Change Management - NHS IT Program Exploring Planned and Emergent Change - Case Study Example

Change Management-NHS IT Programme exploring planned and emergent change Introduction The successful implementation of change in modern organizationsis depended on numerous factors, including the resources available for supporting the particular plan, the skills of individuals involved, the responses of employees to the attempted change but also the conditions in the organizational environment. Moreover, the experience of an organization in such projects is vital, especially in markets that are highly turbulent and where the appearance of unexpected problems when initiating critical business plans is quite possible. Current study focuses on the presentation and analysis of a critical change plan: the IT programme/connecting for health, a programme that aimed to improve the efficiency of NHS, one of Britain’s most powerful organizations. NHS is part of Britain’s public sector, a fact that makes the promotion of change in the particular organization more difficult. However, British government has made important efforts for supporting the increase of NHS effectiveness, as proved through the change plan presented in this paper. The evaluation of the particular plan requires the reference to two, key, modes of organizational change: the planned change and the emergent change. The literature developed in regard to this theme is used for identifying and explaining the plan’s elements but also its strengths and weaknesses. It is proved that the change promoting through the specific plan is rather planned change but certain implications related to emergent change have not been avoided. For this reason, suggestions are made in this study for controlling the programme’s failures and for improving its effectiveness, without exceeding the limits sets by the programme’s planners, in regard to time and resources involved. Part A Literature review on planned and emergent change Change, as related to the business environment, can be described as ‘the process that changes either the composition or the purpose of business’ (Iqbal 2011, p.88). The implementation of change in modern organizations can be a challenging task due to the following fact: ‘business environments worldwide are uncertain’ (Bamford 2006, p.182). For this reason, attempting change by using a carefully designed plan is related to many risks (Bamford 2006). As a result, managers tend to prefer change plans that are quite flexible and are not standardized as of their requirements (Bamford 2006). The change promoted through such plans is also known as emergent change, as opposed to planned change which has fewer risks but the terms of which are difficult to be strictly met. Planned change, as a concept, was introduced by Lewin (Liu 2009). The term is used for showing change which is initiated using a carefully designed plan, being differentiated from change that appears suddenly under the pressure of emergent and unexpected organizational needs (Liu 2009, p.234). Planned change, as described by Lewin, has three, key, components, a view which is promoted through the ‘Three – stage theory of change’ (Sarayreh et al. 2013, p.1, Figure 1 below). Figure 1 – Lewin’s Change model/ Three-stage theory (Sarayreh et al. 2013, p.2) By its nature, planned change cannot be promoted in a series of cases: a) in highly turbulent business environments, b) if the needs of the change plan in regard to learning are extensive and the organization involved has not access to the required resources and c) when the resistance by employees to the attempted change is expected to be quite strong (Liu 2009, p.234). In the above cases emergent change should be preferred. Emergent change should be also used when organizational politics are flexible, offering the potential to leaders to alternate the relevant change plan according to the conditions in the business environment (Liu 2009, p.234). Still, planned change can help to increase employees’ support to change; this target can be achieved through ‘strategic interventions carefully designed’ (Chow 2014, p.25). In regard to planned change, emphasis should be given to the following fact: a plan promoting this type of change is highly based on the leader’s skills. Indeed, when having to implement planned change a leader needs primarily to check whether the attempted change ‘is necessary or not’ (Fernandez and Rainey 2006, p.169). The process through which the needs of an organization in regard to change are identified is also known as ‘organizational diagnosis’ (Hassin 2010, p.24). At the next level, the leader has ‘to persuade stakeholders on the necessity of change’ (Fernandez and Rainey 2006, p.169). An important problem related to planned change is the following: the responses of employees towards such change may not be always positive, a fact that it is often ignored by managers (Visagie and Steyn 2011, p.99). Visagie and Steyn (2011) had studied the responses of employees of a firm operating in the telecommunications industry of South Africa (p.99). The relevant research was conducted through a survey; about 113 employees accepted to participate in the survey (Visagie and Steyn 2011, p.98). The hypotheses on which the research was based were confirmed, as made clear in Figure 1 (Appendices). The key finding of the above study was the potential of change to affect the level of organizational commitment (Visagie and Steyn 2011, p.115). It was also made clear that the implementation of planned change within an organization cannot be completed successfully unless communication is at excellent level and under the terms that the firm is appropriately prepared to support the plans of change in all their phases (Visagie and Steyn 2011, p.115). Towards this direction, it has been supported that employees who are highly committed to their organization are more likely to support organizational change (Vakola and Nikolaou 2005, p.163). Still, even in the above case resistance to change can appear if the attempted change plan is opposed to the organization’s interests (Vakola and Nikolaou 2005, p.163). The inability of planned change to support continuous innovation has been considered as another drawback of the particular type of change (Jamaludin and Ahmad 2012, p.160). For confronting this challenge a leader can use a change plan based on revitalization, as suggested in the graph in Figure 1a (Appendices). On the other hand, the ability of a manager to respond to the needs of planned change is not guaranteed. In fact, planned change requires the willingness of change managers ‘to learn and to adapt their perceptions to their environment’ (Burnes 2004, p.311), otherwise, planned change cannot be effectively promoted. Planned change, as described above, is highly differentiated from emergent change. The term emergent change is used for describing a changing process that it has the following characteristics: ‘it is political, unpredictable and political in nature’ (Sarat 2009, p.5). In the context of emergent change employees have to retrieve solutions to problems and to make appropriate use of opportunities that appear in the workplace on a daily basis (Sarat 2009). In other words, in emergent change there is no case of plans that have to be accomplished by a specific deadline, as in planned change (Sarat 2009). An important implication of emergent change is the following: due to the lack of any preparation for promoting change, managers who have to deal with emergent changes may fail in managing effectively all aspects of such change, a fact that can result to ‘severe organizational turbulences’ (Sims 2002, p.332). In fact, it has been proved that ‘the chaotic effects of emergent change’ (Sims 2002, p.332) are often difficult to be controlled even by experienced managers. Also, in practice most plans related to emergent change tend to fail due to lack of appropriate design or because their execution has not been aligned with the guidelines given by managers; such phenomena are quite common in organizations with important communication and cooperation problems (Cummings and Worley 2014). Indeed, as Frahm and Brown (2006) explained the success of a leader in regard to the management of change plan is highly based on the emphasis given to the leader’s performance in regard to ‘message reception’ (Frahm and Brown 2006, p.3). Helms-Mills et al. (2008) note that emergent change plans are often implemented without the organization involved to have any ‘participation in their planning’ (p.32). For example, the adoption by a firm of ISO standards with no prior intention by the firm to proceed to such initiative can be considered as an example of emergent change. In the above example, the use of these standards may have been imposed to the firm by local authorities in order to ensure the quality of the firm’s products/ services (Helms-Mills et al. 2008, p.32). Emergent change is also related to the following phenomenon: the progress of the emergent change plans can be slower than initially estimated (Marwah 2013, p.12). For this reason, it is suggested for emergent change plans to be used at the level of business operations, i.e. for altering certain aspects of a firm’s daily operations (Marwah 2013). In opposition, when changes are required at the level of a firm’s overall strategy, then planned change should be rather used; however, even in the above case ‘small emergent changes could be used for causing the change at strategic level’ (Marwah 2013, p.12). Despite its implications, the popularity of emergent change in modern organizations seems to be continuously increased. Higgs and Rowland (2005) developed a qualitative research/ interviews among the employees of eight organizations of various sizes. In total 40 employees of these organizations accepted to participate in the study; these employees provided ‘70 change stories’ (Higgs and Rowland 2005, p.131). The stories reflect the personal experiences of participants in regard to the management of change in businesses of different industries (Higgs and Rowland 2005, p.131). These stories have been categorized by Higgs and Rowland (2005) in a diagram using four categories (Figure 1b, Appendices). The stories, as placed in the diagram, show a clear trend of ‘moving from directive to emergent change’ (Higgs and Rowland 2005, p.131). Liebhart and Garcia-Lorenzo (2010) note that the use of emergent change in organizations is inevitable since modern markets are highly turbulent and tend to change continuously. In such environment, businesses cannot survive by focusing on ‘stabilization and standardization’ (Liebhart and Garcia-Lorenzo 2010, p.6). In addition to the above, particular reference should be made to the relationship between organizational culture and change. According to Smollan and Sayers (2009) in organizations where employees’ values and culture are close to the culture of the organization, the emotions of employees to change attempted in these organizations would be positive (p.11). The above view refers to both types of change, as presented above, i.e. to planned change and to emergent change. It should be also noted that when initiated within a particular organization a change plan is likely to affect the members of the organization at different level (Kamugisha 2013). In a research developed in the National University of Rwanda it was proved that managers at the middle level are more likely to be influenced by change compared to staff at other levels of the organizational hierarchy (Kamugisha 2013, p.12, Figure 2, Appendices). In the above case, emergent change has been initiated as the University’s environment has been highly turbulent (Kamugisha 2013, p.12). According to the above, planned change and emergent change are highly differentiated; when having to promote change managers are likely to use the type of change that it is more suitable for their organization taking into consideration the conditions in the business environment and the organization’s readiness to support the particular plan (Cummings and Worley 2014). In this context, Iqbal (2011) noted that organizational change, planned and emergent, is a complex process depending on the organizational culture/ structure and the organizational environment (Figure 3, Appendices). Part B NHS IT Programme/connecting for health – Description of the change process The NHS IT Programme ‘was introduced in 2002’ (House of Commons 2007, p.10). The key aim of the Programme has been the improvement of NHS’s existing IT infrastructure (House of Commons 2007, p.10). Particular emphasis has been given on the creation of a central service for the process and storage of patients’ medical records; the ‘NHS Care Records System’ (House of Commons 2007, p.9) would have two parts: a patient’s record available at local level and a patient’s record available at national level (House of Commons 2007, p.9). The latter could be particularly valuable in certain cases, such as if an individual ‘is injured while being far from home’ (House of Commons 2007, p.9). The cost of the Programme has been quite high, reaching in total, as of all its aspects, the £12.4 billion, as analyzed in the Graph in Figure 4 (Appendices). The Programme’s initial duration was set to 10 years, from 2002 to 2013 (House of Commons 2007, p.3). Indeed, in 2013, end of March, the ‘NHS Connecting for Health’ Programme was terminated (NHS 2013, Connecting for Health). The Programme referred not just to the medical records of patients but to several other ‘applications and services’ (NHS 2013, Connecting for Health), such as ‘electronic prescriptions, pathology messaging and summary care records’ (NHS 2013, Connecting for Health, Services and Applications). The parts of the Programme are presented in the table in Figure 5 (Appendices). It should be noted that in NHS a specific approach exist in regard to the management of change. This approach has been also used when implementing the IT Programme of the organization. The various aspects of this approach are presented in Figure 5a (Appendices). It is clear that emphasis is given to optimistic perceptions and willingness to support continuous improvement. Of course, the process should be also based on certain values, so that its credibility is secured. These values are presented in the graph in Figure 5b (Appendices). Through this diagram it is clear that transparency, quality of product/ services delivered and stakeholder engagement are important elements of the organization’s culture. These values have been considered as important by the Ontario Ministry of Health that had tried to implement a plan of change similar to that of NHS (Ontario Ministry of Health 2013). Still, these values have not been taken into consideration in regard to the specific project, as proved through the inefficiencies related to the Programme’s power, learning and culture, as analyzed below. When reviewed by the relevant body of House of Commons, in 2007, the Programme was found to a series of failures, such as the radical increase of the Programme’s cost, to the non-delivery of the medical records system, which is the Programme’s key element, the lack of support from physicians, the failure of suppliers to meet their obligations and so on (House of Commons 2007, p.5-6). Robertson et al. (2010) tried to explore the effectiveness of NHS’s ‘electronic health records system’ (p.1) especially at the level of secondary care. The relevant research was based on various sources, including interviews and primary data; it was proved that the implementation of such system in Britain was characterized by a key problem: ‘lack of flexibility and adaptability’ (Robertson et al. 2010, p.1). It should be noted that when beginning the process the Programme’s top managers have employed a plan for securing capability. The plan is presented in Figure 5b (Appendices) The development of the NHS IT Programme was characterized by the following trends: a) extensive downsizing; NHS employees in the organization’s central units were reduced to ‘4,000 from 15,000 as in the beginning of the process’ (Ontario Ministry of Health 2013, p.7); the building capability scheme introduced by the organization (Figure 5c, Appendices) has not been particularly helpful for its employees, b) the integration of the NHS’s system of medical records was not achieved (House of Commons 2011, p.5); the above target has been the plan’s core aim but it has not been achieved, despite the extensive amounts spent on the particular project; c) the lack of accountability has been also proved to be the Programme’s most important problem; for ensuring that no similar phenomena will appear in the future the House of Commons has suggested a scheme for monitoring the progress of Healthcare schemes in Britain, as this scheme could be used by all governmental bodies in UK (Figure 5d, Appendices). Part C Comparison of NHS IT Programme case study with the findings of the literature C.1. Power When referring to organizational change the term power is used for showing those who are able to intervene in the change progress and make suggestions/ take initiatives so that the success of the process is guaranteed (Boonstra and Gravenhorst 1998). In modern organizations the allocation of power in the change management process has been differentiated: instead of being fully controlled by the leader the change management process is now influenced by all stakeholders, including ‘the top management and the employees’ (Boonstra and Gravenhorst 1998, p.98). At the same time, if power is not appropriately distributed in a change management process, then important conflicts can appear; most commonly, these conflicts are caused by the lack of agreement between the stakeholders in regard to the use of resources (Hotepo et al. 2010). The role of the mis-management of power in the development of organizational conflicts is made clear in the table in Figure 6 (Appendices). On the other hand, in the public sector, as in the case under examination, the effective management of change can be quite difficult mostly due to the following fact: a government cannot act like a leader, since its actions have to be checked and verified by the relevant bodies (Kuipers et al. 2014). In other words, it is quite difficult for a government to take emergent initiatives and to take risks, as a leader can do for facing unexpected problems (Kuipers et al. 2014). This fact can be a major obstacle in the effective management of change plans related to the public sector. On the other hand, government cannot be close to the employees of an organization at the same level as the organization’s leader (Randall et al. 1999). This means that government cannot be effective in enhancing employee motivation and employee performance as the leader can be, since leader can communicate daily with employees and can be fully aware of their actual needs and expectations (Randall et al. 1999). Of course, the power given to a leader in regard to a change plan should be controlled in terms of accountability (Nafei et al. 2012, Manshadi et al. 2014). The NHS IT Programme has been initiated by the British government in order to respond to the needs of patients across UK. In other words, the Programme had the necessary political support to succeed (Maughan 2013). However, the politicians involved in the design of the process were not aware of the Programme’s demands, meaning that the Programme’s feasibility was not appropriately checked in advanced (Maughan 2013). The Programme has been periodically checked by the government as of its performance, as proved through the relevant reports of the House of Commons, two of which, published in 2007 and 2011, are presented in this paper. In its latest report, of 2011, the House of Commons repeats its concerns for the mismatch between the Programme’s initial cost and its new cost. For this reason it is also suggested that the ‘remaining £4.3 billion is spent elsewhere’ (House of Commons 2011, p.3), meaning probably the remaining amount from the project’s budget. C.2. Organizational learning When a change plan is implemented it is necessary for the stakeholders involved to be fully informed on the plan’s various aspects, so that they are able to support the plan in all its phases. More specifically, it would be necessary for seminars and similar learning sessions to be arranged so that stakeholders are given sufficient information on the plan’s structure, its scope and its needs; otherwise, it is quite possible for resistance towards the attempted change to appear (Ijaz and Vitalis 2011). The potential reactions of stakeholders to a change plan in case that organizational learning, as part of the change process, has been ignored are made clear through the table in Figure 7, where the findings of the study of Pieterse et al. (2012) to a similar project have been summarized. In any case, the role of leadership in balancing interests and eliminating conflict is vital (Carter et al. 2012), a fact that should be taken into consideration in the case under examination. It is implied that a leader can understand the learning needs of employees and of other stakeholders and suggest appropriate schemes for covering the relevant gaps. Problems can appear though, if the leader has to manage a plan that it is characterized by discontinuous change, as in the case under examination (Lant and Mezias 1990), since the learning needs of such plans are difficult to be identified. Moreover, the responses of the stakeholders to the learning schemes introduced for a specific change plan cannot be estimated in advance; the difficulty is increased when the change plan involves in the public sector where the number of stakeholders is extensive (Sohaib et al. 2013). However, if no effective scheme is introduced for providing to the stakeholders of a change management plan sufficient information on the aspects of change, then the chances for the failure of the plan are quite high (Cho 2007). Of course, the learning scheme chosen for a change management plan has to be fully aligned with the plan’s characteristics (Austin and Harkins 2008). This means that if a change plan has features similar to planned change and to emergent change, as in the case of NHS IT Programme, then its learning needs should be assessed accordingly (Mehrabi et al. 2013). In the case of the NHS IT Programme no such approach was used. In fact, the implementation of the Programme was not followed by clear explanations to stakeholders, especially the physicians and the patients, in regard to the Programme’s role (Maughan 2013). According to the 2011 Report of the House of Commons the information provided to the Programme’s stakeholders, including its users and the British government, in regard to the Programme’s characteristics and functions has been quite limited (House of Commons 2011, p.5-6). In fact, it is noted that with existed information the users of the Programme are not able to use it (House of Commons 2011, p.5). Normally, the users of the Programme should be given instructions on how they would use the various features of the Programme and how they could be most benefited from the Programme as of their daily tasks and needs (Maughan 2013). No such strategy was used, leaving the Programme’s stakeholders unaware of the processes and the benefits involved; in this way, the actual value of the Programme was significantly reduced by the beginning of the implementation process (Maughan 2013). C.3. Organizational culture When trying to promote change in a specific organization, particular emphasis should be primarily given to the organization’s culture (Al Zu’bi 2011). In the case of organizations operating in the public sector, different culture needs would appear compared to corporations of the private sector (Al Zu’bi 2011). In regard to this issue, Sarros et al. (2008) explained that understanding the culture of an organization is vital for attempting to implement change in the particular organization. It is also made clear that only successful leaders are able to realize the actual change potentials of their organization since these leaders are fully aware of their organization’s culture (Sarros et al. 2008). In addition, the understanding of organization culture is a prerequisite for managing any conflict that would appear in the specific organization as a result of the efforts to implement change (Ghorbani and Razavi 2011). Apart from the leader of the organization, organizational culture should be also clear to employees at the level that their support is critical in the success of any change plan (Uddin et al. 2013). The issues referring to the value and the role of organizational culture, as presented above, are relevant to both cases of change, i.e. both to planned change and to emergent change. Since its appearance the NHS IT Programme has been related to an important problem: the managers involved in the implementation and the monitoring of the Programme were not held accountable for the tasks assigned to them (Maughan 2013). Rather, they have been given full power to take initiatives in regard to the Programme’s various phases, without reporting the progress of the relevant plans (Maughan 2013). However, in a Programme of such value, both in terms of its cost and in terms of its effects on people across Britain, the lack of any accountability can be considered as a severe drawback (Maughan 2013). In its report of 2011 in regard to the NHS IT Programme the House of Commons highlights the lack of accountability as one of the Programme’s major weaknesses (p.6); emphasis is give to the fact that risks have been taken in this Programme even if there is no sign of ‘a specific Risk Management plan’ (House of Commons 2011, p.6). In addition, the multi-providers practice used, i.e. the simultaneous involvement in the Programme of a series of providers/ suppliers has severely decreased the Programme’s efficiency since the communication and the cooperation between these providers and the Programme’s supervisors has been quite poor (Maughan 2013). The Programme’s culture, as characterized by the above two trends, had to be radically changed in order for the successful implementation of the Programme to be secured. Part D Conclusions The NHS IT Programme has been initiated in order to cover critical health needs of people across Britain. Indeed, as noted in the two reports of the House of Commons presented in this paper, one of 2007 and one of 2011, the particular Programme had a specific role: to improve the efficiency of NHS’s IT systems so that the data involved in patients to be available on time and for risks related to the storage/ process of such data to be minimized. However, the review of the progress of the Programme revealed that this target has not been achieved. The question that appears is the following: can this failure be considered as expected, in the context of the change management process, or it has been rather the result of extensive mistakes by the Programme’s planners and supervisors? The answer can be located somewhere between these explanations. More specifically, the Programme had initially the form of a common planned change process, at the level that all its parts were carefully designed and deadlines were set. However, during its development, the Programme was also related to emergent change; this phenomenon could be identified in cases such as the unexpected termination of contracts with certain providers, the appearance of costs that had not, initially, taken into consideration and the lack of experience/ knowledge by a major part of the stakeholders, also an issue that was not considered when designing the Programme. In addition, as the Programme was in progress, the lack of any accountability by the Programme’s supervisors/ top management team, verified the similarities of the specific plan to emergent change plans. According to the above, the effective management of the NHS IT Programme has been a major challenge for its leaders. Still, the difficulties in managing the Programme had become critical due to the lack of any provision for addressing emergent demands/ needs of the Programme. This means that despite its challenges, the Programme would not have failed if provisions would exist in regard to the following areas: a) power: since the British government could act as effectively as a leader, a provision should have been added in the Programme for the increase of powers of the Programme’s top management team so that initiatives were allowed, when necessary, for addressing issues that should be managed with no delay, b) at the next level, changes should be made to the Programme’s culture: the terms for the accountability of the Programme’s supervisors/ top managers should be clearly set so that all leadership decisions are controlled as of their validity/ legitimacy and c) the severe gaps in the Programme’s learning needs, should be covered through appropriately designed learning schemes, including seminars, printed material and online sessions that would provide to all stakeholders necessary information for understanding the Programme’s scope and for using its various features according to their needs. 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Hypotheses are followed by the result of the research (Visagie and Steyn 2011, p.115) Figure 1a – A model for change management based on Revitalization (Jamaludin and Ahmad 2012, p.166) Figure 1b – Categorization of change stories provided by participants in eight organizations from different sectors (Higgs and Rowland 2005, p.132) Figure 2 – Staff in Rwanda National University, as affected by change (Kamugisha 2013, p.12) Figure 3 – An integrate model of organizational change (Iqbal 2011, p.88) Figure 4 – Cost of NHS IT programme (House of Commons 2007, p.10) NHS IT Programme/ elements Analysis of elements NHS Care Records Service A system that would present the medical records of patients in electronic format, both at national and local level Choose and Book A service allowing patients to make bookings Electronic Prescription Service A system for supporting prescriptions in electronic format N3 Broadband services for NHS Picture Archiving and Communication Systems Database necessary for the storage of images that are part of patients’ medical records NHSmail E-mail service for the staff of NHS Figure 5 – Elements/ parts of NHS IT programme (Liddell et al. 2008, 1-2) Figure 5a – Management of change in NHS, phases (NHS 2014, Change Management) Figure 5b – Values in NHS (Ontario Ministry of Health 2013, p.3) Figure 5c – A building capability scheme in managing NHS change plan (Ontario Ministry of Health 2013, p.7) Figure 5d – Management of information/ control over Healthcare projects at governmental level (House of Commons 2011, p.43) Figure 6 – Conflict Management in modern organizations, causes and technologies available (Derr 1975 in Hotepo et al. 2010, p.4) Figure 7 – Formal and informal reactions to change (Pieterse et al. 2012, p.809) Read More