Analysis of Change Management in Flowers Hospital - Research Paper Example

Analysis of Change Management in Flowers Hospital The health care management in the modern world faces a lot of challenges that necessitate continual change and transformations. The challenging position according to Campbell (2008) is on how to maintain a competitive edge in the healthcare market while leading the organization through constant change. Rapid changes are occurring in healthcare organizations as they strive to adopt new technology, implement initiatives that affect quality improvements and institute performance plans. The management of public health institutions, therefore, needs an edge in managing this change and helping the workforce in adopting these new ways of doing things. Kotter provides a framework that can guide managers through this process. This paper will analyze the concept of transformational change as brought forth by the philosophies of John Kotter and provide a case study of a public health organization that effected this change. Leading change is a complex and multi-disciplinary task that requires skilled focus and attention of leaders at every level of the organization. Increasingly, it has become the driving force in the success of an organization. However, the process is not easy as it is often characterized by high by high failure rates. Organizations are built for stability with policies, structures, responsibilities, roles and procedures. This stability is inherent that it becomes virtually impossible to think about other ways of doing things and getting people to conform to these changes. The speeds of change and new knowledge create immense pressures for institutions to be always aware and build new strategies to manage the flow of information. Staying focused on the immediate processes and concerns while maintaining a vision for transforming the organization requires the ability to be shrewd. Health care systems in the world have reached a critical turning point. Patients and their next of kin are demanding more information, value for their money and transparency. The innovations in the field of technology and service delivery create a force that drives the need for transformation. The demand for holistic approaches to care, advances in care, value-based incentives, emphasis on lifestyle and behavior modification have created expectations for new partnerships, cutting edge innovations and better patient outcomes in health institutions (Davis, Schoen and Schoenbaum, 2000). Transformational change and governance should thus be the goal of every hospital and health system in today’s world. Effective management and legal structures can help health systems enhance their operations to control costs and improve safety and quality. Kotter observed the behaviors and results of hundreds of organizations and leaders at all levels in their efforts to transform or execute their strategies. He proposed a framework that consisted of an eight-step approach in effecting and managing organizational change. The steps in this model include increasing urgency, building guiding teams, getting the vision right, enlisting a volunteer team, enabling action, creating short-term wins, sustaining acceleration and instituting change (Appelbaum, Habashy, Malo and Shafiq, 2012). Kotter organized these steps into three distinct phases: “creating a climate of change”, “engaging and enabling the whole organization” and “implementing and sustaining change.” Creating a climate of change involves crafting and using identified opportunities in influencing people to sign up to change their organization. The managers then build guiding teams that consist of people with the power and energy to lead and support collaborative change efforts. A strategic vision that will help steers the change effort and develop strategic initiatives to achieve the vision is then set. The second phase in Kotters model involves enlisting a volunteer team that will raise a large force of people who will be ready and willing to drive the change. This change can only be realized if the obstacles to change systems or structures that pose threats to achieving the vision are eradicated. The team should also consistently produce, track and evaluate the levels of their achievement and correlate them with the results. The final phase also known as “implementing and sustaining change” entails sustaining acceleration and instituting change. Sustaining acceleration involves the use of increasing credibility to change systems, structures and policies that do not align with the vision. It also entails hiring, promoting and developing employees that can implement the vision and Reinvigorating the process with new projects, themes, and volunteers. Lastly, change is instituted by demonstrating the connections between the new behaviors and the success of the organization and setting means to ensure leadership development and succession (Appelbaum, Habashy, Malo and Shafiq, 2012). The American Hospital Association is a national organization that was founded in 1898 with an aim of promoting health care provisions in hospitals and health care systems. The organization carries out its mandate through public policy and availing information on health care and health administration to the public and health care providers (AHA, 2011). Hospitals and health systems in the United States face growing pressures to change in the future. Health experts have projected that multiple environmental forces will drive the transformation of health care delivery and financing over the coming decades. These influences according to the American Hospital Association include a rise in provider accountability for the cost and quality of care, demand-altering demographic changes, and uncertainties in health care regulation and so on. As a result, the American Hospital Association formed a committee on performance improvement in 2010 to provide a guidance in supporting development across its membership. The committee on performance improvement identified ten must do strategies that the health care organizations are to implement in order to ensure successful transformational change. Out of the ten strategies, the committee singled out four as major priorities. These included aligning hospitals, physicians and care providers across the health care system and utilizing evidence-based practices in improving quality and patient safety. The third priority was to improve efficiency through productivity and financial management and lastly developing integrated information systems (AHA, 2011). The committee also pointed out that organizational culture is a crucial foundation for the success of the execution of transformation strategies. They emphasized that a culture of performance improvement, focus and accountability enhances an institutions ability to implement the strategies successfully. The right culture is, therefore, an influencing factor in the transformation of hospital care systems of the coming decades. A metric system was also set by the committee to assist in measuring the success of these four priority strategies. Reliable patient care processes, the level of admissions, readmissions and mortality and effective measurement of care transitions were used in measuring the success of evidence-based practices. The evidence-based initiative, patient focused delivery, and multidisciplinary team training have been employed in improving quality and patient safety by several health institutions. Flowers Hospital in Dothan, Alabama is an example of a public health organization that utilized evidence-based strategies in effecting change in the delivery of health care. Flowers Hospital is located in the rural part of Alabama and serves as a referral hospital in the area. The institution has 235 licensed beds and serves an average of 160 patients daily. It caters for patients under Medicare and blue cross as well as self-pay patients. Flowers hospital had for a long time experienced delays in identifying higher risk patients that led to low outcomes manifested in the high mortality rates and readmissions. However under the leadership of Keith Granger the hospital progressed from average to exemplary in the Centers for Medicare and Medicaid services processes of care in high-risk diseases. The institution was able to accomplish the above in a period less than two years (Edwards, 2008). The organization incorporated a unique approach that enabled them achieve high performance. The approach had five elements; patient identification, concurrent review, tools for frontline staff, quality improvement team and performance oversight and accountability. These elements were in line with Kotters proposed strategy in effecting transformation changes. Flowers Hospital set out a mechanism that identified patients who suffered from high-risk diseases (Heart attack, pneumonia, heart failure or surgical infection)before they were hospitalized. Identifying these patients as target groups was an essential component in the hospitals quality strategy. Patients who suffered from heart attack and surgical infections were easily identified as opposed to those suffering from pneumonia and heart failure because the admitting diagnoses are often characterized by several conditions. New admissions were reviewed for likely cases of pneumonia and heart failure and through analysis of the medical histories. This move ensured that appropriate care was provided accordingly and in a timely manner (Edwards, 2008). A concurrent nurse reviewer was then assigned to a group of eligible patients to monitor and ensure that their care met the standards and intervened as needed. The nurse kept tab of the patient’s charts and reviewed whether the patient was a candidate of the prescribed care. (Edwards, 2008). The quality improvement department developed packets using different colors foe each medical condition. The packets described the care standards and contained patient education material, steps to be followed in providing care and additional tracking information. A brightly colored label placed in the chart enabled easy identification of the patients conditions and indicated the schedule of care to be provided by the nurses. This allowed the concurrent reviewer to monitor the progress in caregiving. Flowers Hospital had an interdisciplinary quality improvement team for each of the high-risk conditions. These teams were led by nurses, pharmacists, and other clinicians. The team reviewed data on compliance with the CMS standards, identified failures and their root causes and proposed modifications in the care process whenever necessary. This move ensures continual adherence to the guidelines in the future. Finally, the leaders of each team met the CEO and discussed shortcomings and established accountability measures for achieving the goals among the staff members. The results of these strategies were impressive. According to AHA (2011), Flowers Hospital attained a 99.7% compliance rate with CMS core measures in 2007. The score being the second highest to have ever been recorded in the United States. The hospital achieved exemplary performance across all its core measures. They however encountered some challenges in the implementation of these strategies. For example, the screening that took place during patient identification was not able to identify and track all the data recorded. The hospital missed between 30 and 50 new heart patients every month (Edwards, 2008). By the time these flaws were recognized, the patients had been discharged, and there was no chance of improving the experience of the patient. A majority of the patients who missed out turned out to be renal patients. On realizing this shortcoming, Flowers Hospital formulated a framework that include renal conditions in the high-risk disease category. All renal patients were scanned for heart failure and were subjected to the B-type natriuretic peptide tests to ascertain the risk of heart failure. There were also shortcomings in the tools used by the frontline stuff. The color coded packets did not explicitly outline the care protocols for heart attack and heart failure patients. As a result, these patients were not accorded with the recommended care standards. For example patients whom suffered from heart attack and had aspirin allergies appeared to be out of compliance with the set recommendations for providing aspirin upon arrival. This was because doctors were not adequately documenting this exemption (Edwards, 2008). This limitation necessitated the integration of progress notes in which the nurses and physicians checked off the relevant exclusions and staff reports. Pre-printed orders also enabled the achievement of greater levels of uniformity in the care process. Patients that were admitted for surgery for example were given standing orders that indicated the commencement and stop of the recommended antibiotics. This enabled the physicians check off the right drugs and dosage more efficiently. The leadership skills of Keith Granger, the chief executive officer of Flowers Hospital was instrumental in the success of the evidence-based initiatives and strategies. Edwards (2008) points out that Keith’s willingness in taking up a calculated risk in adopting these health care policies contributed to the positive outcomes. He not only trusted his instincts but also involved his work personnel in laying down policies and reviewing the progress. Keith showed a willingness to adapt and respond to the constant changes in the healthcare environment. This is evidenced in his ability to formulate and incorporate new strategies whenever there were shortfalls. The chief executive officer also showed the willingness to listen and entertain new ideas. His move to creating interdisciplinary teams tasked with reviewing the compliance process and reporting their findings and recommendations indicated his willingness in considering new ideas. Keith’s motivation skills enabled the staff of Flowers Hospital embrace the initiative. He executed staff motivation through the issuance of personal and positive feedbacks to his workforce and monitory incentives. Keith’s visionary leadership has earned him recognitions from the Alabama hospital association, the Alabama Quality Assurance Foundation, and the American Hospital Association. The American Hospital Association recognized Keith Garner for his leadership on quality and safety through grassroots work with organizations in Alabama. Flowers Hospital has a result been used as a benchmark institution in evidence-based practices due to its successful work processes. It is evident that transformational change and governance in today’s healthcare sector requires the unique combination of skills, experience, leadership and strategic vision. The pace in advancements of information technology necessitates transformational changes in health care institutions (Grol, Wensing, and Eccles, 2004). The process of effecting change is complex and requires an in-depth analysis of the challenges and obstacles. In order to successfully effect these changes, health care organizations need to focus on the development of their leadership capabilities through training and awareness programs, mentorship and skill development programs. It is only through effective leadership systems that health institutions can realize transformational changes. References American Hospital Association (2011). Hospital and Care Systems of the Future: A report from the AHA Committee on Performance Improvement: Available at < http://www.aemh.org/pdf/AEMH11-105Info-AHAHospitalsandHealthSystemsof theFuture.pdf > [Accessed 9th April 2015] Appelbaum, S. H., Habashy, S., Malo, J. L., & Shafiq, H. (2012). Back to the future: revisiting Kotters 1996 change model. Journal of Management Development, 31(8), 764-782. Campbell, R. J. (2008). Change management in health care. The health care manager, 27(1), 23-39. Davis, K., Schoen, C., & Schoenbaum, S., (2000). A 2020 Vision of American Health Care: Archives of Internal Medicine, 160: 3357–62. Edwards, J., (2008) Flowers Hospital: Nearing Perfection on Core Measures. The Commonwealth fund. 1193 (1). Available at< http://www.commonwealthfund.org/~/media/files/publications/case-study/2008/dec/flowers-hospital--nearing-perfection-on-core-measures/edwards_flowers_case_study_1193-pdf.pdf > Accessed 9th April 2015] Grol, R., Wensing, M., & Eccles, M., (Eds). (2004). Improving Patient Care. The Implementation of Change in Clinical Practice. Oxford: Elsevier. (Grol, Wensing and Eccles, 2004) Read More