Case Study: Leading Organisational Change
Although the CEO of Trust could see what is required of him under increasing political and social pressure, yet he could not foresee what needs to be improved in the hospitals. General employee population could not comprehend what needed to be done and how the suggested action plan would help in future.
For change to happen, it helps if the whole company really wants it. Burns took up the Job with all honesty and she really wanted to improve the situation in her organization, out seen 010 nave some Interests Deanna patient perspective, I. E. , “to try to increase the nursing voice and demonstrate how nursing could 7 contribute to the agenda”.
Due to her underlying personal viewpoint, bias and dual agenda, she could not formulate a clear strategic vision. Conflicting messages seeped through the organization, which ought to make people get a feeling of being used for the wrong purpose.
Clear strategic priorities were not formulated before embarking upon change initiative. Actions were taken as the need arose. A key part of successful change is building and communicating the reasons and the vision for change. Strong communication efforts will not ensure success, but poor communication will certainly sabotage it (Hay Group 2005).
In writer’s opinion, the biggest reason of resistance to Burns was communication barriers. She perhaps underestimated the value of communicating well at all levels of patient care.
Nurses led discharge was given rather too much importance. All the stakeholders involved in the discharge process were not taken aboard. Communication with doctors was extremely poor. This is the group that usually stays quiet, but that shouldn’t have meant that they did not have high stakes in the change recess. When one of the nurses objected to the idea, he was brought individually down to A&E to see patients waiting for long hours.
Such small scale and individually directed acts got Burns’ team to convert only “friends”, but was it the correct way to communicate? Poor relationship with social services was identified as one of the causes of delays in discharge, but this matter was set low on the priority list. 8 “What’s in it for me” Human factor is integral in overcoming resistance to change. The successful implementation of new working methods and practices into a group is dependent upon the willing and effective co-operation of employees and management. When a company’s goals for new behavior are not reinforced, employees are less likely to adopt it consistently.
There was no direct cost to the stakeholders in this scenario, yet someone was going to take someone else’s Job for nothing? “Oh no, discharge planning is boring” “Discharging patients early means more work” “A lot AT paper work” These and other remarks clearly meant that there was no personal interest for the nurses in it.
For years discharging patients had been solely the responsibility of physicians. Why would nurses take that Job? This meant a major shift in the culture which had been practiced for generations. In writer’s experience, medics have only one weak point, I. E. , patient care.
Perhaps Burns and team could have stressed more upon better patient care outcome, than meeting the targets or getting stars etc. These incentives may interest managers but not medics. On many occasions it is seen that the managerial staff and the medics in a hospital, work in the same premises but they don’t seem to work together. They work parallel to each other, but they never Join. There is dire need for making small bridges between these two tracks, so that the ultimate beneficiary could be the patient. Lack of a Creative Response There are three main reasons that diminish the creativeness in search for appropriate change strategies.
Fast and complex environmental changes; which do not allow a proper situation analysis b. Reactive mind-set, resignation; or tendency to believe that obstacles are inevitable Inadequate strategic vision; or lack of clear commitment of top management to changes All of the above hold true for the said case. The Trust had been under heavy erasure due to the programmer of NASH reforms launched by the Labor Government in July 2000, when an ambitious pledge to cut maximum waiting times was unveiled. Penalties were announced for the hospitals and Trusts in the form of reporting to health authorities, restraining funds etc.
On meeting targets, hospitals were being awarded stars and given incentives in the form of funds. King Edgar Hospitals Trust was cash-strapped.
It could only work to meet its targets through the available resources. Expedient measures were taken which caused obstruction in assigning new tasks to already fatigued staff. The writer wonders, did they forget that in hospitals, sick humans were being treated. Every human behaves differently when sick (or in health). The course of similar disease is not necessarily same in everybody.
Things cannot be predicted accurately in a health care setting.
It is not akin to a car factory. It cannot be treated as a production line. Distribution of diseases is not according to per capita. Certain hospitals would receive sicker patients who would stay longer as compared to certain other hospitals (the lucky ones). Political pressure aside, Trust’s own management did not show clear commitment to hat they wanted to achieve.
No matter how well designed and committed Burns and her team were, transformation efforts were prone to sink unless every individual in the organization was prepared to change his or her behavior.
Earlier in the planning they did not think that getting other managers involved in the process was as important as the nurses. If no information is being passed clearly to people and their roles are not defined and given value, they would be very reluctant in taking any initiatives. On one occasion general managers were requested to send the message bout meeting with physicians. When the time arrived it turned out that majority of physicians did not receive any message.
Buns got surprised but it was too late to hold the meeting as per schedule. This agenda was low on general managers’ priority list.
They did not take orders from Burns. They were under no obligation to follow her instructions. They would have liked to help Burns and her team but they had not been made part of the process. If participants can understand the dynamics of the whole process, 1 1 they will realize how their actions affect the rest of the organization.
Cotter (1995) suggested that for change to be successful 75% of a company’s management needs to “buy into” the change. The strongest resistance came from physicians, initially in the form of reactive mindset or resignation and later as breach of their deep-rooted values.
Burns received typical responses like “you can do what you want, but I’m not doing it” or “l don’t see the point” and “it’s a waste of time” Change does not come readily to adults. Lectures, training modules and workshops may lay Dare ten mechanic AT organizational change, out teen are unlikely to revolutionist people’s work practices. The Coo’s attitude towards implementing the change was also questionable.
He perhaps had perceived that there was going to be resistance and he was going to handle it firmly.
A reply like “resistance was futile” depicts that he had not considered the human side of it. Employees will alter their mindset only if they see the point of the change and agree with it. People must understand the role of their actions. It isn’t enough to tell employees that they will have to do things differently. If people believe in the overall purpose of change, they will be happy to change their individual behavior to serve that purpose.
2 Political and Cultural Deadlocks Successful programmer depends not only on carefully conceived strategy, but also on a culture that accepts change.
The idea of nurse led discharge was indeed a culture shock for most of the involved personnel in the hospital. Majority of the nurses choose to be nurses because they want to serve the patients as nurses. Nursing care is different from medical care. Discharging the patient had been considered as “medical issue”. Nurses are loyal to their profession and their patients.
It needed more education and more motivation both for doctors and nurses to believe in the ewe idea. Burns and her team came across strong resistance not only from physicians but also from within their own department of nursing.
In 1957 the Stanford social psychologist Leon Festering published theory of cognitive dissonance, the distressing mental state that arises when people find that their beliefs are inconsistent with their actions. Festering observed in the subjects of his experimentation a deep-seated need to eliminate cognitive dissonance by changing either their actions or their beliefs. Burns should have worked harder to change the beliefs of doctors and nurses.
Other Sources Despite all her efforts Burns failed on most occasions to take other managerial staff on board.
She did gather some of her nursing colleagues around her, but she did not work with multidisciplinary teams. Later during the process when Burns and her team collected a few personnel from other fields, it was perhaps too little too late. Even then they did not take doctors in confidence. RESISTING THE RESISTANCE I racy Burns’ ways AT Implementing change were Emma to Tall. Lets try to evaluate the methods adopted by her to manage the resistance she faced, with the background knowledge of Cotter’s 8-step model (appendix 3) The first workshop by Sue Green was an effort to have an honest and convincing dialogue with matrons.
Unfortunately it didn’t turn out to be success. They put matrons and nursing staff on their priority list as target audience. And even after having a few workshops and meeting they were unable to convince many of them. To create a sense of urgency in the beginning it was important to have many people talking about the change they proposed. Major threats like physicians were not identified early. Other healthcare professionals like 14 physiotherapists and occupational therapists were involved very late in the process.
There were no open discussions to give dynamics and reasons to get people talking and thinking about the need.
One of the senior physicians heard about nurses led discharge only on the day it was being done. Burns made a team, but it was collection of likened people from same profession. One could call it a group of friends working for the same cause. To lead change she needed to bring together a coalition, or team, of influential people whose power came from variety of sources. Having CEO on their side was Just not enough.
Burns should have formed a multidisciplinary team forming a “change coalition” which would intention to build urgency and momentum around the need for change.
Burns & team surely had a vision about their objective but they kept it amongst a small number of people. They tried to communicate their vision through a quick campaign of making posters and distributing leaflets, but that was too little too late. It was also done half heartedly and with only one person’s efforts. It was again lack of team work. “they do have to prompt him with cattle prod”.
Statements like this is self explanatory about the way they tried to remove obstacles. Situation required to identify people ho were resisting the change and help them see what was needed. 5 Burns chose short term targets, but wrong ones. She gave too much importance to nurse led discharge. Whereas improving discharge lounge facilities or reducing waiting time in EAI or reducing admission rates through EAI could have been good short term goals to celebrate.
They did build some momentum in the movement and got many like-minded people involved, some willingly and some unwillingly. But because the basis of change process was wrongly set, it fell apart with the Coo’s departure. Systems which depend on personalities shatter as the person who starts it perishes.