about adding to their responsibilities and their accountability. They were very much comfortable and happy with the current system, and so, they did not want to change the way they worked. From the very beginning, there was no support at all from the staff. They preferred to work in the hospitals where they could work with their close friends and with other staff members. Dr. Saeed sat with the staff and illustrated to them how important the project was in allowing the department to handle and admit new patients while still being able to care for chronic care patients. Dr. Saeed also explained to the staff that they will have training sessions on how to monitor patients at home and on how to use the technology devices for home treatment. He further explained that the hospital will also invite the health workers from the National Guard Hospital to share their experiences in implementing the first home care delivery system in the country. All department heads also met with their staff to discuss the new project. The head of the respiratory department also clarified to us how the project will help achieve the ICU department objectives. There was also organizational level resistance from the senior levels. They argued that the hospital had to spend lots of money to buy medical equipment in order to implement the project. In the end, they opine, this project will still not reduce the cost of treatment. However, Dr. Saeed argued that this project will indeed reduce the cost of services for patients. He also argued that this project will make more beds available for other patients who will need medical attention. The families of the patients would also be educated on how to take care of their family member; and the hospital staff would still monitor the patients on a weekly basis. The hospital board agreed to the project and they assigned a project manager to monitor the performance and to measure the outcomes for both staff and patients. The manager of the project met with the staff to discuss the possible barriers and solutions in the implementation of the project. Staff members expressed their concerns about the change. Their concerns mostly revolved around scheduling and spending more time outside the hospital visiting patients. The project manager assured them that the schedule would be very flexible and each staff would only do home visiting care about 3 times a month. They worked with the project manager in order to develop a framework of policy and procedure. They decided to follow the AARC (American Association of Respiratory Care) guidelines to develop the policy. It took more than four months to finally start the project. After the commencement of the project, the number of patients at step-down ICU was decreased and more beds were now available to other patients. Patients who met the criteria of home care treatment were evaluated by the ICU and primary consultant. Their family received education sessions on how they could take care of the patient. The hospital staff visited the patients 3 times for the first week and then once a week from the second week onwards. Dr. Saeed asked the staff to give their feedback to the project manager about the progress of the project. Many staff showed their hesitation about reporting some poor treatment by the family. Although all family relatives were instructed on how to take care of the patients and how to troubleshoot the associated devices, many of them still kept calling the hospital to ask help about issues they were facing with the patients. Many nurses have been going back and forth for some patients who needed medical advice in some issues. Many of the patients were frustrated about the new change because they started to face new problems on a daily basis. Dr. Saeed met with the group leaders of the staff to discuss their concerns and to get their feedback about the new project. The main problem was the workload because the number of patients receiving home care was increasing. Dr. Saeed said to the group leader that he will later discuss with the financial department a possible 10% increase in the salary of the staff to compensate them for their hard work, cooperation on the project, and for their increased work load. Discussion/Lessons Learned The case study above exemplifies the different challenges or barriers that managers face when change is implemented in the organization. One primary barrier to change is the employees’ resistance. Resistance to change can be attributed to a number of factors. A perception from the employees that change is being handled poorly in the organization will prompt resistance. Some employees may feel that the change is being communicated poorly to them, and that change is being imposed by their managers or supervisors without prior consultation (Young, 2008, p. 5). In the case above, some of the employees did not understand why the change was being implemented. The administrators did not fully explain to the employees why the change was needed in the hospital and as a result, the employees did not embrace the new changes. Resistance to change can also be affected by perceptions of previous changes implemented in the organization (Young, 2008, p. 5). Previous changes which were poorly implemented in the organization can affect the reception of the organization to current changes. The temperament of members can also contribute to the resistance of the organization to change (Young, 2008, p. 5). Enlightened and receptive minds in the organization tend to create a more receptive environment to change. A very traditionalist and conventional organization, on the other hand, tends to resist changes in the organization. Some employees have fears of the unknown and the unfamiliar. Many of them have already found their comfort in the familiarity of their work, and they do not feel at all confident in how they would function in the new set-up. The members of the organization are “exchanging the known for the unknown, certainty for uncertainty, existing patterns of behaviour and adaptation for the need to evolve new patterns, or tried rewards for untested ones” (Burke, 2002, p. 94). And this venture into unfamiliar territory breeds resistance to change among the members of the organization. Resistance to change may also be attributed to purely selfish interests. Their selfish interests usually stems from their unwillingness to give up their power, their face, their income, and their job security. Power, income, and job security are matters that employees have already sought hard to establish and protect in the organization (Garside, 1998, p. 10). With new changes to be implemented, most of them fear that they would lose all these in the new scheme of things. Selfish interests were contributing factors in the case study illustrated above. Some employees did not want to give up their power and control in the organization. Some of them felt that they would have little opportunity to control the actions and activities of their fellow nurses who will be assigned on home visits. Resentment can also contribute to the organization’s resistance to change. This resentment may develop against the people who want the change to be implemented; against the change itself; or against the increased presence of power or authority in the organization (Garside, 1998, p. 10). This resentment may develop from a number of factors in the organization. It may be a personal resentment of the people involved in the change, or in some instances, it may be resentment against the administrators in general (Garside, 1998, p. 10). Some employees in the case study often resented the administrators for implementing the new changes in the organization. Their resentment mainly stemmed from their lack of understanding of the changes to be implemented in the organization. They also did not trust the administrators of the organization; some of them felt that the changes may be a way of favouring or disfavouring some employees. Some employees like being assigned to home visits because they had decreased supervision while they were visiting patients; but some others did not like being assigned to home visits because they did not want to carry too much accountability for the patient’s welfare outside the walls of the hospital. Their confidence about caring for the patient outside hospital walls was low. Employees who did not like being assigned outside the hospital felt like they were being disfavoured when they were assigned to do home visits. Some analysts also credit this low tolerance for change as based on “the fear of being unable to learn new skills or work behaviour” (Garside, 1998, p. 10). Employees often feel that they may not be able to cope, learn, or adjust well to the new changes and as a result, their performance or their effectiveness as a member of the healthcare team may be compromised. They fear that it will eventually be a reason for them to be slowly phased-out of the organization. There are various ways of successfully implementing changes in organizations. Communication is the best and most effective way to successfully implement change. By “developing a common understanding of the visions, goals, strategies of the organization” (Young, 2008, p. 9) employees and other members of the organization will be more receptive to the changes in the organization. In the case study, Dr. Saeed did not fully explain to the employees why the change was being implemented in the organization. Some employees did not understand why home-based services were being opened by the hospital, therefore they resented the new change and did not fully embrace it into their practice. The meetings that were conducted during the initial planning phases of the project involved the department heads of the hospital. The employees and other healthcare workers were not sufficiently consulted during the planning phase; they were only called in when the project was to be implemented already and when they already did not have any choice but comply with the decision of the management. Consultations that were held during the implementation of the project helped the organization deal with the problems that the employees were having in the implementation of the project. These consultations helped ease the problems of the employees, but some of these concerns would have been better handled if they were brought up during the planning phase of the project. By engendering a culture of communication with the employees, by making them a part of the decision-making process, they would feel more receptive about changes in the organization. They would feel a more personal attachment to these changes, and would take a more active participation in implementing them. Open lines of communication between employees and management can make the change transition easier for the organization. Communication “helps overcome ambiguity and uncertainty, and provides information and power to those who are the subject of change” (Proctor, 1999, p. 243). It helps to arm employees with the tools they need in order to deal and cope better with change. A sense of urgency created in the organization can also help make help make the change transition easier for the members of the organization. By imparting to the employees the costs and risks of not making and accepting the change in the organization, the employees will eventually accept the need to implement change (Young, 2008, p. 9). A ‘make or break’ attitude is an urgent process that can disrupt the normal culture in the organization, however, it can be a very effective method in getting the employees’ cooperation. Establishing trust with the members of the organization can also help ease change into the organization (Young, 2008, p. 9). A relationship of trust can also be built through a culture of open communication with the members of the organization. “Open dialogue produces trust and confidence in both the change process and those responsible for managing and leading the change” (Sims, p. 44). The employees and members of the organization would not feel like their status and job security in the organization is being threatened by the administrators because of this culture of trust. In the case study, since there was limited communication with the employees during the planning phase, the relationship with the employees was not built on trust. The employees sometimes felt that they did not know and understand what was happening in the organization; therefore they did not trust the changes being implemented by the organization. Feedback can also help manage change in an organization (Young, 2008, p. 9). By gathering, listening, and acting on feedback, the members of the organization would now feel more receptive to change. Feedback is also important in implementing change because groups or individuals can “get either positive or negative reinforcement for their efforts” (Thomas, 2001, p. 50). In the case study, feedback was encouraged by the project manager and by Dr. Saeed. However, the response or adjustments made in order to accommodate the concerns of the employees was not improved through this feedback process. And in order to make the feedback process effective, the administration needs to improve its ability to act on the employees’ feedback. Managing change in organizations is a challenging task. In the case study where a home-based care was set-up by the hospital, various barriers were met by the administrators. In any organization implementing change, similar barriers relating to resistance are bound to be encountered. But by opening the lines of communication in the hospital, a culture of trust can be built in the organization and can usher in change. Works Cited Burke, W., 1999, Organizational Change, California, Sage Publications. Burke, W. &Litwin, G., 1992, A Causal model of organizational performance and change, Journal of Management, vol. 18, no. 3 (523-545). Garside, P., 1998, Organisational context for quality: lessons from the fields of organisational development and change management, Quality in Health Care: 7 (S8-S18). Mabey, C. & Mayon-White, W., 1993, Managing Change, London: Paul Chapman Publishing. Proctor, T., 1999, Creative Problem Solving for Managers, New York: Routledge Schlesinger, L & Kotter, J., 2007, Choosing Strategies for Change, Harvard Business Online Sims, R., 2002, Changing the way we manage change, Connecticut: Greenwood Publishing Group. Thomas, S., 2001, Successfully managing change in organizations, New York: Industrial Press. Young, N. 2008, Dealing with Resistance to Change, Optimal Solutions Consulting Read More