Abstract
London Health Science Centre (LHSC) is among the major hospitals in Canada that offer health care services to seriously ill patients. The hospital, together with other healthcare facilities has recorded a high rate of medical errors for decades. The lack of coordinated operations between physicians, nurses, and other medical professionals contributes to the errors. Additionally, a majority of the patients’ records are filed manually, making it hard for different departments to access the data when it is urgently required.
The complexity of workflow in LHSC’s healthcare system contributes to inefficiencies and paves way for grave and frequently deadly medical mistakes. There is the need for the implementation of a system that can reduce workload and guarantee synergy amid different departments. Susan Johnson, a pharmacy director at LHSC came up with a project dubbed Healthcare Undergoing Optimization (HUGO). She believed that it would go a long way towards minimizing operations cost and guaranteeing patient safety.
The project entailed establishing electronic patient record (EPR) system that would facilitate sharing of patients’ information among nurses, doctors, and other healthcare providers. It was not the first time that HLSC had tried to introduce the EPR system. Previously, the organization attempted to bring in computerized provider order entry (CPOE), which faced stiff opposition from employees. Thus, Susan knew that the realization of project HUGO would be a difficult undertaking. The project faced numerous hurdles among them resistance from workers, financial constraints, a high number of operations that required changing, and meeting the deadlines.
Introduction
Change Management entails preparing, equipping, and helping employees to adopt transformations to promote organizational growth successfully. Even though all changes and employees are unique, studies indicate that there are a set of actions that organizations can utilize to influence workers in their personal development. Change management offers a prearranged approach to assisting workers in an organization to transition from their current state to another one that is more effective (Al-Haddad & Kotnour 2015).
Numerous factors influence the success of change management. They include employee resistance, corporate culture, communication strategy, and value systems among others. According to Al-Haddad and Kotnour (2015), organizations cannot treat change management as a blueprint to pursue blindly. Managing the “people side of change involves one of the most unpredictable variables that you will ever encounter” (Al-Haddad & Kotnour 2015, p. 237).
Hence, an institution requires scaling and tailoring its change management efforts to the capabilities of employees and organizational attributes. This article will use different change management concepts, models, and theories to analyze the implementation of project HUGO at LHSC.
Change Management Models
Lewin’s Change Management Model
Lewin uses the example of an ice cube to describe how change management occurs in an organization. An individual with an ice cube may realize that he/she no longer requires it. Instead, the person could be in the need of a cone of ice. To get a cone from the cube, they require melting the ice to allow them to shape it according to their desires. Lewin refers to this process as unfreezing. One can then cast the iced water according to their preferred shape (change) and solidify it to realize the final results (refreeze) (Manchester et al. 2014).
Organizations ought to view change as a continuous process comprising multiple unique phases. It would allow them to understand future eventualities, thus planning. Most organizations fail to succeed in change implementation because they approach it blindly. Employees must understand the necessity for change before its implementation. Manchester et al. (2014) argue that employees are unlikely to embrace change unless they are motivated. Lewin identifies unfreeze, change, and freeze as three critical phases of change management.
The unfreeze phase entails preparing employees and the entire organization to embrace change. It constitutes the identification of the challenges attributed to the existing status quo to enable employees to appreciate the need for change. Maria (2013) claims that the unfreezing phase comprises developing a persuasive message that explains why there is the need for changing how an organization operates. Susan uses media reports and research from the Institute of Medicine to underpin the importance of introducing the EPR system to LHSC.
She had come up with a comprehensive report detailing all the necessary changes upon request by senior leadership. The story accounted for the challenges that the healthcare facilities were experiencing and how project HUGO could help to resolve them. Even though the cost of implementing the plan was high and the required changes massive, Susan was convinced that HUGO could help to streamline operations and minimize errors.
Challenging organizational beliefs, behaviors, attitudes, and values help to instill a sense of the need for change in employees. Physicians, nurses, and allied healthcare providers did not see the need for change at LHSC because they trusted in the existing system of operations. Some nurses argued that they had perfected the manual system and did not make mistakes. According to Maria (2013, p. 71), “changing the status quo of an organization puts everyone and everything off balance”.
The move may stir up strong opposition from employees. The decision to introduce the EPR system did not go well with physicians, nurses, and allied healthcare experts. They believed that the changes would affect their ways of doing things. Re-examining existing operations at LHSC helped to create a motivation for change, particularly amid the senior leadership.
Lewin’s model holds that the unfreezing phase helps to create uncertainty in an organization. It encourages employees to come up with novel ways of doing things (Sutherland 2013). In the change phase, employees abandon their traditional beliefs and behaviors and agree to embrace transformation. The establishment of a Clinical Informatics Team was a clear indication that the senior leadership and employees from various departments had started to see the need for change. The team was to help in designing, implementing, and sensitizing employees on the significance of project HUGO. The institution of the group was meant to minimize employee resistance.
It would be difficult for workers to embrace change if they do not recognize how it will assist them. Not all employees will comply with changes just because they are necessary and will profit an organization. Sutherland (2013) argues that communication is imperative during change implementation. The Clinical Informatics Team was established to facilitate communication between employees and the information technology staff. It made the workers feel connected to LHSC and the project.
The last phase of Lewin’s model is the refreezing stage, which comes after the workforce begins to embrace changes. Cummings, Bridgman, and Brown (2015) maintain that refreezing phase is critical because it helps to ensure that the transformations are entrenched in organizational culture and realize their intended results. Sustainability is essential when novel changes have been implemented.
The transformations must be institutionalized and officially adopted by all employees. In the case of the HUGO project, the final phase is yet to be executed as LHSC is in the process of persuading employees to embrace the change. Susan understands that failure to establish a new sense of stability may lead to workers not understanding how to execute their duties, thus plunging LHSC into more trouble. She leveraged a report from two Toronto hospitals, which indicated that project HUGO was yielding positive results to convince LHSC stakeholders to embrace the change.
Kotter’s Eight-Step Change Model
Many scholars have built on Lewin’s model to come up with more effective theories of change management. One of such scholars is Kotter, who devised the eight-step model. The model argues that change management involves eight essential steps and skipping one of them affects the success of the transformation. The first step entails creating a sense of urgency. According to Chappell et al. (2016), employees cannot embrace change unless they realize that the current operations threaten their jobs.
They need an assurance that the only solution to the prevailing condition is embracing change. In the case of LHSC, doctors, nurses, and allied healthcare providers were opposed to change because they believe that it will affect their operations. They did not consider the numerous preventable incidents that happened in the hospitals due to a lack of efficient and coordinated activities. Susan needed to remind them about the tragic impacts of medical errors to create a sense of urgency.
LHSC was keen to enhance patient safety and to provide quality care. Nevertheless, the hospital could not realize these objectives with its existing system of operations as it was prone to many errors. Reports that highlighted the effectiveness of EPR in promoting patient safety motivated LHSC leadership, thus the resolution to implement the system.
The second step of Kotter’s change management theory involves the establishment of a guiding team. After employees understand the need for change, organizational leadership should identify individuals who will help to steer ahead of the transformation.
The guiding coalition should comprise employees from all units that will be affected by the intended changes. It will help to ensure that the needs of the various departments are considered during transformation. Susan established a Clinical Informatics Team comprising employees from different departments. The group was to help in the implementation of project HUGO. It served as an advocate for healthcare workers and sought to encourage employees to accept technology.
The third step comprises the development and communication of a vision for change. Employees oppose change if they do not have a clear understanding of its impacts not only on the organization but also on their careers. Hence, a person proposing transformation should formulate a precise change vision to ensure that workers understand it and its significance (Jansson 2013). Apart from creating an idea, it is imperative to come up with strategies to guarantee its achievement. Susan had developed a vision for project HUGO following the request by the senior leadership. She had identified all the required physical and human resources and the essential change effort.
Additionally, Susan had come up with a roll-out plan and an estimated budget for the entire project. She understood that convincing all the stakeholders to support project HUGO was a difficult task. Thus, she conducted a comprehensive analysis of the factors that contributed to medication errors at LHSC. The findings would go a long way towards persuading doctors, nurses, and other healthcare professionals to support changes to the system. Susan made sure that she highlighted the limitations of the existing system in a manner that was understandable to all employees. That way, it was easy to convince employees who were opposed to the launch of project HUGO.
The fourth phase of Kotter’s model concerns communicating the vision. It is imperative to ensure that employees do acknowledge not only the intended change but also support it. As per Rafferty, Jimmieson, and Armenakis (2013), effective communication of a vision can result in employees committing themselves to a transformation. Individuals leading a change ought to communicate with employees whenever they get a chance.
Understanding and addressing the concerns of workers can go a long way towards ensuring that an intended change is supported across the departments. Rafferty, Jimmieson, and Armenakis (2013) argue that communication must be precise and straightforward. Also, it is imperative to understand the mood of employees before passing a message. At LHSC, the majority of the employees are opposed to the introduction of project HUGO. Susan is baffled to find that even her physician friend is openly against the plan. LHSC has not taken sufficient time to communicate the benefits of the intended changes to employees.
It may underline the reason most workers are against the project. Some staff argues that project HUGO will increase their workload. There is a need for the company to communicate the vision of the project to all workers if it expects to win their support. The leadership of LHSC has established a Clinical Informatics Team that is under the direction of Susan. The move marks the first step towards communicating the vision of project HUGO to employees.
The fifth step comprises removing hurdles that might impede the success of an envisioned change. Simoes and Esposito (2014) utter that communicating with workers helps to identify individuals who are opposed to the transformation. An organization ought to make sure that a change process incorporates the ideas of workers who are against its implementation. Kotter’s theory recommends the use of motivating stories from employees to build self-confidence and optimism (Simoes & Esposito 2014). Additionally, an organization can rely on staff with experience in change implementation.
In the past, Susan had worked as the coordinator of pharmacy operations where she amassed experience regarding processes automation. She has sufficient knowledge about the EPR system and can help to allay fears amid the employees that the proposed change will affect their operations. Relaying stories regarding the success of EPR systems in other institutions can go a long way towards eliminating potential employee resistance. Susan has taken advantage of the success story from two hospitals in Toronto to encourage workers at LHSC to embrace project HUGO.
Success motivates employees, making them commit to the transformation (Hornstein 2015). The sixth phase of Kotter’s model involves establishing short-term wins. The formulation of short-term goals helps employees to appreciate what is happening in an organization. The realization of the objectives serves as motivation to workers, encouraging them to expand the change. One of the factors that hinder the success of change implementation is an attempt by the management to pursue complex goals. Organizational leaders and the guiding coalition have a duty to break a project into small, measurable goals.
The goals must be connected to the overall change. Susan appreciates the complexity of project HUGO. Consequently, she has split it into two primary components, which are easy to quantify. They include CPOE and closed-loop medication administration process (CLMP). The failure of the first component hinders the success of the second. Thus, it is possible to determine if the intended transformation is on the course by evaluating the success of CPOE.
The seventh stage of Kotter’s eight-step model of change management entails the consolidation of improvements. According to Small et al. (2016), most transformation processes fail because organizations declare victory prematurely. It is imperative to understand that change is a step-by-step course that requires being integrated into the organizational culture. Short-term wins mark the beginning of a lasting transformation. Small et al. (2016) argue that corporate leaders and coalition teams should continue to look for possible improvements. A company can only consider a transformation to be successful after the realization of multiple short-term goals.
One way of consolidating enhancements involves hiring an appropriate workforce. Susan posits that LHSC requires employing a hundred workers to facilitate the achievement of project HUGO’s objectives. Consolidation of change also consists of the elimination of unproductive processes, inter-departmental procedures, and internal relations that impede the progress of a transformation. Susan has identified the use of written orders and the involvement of numerous personnel in inpatient management as some of the factors that contribute to errors. Project HUGO will help to eliminate these challenges, therefore enhancing efficiency and patient safety.
The final phase of Kotter’s model involves entrenching the change in corporate culture. Tan et al. (2016, p. 18) aver, “A change will only be part of the organizational culture when it has developed into a constituent of the core of the company”. The organizational standards and values must align with the new vision for change to succeed. Additionally, human resource procedures, training and development, reward systems, and other infrastructure areas must be altered to support evolution.
LHSC is yet to implement project HUGO. Thus, the leadership does not know the components that will work and those that might require changes. Nevertheless, it is imperative to come up with measures that will facilitate the success of the project once it is implemented. The leadership should change employees’ attitudes towards the EPR system and make them realize its benefits.
Recommendation
Physicians, nurses, and other healthcare experts are opposed to projecting HUGO because they do not understand its benefits. The employees are accustomed to the current mode of operations and fear that the introduction of a new system would affect their careers. The leadership of LHSC should allay such doubts by explaining the significance of the intended changes. The current system of operations contributes to extended wait times in the emergency units and medication errors.
Employees have to understand that they cannot guarantee the safety of patients with the present way of doing things. The management should ensure that HUGO is accorded a reliable place in LHSC. Moreover, employee training and recruitment must align with the objectives of the anticipated transformation. Offering public recognition to employees who support the project will help to encourage others to come aboard and assist in the realization of the goals of the program.
Reference List
Al-Haddad, S & Kotnour, T 2015, ‘Integrating the organizational change literature: a model for successful change’, Journal of Organizational Change Management, vol. 28, no. 2, pp. 234-262.
Chappell, S, Pescud, M, Waterworth, P, Shilton, T, Roche, D, Ledger, M, Slevin, T & Rosenberg, M 2016, ‘Exploring the process of implementing healthy workplace initiatives: mapping to Kotter’s leading change model’, Journal of Occupational and Environmental Medicine, vol. 58, no. 10, pp. 341-348.
Cummings, S, Bridgman, T & Brown, K 2015, ‘Unfreezing change as three steps: rethinking Kurt Lewin’s legacy for change management’, Human Relations, vol. 69, no. 1, pp. 33-60.
Hornstein, H 2015, ‘The integration of project management and organizational change management is now a necessity’, International Journal of Project Management, vol. 33, no. 2, pp. 291-298.
Jansson, N 2013, ‘Organizational change as practice: a critical analysis’, Journal of Organizational Change Management, vol. 26, no. 6, pp. 1003-1019.
Manchester, J, Gray-Miceli, D, Metcalf, J, Paolini, C, Napier, A, Coogle, C & Owens, M 2014, ‘Facilitating Lewin’s change model with collaborative evaluation in promoting evidence based practices of health professionals’, Evaluation and Program Planning, vol. 47, pp. 82-90.
Maria, S 2013, ‘Lewin’s theory of planned change as a strategic resource’, Journal of Nursing Administration, vol. 43, no. 2, pp. 69-72.
Rafferty, A, Jimmieson, N & Armenakis, A 2013, ‘Change readiness: a multivariate review’, Journal of Management, vol. 39, no. 1, pp. 110-135.
Simoes, P & Esposito, M 2014, ‘Improving change management: how communication nature influences resistance to change’, Journal of Management Development, vol. 33, no. 4, pp. 324-341.
Small, A, Gist, D, Souza, D, Dalton, J, Magny-Normilus, C & David, D 2016, ‘Using Kotter’s change model for implementing bedside handoff: a quality improvement project’, Journal of Nursing Care Quality, vol. 31, no. 4, pp. 304-309.
Sutherland, K 2013, ‘Applying Lewin’s change management theory to the implementation of bar-coded medication administration’, Canadian Journal of Nursing Informatics, vol. 8, no. 2, pp. 1-6.
Tan, S, Lim, W, Liu, S, Phoon, W, Tan, T, Viardot, V, Chan, J, Nadarajah, S & Tan, H 2016, ‘Kotter’s eight-step change model: one center’s experience for transition to the GnRH antagonist protocol’, Journal of Womens Health, Issues and Care, vol. 5, no. 5, pp. 14-31.