Change Initiative and Kotter's Change Theory - Essay Example

Change Initiative Kotter's Change Theory The Change Initiative In the Kotter world of change their is the theory that change has both emotional and situational components. Kotter uses an 8 step model that manages both at several points in the model. The theory consists of developing urgency, building a guiding team, creating a vision, communicating for buy in, enabling action, creating short term wins, don't let up and making it stick. When successful change occurs, according to Kotter (2002), it is reflected in the change in behaviors that support the change effort. Accordingly it is important that people have to see the world around them differently and the change actually occurs because of their new perception. This paper will discuss the change effort to be made in one institution, Comanche Regional Hospital. Change Strategy Creating an Urgency Most people that have a change issue in their company are aware that a change needs to happen. They begin to get complaints or sales fall off. In the case of Comanche Regional Hospital the bottom line is running in the red and the turnover rate of new motivated managers is very high because of the age and beliefs of the older senior team running the facility. Even when there is a need for change as great as this one, however, complacency is most often the problem (Kotter, 1996). Urgency, at this stage must be created. In this case, there is a huge barrier and that is the mature management team that has been there for some time and talks a lot about change but never sees it happen. The next step in this case is the board. Creating a sense of urgency demands risky action. Going to a board meeting with a group of recent department directors who turned over quickly and customers that have in the past used the hospital is the move in this case that will create urgency the fastest. At the same time take a well created report to a management meeting showing how the bottom line is dropping off, how many jobs will be lost in what departments (it is much more urgent for a department director who must go to his staff and tell them they are laid off) and show over the last two years the number of department directors that have been hired and who have left the organization. Relate that to the cost of recruiting, hiring, and orienting this group. Continue by showing where the hospital could be as far as raises and incentives and management bonus if the bottom line is improved and that money is not spent recruiting the same positions all the time. Most recently there has been a very poor JCAHO review which came close to causing a closure of the facility. This has created a sense of urgency in itself and because of that and that we will create it is time to strike. Create a Coalition In every organization there are formal and informal leaders. Those people must be identified at this time as they will need to be on the guiding coalition. There are two champions that have influence and could be chosen at this time. One is Dr. Ben who has general influence in the hospital as well as in the community. He is well liked and retired from practice but working closely with other physicians. The other is Dr. Dale who is the head of the hospitalist program and this year will be Chief of Staff. Nurse D will be added to the list as she is a manager of the medical departments and has a good ability to work well with management as well as the nurses and staff. She is highly respected. Nurse A is the department director for the critical care units and due to the fact that she is fairly new to the hospital and has led successful change in her past, she is a great addition to this coalition. JP is a board member who has good communication skills among all of the different factions and has respect on both side of the boundaries. He will provide the coalition with more power and be able to carry what is needed back to the board. Each of the other seats will be filled by staff people who have been progressive in stepping out of the box to improve things in their departments. These are the informal leaders and the people who be able to affect change at the staff level. In managing this process, it has to be remembered that the senior team must be included and because a change must involve this level. This team must see the need for the change and be involved. The board involvement can help them see their sense of urgency and we now have the effect of a poor certification which might also help to move them. There needs to be fours kinds of power in our coalition. Those include position power (the two physicians, our board member and senior team), expertise power (those new directors that have participated in major change elsewhere), credibility (people with good reputations, Nurse D and Nurse A., and are respected in both the upper and lower levels of staff, and leadership (both formal and informal leaders). In review of our coalition, it appears that we have included all of these necessary people (Kotter, 1996). Developing a Vision Developing a vision is very important. A team must understand where it is going (Periyakoil, 2009). Creating a vision statement and energizing the team toward expectations can create an energy toward actualizing the actions needed to make the change. The vision statement: "The hospital will initiate strong throughput initiatives throughout the hospital creating a movement of patients through the facility that is both comfortable and timely for patients as well as effective and cost efficient for the hospital." The following plan will need to happen to meet this vision. 1. Several staff meetings need to be held right away to assure that everyone on staff understand the importance of throughput and what it means for both patient satisfaction and the bottom line. There must be a fire set in the understanding that complacency will no longer be tolerated from any part of the organization and that the plan would be to move ahead quickly. 2. Patients will no longer be held in the emergency room greater than 1 hour after order for admission is written. This will make nurse managers and case managers accountable for assuring that there is a bed opened up for an emergency admission. They must think out of the box in a manner that will allow movement of those patients quickly through the system. They will no longer be able to be complacent about how much time it takes because the patient is coming, no matter what. 3. Patients families are informed ahead of time on when a patient is to be released and will not be held in the bed on the floor greater than 1 hour after a discharge order is written. This policy will provide the fuel for the staff to understand that they cannot do discharges last or they will end up with patients in their hall. They are also able to improve patient satisfaction here as a well planned discharge will get the patient home quicker. 4. Determine a normal discharge time such as 11:00 am. That way physicians are able to gauge when to make their rounds and when to get their discharge orders written. At the same time the lab and radiology can determine how early the need to have results on the chart so physician can make decisions. Compelling Communication Even though we have planned to provide this information through staff meetings, it will be forgotten quickly in the everyday work of getting patients taken care of. Therefore, to continue motivating, it is important to find a common understanding that will continue the motivation. The plan in this case would be to create graphs on poster board that will allow staff to see where the facility is going. These graphs would have to change rapidly, even weekly to keep the staff concentrating on the need for change. The graphs in this case would be 1. Where is the bottom line now and where does it need to be to create a 4% raise this year Post that graph in every unit break room and in every managers office. Be sure that the changes are made on the graph weekly showing (hopefully), an improvement in the bottom line. 2. Where is the staff turnover rate throughout the hospital now and where does it need to be to improve the bottom line Again, all of these need to be changed frequently, providing constant communication and feedback. 3. How many patients are waiting in the ER greater than one hour after admission order now and how is that improving How is that improving the bottom line 4. How many patients on the floor are there greater than one hour after their order is written and how has that improved 5. What is the patient satisfaction rate now and how is it improving All of this information and more as the process moves forward needs to be consistently communicated to the staff. This includes at staff meetings, as well. The guiding coalition must be consistently involved and providing to support to all of the team members. This change, if it is to be successful must also involve buy in from the staff and buy in comes from participation. Providing consistent forums for employees to provide information is very important (Gray, 2004). Those who come forward with great ideas should be celebrated and the effect of their idea should be rewarded (maybe a gift card) to encourage others to step out of the box and provide ideas. The best ideas that come up are going to come from the staff that works closest with the situation that needs to change. Empowering Employees Empowering employees is more difficult than it seems and often means breaking down barriers to the change. In this case, it is important to note that the greatest barrier is the senior management team and their older leadership ideas. They have been pushed forward by involving the board but those people on the guiding coalition, including the board member will need to continue to push this team forward or that barrier alone will take away any employee retirement. There is a medical group of hospitals out there that has a great incentive plan that works great for employees and would be well adopted here. We will call it the idea tree. In this effort, employees contribute ideas to the change. The idea is calculated using an ROI type calculation. If there is a savings to the bottom line, the idea is piloted. The employee receives 10% of any savings to the bottom line that is created in the first 6 months and another 20% of any savings over a year. This is highly motivational and keeps the staff coming up with great ideas on a regular basis. The empowerment here, comes not only from the possibility of monetary reward but also from the pride of having an idea that works and having the rest of the facility know about that. Short Term Wins In some ways, we have discussed our short term wins in previous sections. Short term wins are important because they establish credibility of the system along the way.(Kotter, 1998) This provides the guiding coalition and the staff that they really are making a difference and the change is making the right difference. For our purposes, short term wins will b shown weekly on our posters and in staff meetings by discussing the things that are happening for the hospital in general as a result of this change. For the staff, of particular interest will be the graft that shows how much they have moved toward the number on the bottom line that would spell 4% raises this year and any employees that have gained in the incentive program. Aligning the Organization In the case of this organization, this change will have to occur first as it is important in keeping the organization alive as well as improving patient satisfaction. However, there are many other healthcare organizations in town that could help in the throughput issues needed in this facility. Those include nursing homes, home health agencies, skilled facilities, and citizens. By pulling many of these together and working closely together, a continuum of care can be created to expand the ability of moving patients to a lower level of care in a more seamless way. For example, a patient may not be able to go to a nursing home on Saturday now because they do not admit on Saturday. As the change agent for this process, speaking with and working closely with the nursing homes to change this policy would improve the chances of a successful change within the hospital. Cultural Implications The cultural implication here are a little difficult as it could mean the senior management team will not survive as leaders in this organization. This would have to be evaluated by the board as the change occurred and it is not something that would be considered as part of the change but could be a cultural side effect of the change as the disallowance of complacency is a major change in culture in this organization. Other major cultural changes include such things as incentives for employees. Because of the management style in the past there has been discouragement for incentives for employees or management staff as far as that goes. Using incentives will be a major cultural shift, empowering employees. Over the short term, there is the communication and information cycle created by the graphs and constant information given to staff. This has also been a part of the previous culture in the fact that information was not readily given to the staff so for them this is a short term win in itself. Conclusion Comanche Country Hospital is a hospital in trouble and it has been slowly moving that way for a long time. Change is near to impossible based on the old-fashioned leadership style of the senior management team. However, there are ways to do it such as involving the board in a guiding coalition that involves presenting a vision to the board with an understanding of where the hospital could go and the fact that there are ways to bring this hospital out of the crisis it is in. Many people have come and tried to make a difference and many have gone. This is expensive and creates a defeatist attitude. Kotter's plan for change, if followed correctly, this writer believes will make a difference by empowering the staff, providing a coalition with the right power and creating short term and long term wins that will solidify the change. References Gray, J. (2004) Ch-ch-ch-changes. Canadian Business 77(14) Kotter, J. (1996). Leading Change. Harvard Business School Press: Boston. Kotter, J. & Cohen D. (2002). The Heart of Change. Harvard Business School Press: Boston. Periyakoil V. (2009). Change management: the secret sauce of successful program building. Journal of Palliative Medicine. 12(4). Read More