Implementing Change in Healthcare - Essay Example

IMPLEMENTING CHANGE IN HEALTHCARE Healthcare Industry The technological improvements in health care have created an increased demand to take care ofpeople with any kind of disease. With the increasing number of people coming for checkups and treatment for even the minutest problems, the staff at the hospital/clinic falls short to cater all the patients. With the higher paying hospitals/medical care facilities employing most of the medical professionals, the lesser successful hospitals are left in need of more staff. However with the current shortages in medical profession it will be extremely difficult to get hire skilled and good quality of employees. The basic problem with healthcare is that there are too many patients wanting the same type of health care. This breeds monotony into the life of a heath care professional and hence the employee becomes bored of doing the same job again and again. Also an employee gets de-motivated when patients keep coming with the same diseases and they feel that they aren't doing anything substantial to help patients. For an employee to feel satisfied, he/she should be put of job rotation so that different kinds of jobs are being done after every few days. Seeing different diseases and helping out to solve them, is not only beneficial for the employees to learn new healthcare techniques, it also helps them to realize the importance of their jobs. Such a situation calls for bringing about a change in the medical profession. Resistance to Change No matter whether a change is of major proportions or is objectively rather small, the change manager must anticipate that people in the organization are going to find reasons to resist changes. It is a basic tenet of human behavior that any belief or value that has been previously successful in meeting needs will resist change. This applies even if there are better more successful alternatives to meet those needs. Resistance to change takes many forms. The more obvious forms consist of active resistance, where people will object, or refuse to cooperate with the change. Other, more subtle forms of resistance, however, are more difficult to deal with. Some examples of "resistive symptoms" include: Negative Impact Of Change Positive Traditionalists Resistors Bystanders Change Agents Passive Active Energy of Response Reasons for Resistance The main reason for resistance is the uncertainty of the new situation. People like to lead their lives the way they have been living in the past unless that life is entirely unsatisfactory. Change is attached with negativity and this bias is not entirely wrong. Factors such as downsizing, change in working conditions, having a new boss or a new organizational structure is related to having a negative affect on these people. Kotter give four basic reasons why employees resist change. 1. 'Parochial' Self-Interest - This belief is that people are selfish and they care only about themselves thus a change in their surrounding is bound to affect them thus they resist it. 2. Misunderstanding - The second reason given by Kotter is that due to lack of proper communication and information/knowledge about the change begets resistance from the employees. 3. Low Tolerance of Change. -Thirdly people want to live the life they have been living and want the security and stability in their work. 4. Different assessments of the situation - The last reason is purely business natured. This reason says that employees in the business would either agree or disagree with the change decision. Some people might see the advantage of change while others might see the same factors as the disadvantages. Force Field Analysis The force field analysis is a method which helps in identifying the most important target groups for a campaign, identify competitors, it helps in identifying how to influence these target groups and helps in investigation the balance of power regarding an issue. The driving forces are written on the left while the restraining forces are written on the right. The force field analysis consists of a series of steps according to Valuebasedmanagment.net, 1. Analyze the current situation 2. Know the desired situation 3. Identify where the current situation will go if no action is taken 4. List all the driving forces toward the desired situation 5. List all the restraining forces toward the desired situation 6. Question all of the forces: are they valid Can they be changed Which are the critical ones 7. Give a score to each of the forces using a numerical scale e.g. 1=extremely weak and 10=extremely strong 8. Chart the forces by listing (to strength scale) the driving forces on the left and restraining forces on the right. 9. Determine whether change is viable and progress can occur 10. Analyze how the change can be affected by lowering the strength of the restraining forces or by increasing the strength of driving forces. 11. Always keep in mind that lowering or increasing these forces may create new forces or cause changes in the existing ones. A diagram of the force field analysis will help explain the model better. The stronger the force is; the longer the arrow, the less the strength of the force; the smaller the arrow. According to the Kurt Lewin's model, the restraining factors need to be reduced while the driving factors need to be increased. Currently an equilibrium position exists but these efforts need to be made to achieve the ideal position or state for the company. There are some reasons why these resisting factors exist in the first place; because employees feel unsecure and uncertain when a change is introduced. The change may cause people to have different perceptions and lack of understanding. A change usually leads to redundancies and employees are always concerned about their jobs. Strategies Change, according to the Institute of Industrial Engineers, is a muscle that develops to abundantly enjoy the dynamics of the life set before us. When change takes place, it is awkward at first but after an adjustment period it becomes okay. This adjustment period varies with every individual. Change management is a set of processes that is employed to ensure that significant changes are implemented in an orderly, controlled and systematic fashion to effect organizational change. The goal of change management is to make sure that change is not being resisted by employees and is being properly incorporated. To make the process of change smoother, a structured and systematic approach should be used. One model used in most situations is called the AKDAR model; Awareness, Desire, Knowledge, Ability and Reinforcement (Hiatt, 2006). This model can be readily applied in any medical profession. First there is a need to create the 'Awareness' by sharing the knowledge of why the change is taking place. This may include telling the employees about the drastic actions required to bring a change. Managers use the concept of 'burning platforms' which includes communicating with the employees hard facts of the organization that will alarm the employees. After the employees are made aware of the need for change, a 'Desire' is created in the employees to opt for change themselves. Motivation is a tool used here to build that desire. Then the managers must be given the 'Knowledge' and explained the process of bringing the change at the medical center. This will be by telling the employees that new information systems will be placed that will make their lives easier and also the benefits that are expected out of the new system. Then the 'Ability' to make the change happen should be taught by changing behaviors and implementing new skills. Once the change has taken place, and the employees have settled to the new systems, the change should be 'Reinforced' to sustain the new processes so that the employees don't go back to their old behavior. Another similar yet more widely understood model was developed by Kurt Lewin (Lewin, 1999). His model comprised of 3 phases; unfreezing, moving and refreezing. The 'Freezing' part covered the Awareness and Desire of the ADKAR model. The 'Moving' part covered the Knowledge and Ability part while the 'Refreezing' part is covered in the Reinforcement part. Other models include the Empirical-Rational model where change is managed according to the people who are assumed to think rationally and have selfish objectives; Normative-Reeducative model where it is assumed that all people are social beings and they are concerned with their social outlook; Power-Coercive model assumes that people are scared of their bosses and all other higher authority; and Environmental-Adaptive model which assumes that people quickly forget bad things that have happened previously and adapt readily to new circumstances and situations which suit them. Since there are many assumptions taken, there is no single change strategy for all situations. The best practice is to choose mix of strategies to handle different situations. But which mix to choose depends on factors like Degree of Resistance, Target Audience, Risk, Time Frame, Availability of Expertise and Dependency on employees (Fred, 2006). Kotter explained six change management approaches to be used in specific circumstances. They include 1. communication and education of the change, 2. involving the employees in the change process, 3. facilitating and supporting the employees throughout the change process, 4. negotiating and compromising where employees are in power, 5. manipulating where other tactics will not work or are too expensive, and 6. coercing in those situations where speed is essential Throughout the change process, the employees are always a source of opposition (Kotter, 1996). The doctors at medical center might not want to learn a new computer system and thus resist change. The high level medical staff might not want a new setup and thus resist change. The lower staff may not want to be reporting to new young interns and thus resist change. All these resisting forces may not be removed, however they can be reduced. Training should be provided to help reduce the prejudice attitude that is held by the employees. Policies of the medical center should be altered to fit the new goals. The employees should be involved when making new policies, thus making them feel that they are a part of a group and their comments may be useful as McClelland (1985) said that affiliation to the organization is a very important source of motivation. Some things that the managers should keep in mind before implementing any sort of change are that the manager should ensure that the existing culture and the perception of the employees is not resistant to change. Employees should feel satisfied with their jobs rather than performing their job just to take their salary home. Herzberg (1959) said that hygiene factors such as job satisfaction, security, salary if present would not motivate but if absent (in our case) would cause de-motivation. The work environment must be kept informal where all employees can easily talk to each other and share their ideas (Mayo, 2003). The employees must be given due recognition for the effort and rewards like increased responsibility through job enlargement and job enrichment, profit sharing schemes, giving promotions etc. will help to motivate them. Works Cited 1. HR Next (2000). Four Mistakes That Drive Employee Dissatisfaction and PR Disasters, Vault, Accessed on April 29, 2008 from http://www.vault.com/nr/newsmain.jspnr_page=3&ch_id=402&article_id=53051&listelement=1&cat_id=1123 2. Rosse, J. G. and Saturay, S. L. (2004). Individual Differences in Adaptation to Work Dissatisfaction, University of Colorado at Boulder, Accessed on April 29, 2008 from www.leeds-faculty.colorado.edu/Rosse/Research/WAM04%20presentation.pdf 3. Herzberg, Frederick (1959). The Motivation to Work, New York, John Wiley and Sons 4. Hiatt, J. M. (2006). ADKAR: a model for change in business, government and our community. Prosci Research. 5. Kotter, J. P. (1996). Leading Change. Harvard Business School Press; 1 edition. 6. Lewin, K. (1999). The Complete Social Scientist: A Kurt Lewin Reader. American Psychological Association (APA); 1 edition. 7. Mayo, Elton (2003). The Human Problems of an Industrial Civilization: Early Sociology of Management and Organizations, 1 Edition; Routledge 8. McClelland, David (1985). Human Motivation, Cambridge: Cambridge University Press. 9. Nickols, Fred (2006). Change Management 101: A Primer, Available at http://home.att.net/nickols/change.html, Accessed on April 29, 2008 Read More