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Organizational Change Plan: Managed Care and Nursing


Nurses are considered to be amongst the core personnel who are charged with the direct responsibility of taking care of the patients (Cesta, 2006, p.130). Therefore, the success of a healthcare institution is dependent on its effectiveness in utilizing nursing services. As a healthcare institution, VA is currently experiencing a challenge with regard to the underutilization of nurses. This has resulted in an increment in the firm’s cost of operation.

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Health institution managers are faced with two main challenges. One of the major problems relates to cost containment. In addition; the institution’s members have considered it more effective to seek healthcare services from community hospitals. In an effort to optimize its resource utilization, the firm’s management team has considered implementing managed care services. The core objective of implementing managed care is to ensure increased nursing utilization. Nurses can effectively optimize patient care through influencing policies regarding health care allocation. Managed care entails a system aimed at controlling a healthcare institution’s cost of operation while at the same time improving service delivery to the members.

Over the past few years managed care in organizations has been considered as one of the most effective ways through which healthcare organizations can improve the delivery of services. Through managed care, it is possible for healthcare institutions to improve nurse utilization. This can be attained through prospective utilization management such as demand management. Nurses can increase patients’ access to healthcare services through the provision of preventative services.

In addition, managed care contributes towards cost-saving within an organization. As a result, the concept of managed care has become entrenched within healthcare systems. According to Mayer (1998), managing utilization entails organizing the entire process of care. In order to ensure that managed care is well implemented, a comprehensive strategy should be adopted. The discussion of this paper is aimed at analyzing the implementation strategy to ensure nursing utilization through managed care.

The systems approach

To ensure effective nursing utilization through the implementation of managed care service, VA’s management team will adopt the system’s approach. Implementation of the strategy will involve evaluation of the need for implementing the intended change in the organization. To achieve this, the firm’s management team will collect data internally and externally in relation to nursing utilization. A comparison of the data from the two sources will be conducted so as to support the need for implementing the change. It is also important for VA’s management team to establish benchmarks so as to identify the most efficient and most needed nursing practices. This will aid in determining resource utilization.

It is important for the firm to establish the benchmarks internally (Spector, 2010, p. 35). This arises from the fact that internal benchmarks are more reasonable when applied to a particular organization compared to national benchmarks. Internal benchmarks will be a classic reflection of the firm. Internal benchmarks will also be accepted by the firm’s employees. In addition, the firm should also evaluate the nursing practices which are least required. This will play a significant role in ithe n identification of any form of redundancy in the nursing practices. To ensure maximum nurse utilization, any form of redundancy should be eliminated.

The resultant effect is that the firm will be able to minimize inpatient costs while at the same time improving service delivery. VA should also establish protocols and standards aimed at ensuring that the expected measurable outcomes are delivered (Mayer, 2006, p. 2). A continuous evaluation of the effect of the practice should be conducted to determine its effectiveness. One of the ways through which this can be attained involves collecting information on patients’ outcomes.

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The relationship between the organization’s related processes, systems, and personal or professional roles and their effect on the proposed organizational change

Incorporation of primary care

In an effort to improve nurse utilization, the firm’s management team is committed at improving its processes of an operation via integration of primary care services amongst the nurses. To ensure improved nursing utilization through implementation of managed care within the organization, the firm’s management team will be required to extend the nurses professional role with regard to primary care (Mayer 1).

This means that the firm will endorse a policy aimed at increasing its resources towards delivering optimal primary care services. In order to deliver the services effectively, VA will be required to incorporate non-physicians providers such as the nurses as one of its primary care providers. In order for managed care to be implemented effectively, the firm will be required to formulate a policy directing all its healthcare departments to formulate strategies aimed at delivering primary care programs. Integration of both managed and primary care in its operation process in an effort to improve nurse utilization will increase the probability of success.

Redesigning the job

Lack of an effective job design can result into underutilization of human capital. This culminates into a decline in the firm’s performance as a result of the decline in the employee’s level of motivation. Job designing in VA can entail the adoption of the hospitalist program. Effective use of nurses will minimize variation associated with patient care while at the same time increasing effectiveness and efficiency in resource utilization (Mayer, 2006, p.1).

Currently, lack of well work design amongst the nurses in VA is contributing towards under utilization of their nursing skills and knowledge. In order to implement managed care more effectively, VA will be required to conduct a job redesigning specifically with regard to the nurses. Nurses spend insufficient amount of time undertaking various functions according to their defined roles (Huang, Yano, Lee, Chang, & Rubenstein, 2005).

However, VA’s management team is required to improve on the effectiveness with which the nurses undertake various managed care services. Job redesigning will increase the effectiveness with which nurses attend to patients so as to deliver optimal health services. However, a number of issues should be put into consideration when conducting a job redesign. The system approach should be adopted. In addition, all the processes and system-wide structures should be redesigned to ensure that the change is sustained.

Role enactment

VA has incorporated a collaborative approach in delivery of healthcare services. The collaborative approach ensures that all the parties involved understand each other individual’s role. This serves in increasing individual accountability. In order to attain this, the firm’s management team ensures that there is a certain degree of collaboration between the nurse, the patient and the patient’s family. Through the collaborative approach, nurses are able to enhance their knowledge and skills. The firm’s collaborative approach will play a significant role in the firm’s effort to implement managed care.

Communication technique

According to Borkowski (2010, p. 71), communication is paramount in all the healthcare managerial functions. All the managerial functions in an organization are made possible by effective communication. However, all the managerial decision whether in relation to leading, organizing, planning or directing are made possible via communication. In addition, the target audience must understand what they are required to do in order to act effectively on the decision. Communication is directly related to employee motivation and the level of satisfaction) Taylor, 2005). However, communication presents a challenge to management teams of firms in various economic sectors.

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In order to be effective in implementing the change, the firm will conduct comprehensive coaching on the nurses. The objective of the coaching will be to acquaint all the nurses with the intended change. Through coaching, it will be possible for the firm’s management team to identify the nurses’ reactions in relation to the intended change.

Use of newsletters

To ensure that all the nurses are conversant with the intended change, the firm will produce newsletters which will be made available to all the nurses. The newsletter will detail all the changes related to nursing practices. Through the newsletter, the nurses will be able to note the changes in their duties and tasks and implement them accordingly. This means that the nurses will be able to take the necessary measures as detailed in the newsletter. Newsletters will ensure that there is effective creation of information.

Information Technology

Considering the rate of technological development, the firm will also make use of information technology. The intended change will be communicated to the nurses through use of the firm’s intranet. The intranet will ensure that the firm interacts effectively with the nurses. As a result, any emerging issue regarding implementation will be addressed effectively and efficiently.


From the analysis, it is evident that VA can improve nurse utilization through incorporation of change in the organization. As a result of managed care, there is a high probability of the firm minimizing cost. This arises from the fact that the firm is able to optimize on its resource utilization. However, the success of managed care is dependent on the effectiveness with which the strategy is implemented.

Considering the fact that the firm intends to minimize the cost of operation, adoption of the systems approach will be appropriate. Incorporation of systems approach when integrating change within healthcare institutions enables the firm to coordinate service delivery while at the same time eliminating redundancy. The systems approach adopted should be well controlled through establishment of internal benchmarks. This will increase the degree of collaboration amongst the nurses.

There is a relationship between the organization’s processes, systems, and personal or professional roles with the intended change. In order for managed care to be effectively implemented, VA should ensure that primary care is well undertaken in the organization. One of the ways through which this can be attained is by extending nurses’ role to include provision of primary care. In addition, the firm will be required to redesign the nurses’ roles so as to increase the effectiveness with which nurses attend to patients thus delivering optimal health services. Incorporation of the collaborative approach will also contribute towards the success of the intended change since all the parties will be involved.


Borkowski, N. (2005). Organizational behavior in health care. Sudbury, MA: Jones and Bartlett Publishers.

Cesta, T. (2006). Survival strategies for nurses in managed care. New Jersey: Butterworth Heinemann.

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Huang, P., Yano, E., Lee, M., Chang, B. & Rubenstein, L. (2005). Variations in Nurse Practitioner Use in Veterans Affairs Primary Care Practices. Health Services Research. Vol., 39, issue 4, pp. 887–904. California: Health Research and Education Trust.

Mayer, T. (2006). Managing utilization successfully in 12 not so easy steps: managed care. New York: McGraw-Hill.

Spector, B. (2010). Implementing Organizational Change: Theory into Practice. Upper Saddle River: NJ: Pearson Prentice Hall.

Taylor, S. (2005).Communication for business: a practical approach. New Jersey: Butterworth-Heinemann.

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