Change Management Dissertation
1. Introduction
People, environment and organizations are experiencing changes on the regular basis. People change their attitudes and beliefs, organizations change their structures, and it is all influenced by the constantly changing environment. Changes are not always for better, but the task of the change management is to see the opportunity in the future inevitable change and to prepare all its participants for it, so that the process went easily and smoothly. Therefore, change management is said to be the process or approach of changing people, groups of people and organizations from present state to the future expected one. Change management process can be as organizational, as well as individual. Both approaches have structured models of behavior.
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Management plays the dominant role in change management. Responsibility of management is to notice trends in the macro-environment and also in the micro-environment so as to be capable of defining changes and initiate future programs. It is also essential to evaluate what affect a change will likely have on behavior patterns of the employee, technological requirements, work processes and motivation. Management must foresee what employee possible reactions can be and formulate a change program that will give assistance as workers go through the adopting change process. The program must then be implemented, distributed among employees, monitored for efficiency, and adapted when necessary. Organizations live within an active environment that is subject to change due to the influence of different change «jump starters”, such as developing technologies. To continue to operate efficiently within this environmental random motion, organizations must be able to change themselves as an answer to internal and external changes.
Nevertheless, change will also influence individuals in the company or organization. Successful change management demands the realization of the possible change affects upon people, and how to manage feasible resistance sources to that change. Change can be said to happen where there is the discrepancy between the present state and the environment.
2. The Problem
When one of the theories of change management is supposed to be implemented on practice, first, of course, comes the problem that positions the obstacle for the present and future successful operations and overall activity. And basically it doesn’t matter what kind of problem hindered the development, as the necessary steps and the order remains the same with the only difference of quality and quantity of resources involved. In my situation the problem was of the following character.
Patients needing PEG (Percutaneous endoscopic Gastrostomy, i.e endoscopic insertion of a plastic tube through the stomach to give food for patients who can not swallow direct through the stomach) in a hospital don’t who have a nutrition team (AS IN MOST DISTRICT GENERAL HOSPITAL)have to wait longer time to be assessed and have access to the procedure.
In our hospital the procedure has to be ordered in a normal endoscopy request form, which is not specific for PEG, but is used to order any other routine endoscopic procedures. Ideally PEG request form should contain more details than a normal endoscopy form, as it is more invasive and entails more risk and high mortality.
Then the form is passed to one of the three Gastro consultants, then when he gets time he goes and assess the patient, if suitable the patient is listed on this named consultant list which could be the next week , although there might be a free slot for other consultants list on the same week.
This would cause delay for patients to have the appropriate procedure within the required time scale, resulting in delaying discharge, increased cost, and high risk of being malnourished resulting in being susceptible to other complication like pneumonia and sepsis, and even poor recovery and less regression of the initial problem (especially the stroke).
The problem was initially highlighted by a senior sister on the stroke ward, and brought to the attention of my consultant, where I offered to look into it.
When the problem is clearly stated, the next step is to find, develop and propose possible solution to it, which would benefit all participants of the future change in the fullest extent.
3. The Change
There are three basic dimensions of the strategic change, which include content (goals and purpose), implementation process that explains how all should be done, and finally context, which would take into account internal and external environment where the change would be implemented.
Pettigrew and Whipp claim that there is the continuous interplay between change dimensions. And the change implementation should also flexible to different circumstances and those who introduce changes should be ready to modify its content in the necessary manner. The change is successful when it is the result of interaction between change purpose and goals, change implementation and organizational context.
In order the change be successful, Pettigrew and Whipp conducted the research and proposed five change factors. The first one is called environmental assessment, which includes monitoring of both internal and external organizational environment on the continuous basis by means of open learning systems. The second factor concerns using human resources as assets and liabilities. As employees should be aware of that they are envisioned as valuable and they should also feel the trust and support of the company or organization. The third factor is linking strategic and operational change. It says that not all changes can be immediate and they are implemented though some time. Rather effective can be bundling of operational activities, which can lead to new strategic changes. The forth factor is leading the change. It involves moving organization ahead and creating new and appropriate climate for future change. It also includes activities coordination, steering, agenda setting not just for the change direction, but also for the appropriate values and vision.
So, we had a meeting with all the gastro consultants, stroke senior nurse, endoscopy senior nurses and manager. And during the meeting I suggested creating a new PEG referral form that contains all the details needed for the PEG to be accepted, and if agreed by any of the gastro consultant it could be done by any one of them and not necessarily that one who accepted it. Also we agreed that there should be at least one free slot for PEG each week.
4. Opposition
Change opposition or resistance is very spread in cases of change management, and therefore individuals and organizations should be ready for it and react adequately. Kotter and Schlesinger (1979) described four primary reasons why people can resist changes. The first reason is parochial self-interest, as there can be some people in the organization that are more self-centered and care primarily for the changes that would bring them personally benefit or profit, as well as care how the future changes would influence their own interests. They are not thinking about success of the organization in general. The second reason is misunderstanding, when people can get inadequate or false information about some facts, or the communication barriers between members can occur. The third reason is low tolerance to change, as some people just fear of change and uncertainties in future, and they prefer live in stability and feel secure, than accept changes. This is what Flanagan (1990) about people having fears and anxieties: “What happens beyond this point, however, is not so desirable. Most people have experienced the discomfort-maybe even embarrassment-of a dry mouth, shaky voice, pounding heart, sweaty hands, or wobbly legs, at some time or another. Everyone knows what it is to be frightened or worried about something; the «something» can be concrete, like a bill or illness, or less tangible, like the anticipation of a future unpleasantness--an exam, interview, or work deadline, for example”. And the final reason is about different assessments of the situation, as some employees can not agree with the reasons for future changes and with positives and negatives of the process of change.
So, in my situation, the difficulty was how to leave an empty slot on the endoscopy list, giving the pressure on the waiting times for routine and outpatient endoscopies and the need to reach national targets.
Also a consultant who does not assess the patient might not feel happy to do the procedure for the patient whose been assessed by somebody else.
Well, when there are obstacles on the way to change, it is essential to evaluate the benefits from the change implementation and inconveniences from change opposition, as in the long run it may occur that they are not so serious and can be easily managed.
Kotter and Schlezinger also proposed six change approaches to deal with change resistance or with obstacles to change. The first approach is education and communication, as when there is information deficiency or inadequate information and analysis. One of the most right ways to over come this problem is to educate and inform people about future changes in advance. And after that communicate with them and educate them so that they realize the logic and necessity in change efforts. This would reduce the level of rumors and incorrect information spread regarding the outcomes of the change results for the organization and its employees.
The second approach is involvement and participation. This approach is effective when those people who initiate changes do not possess all needed information for change design and implementation, and other people have enough power to resist those efforts. And it becomes obvious that when employees are being involve in the process of change and can impact with their own suggestions, they are more likely to desire that change then putting more obstacles on its way.
The third approach is facilitation and support. People usually have adjustment problems, when they resist changes. Management should be supportive to employees in any case and in each situation, and in such a manner it can prevent possible resistance. Support of management assists employees to cope with their anxiety, feeling of uncertainty and fear during the period of transition. It such case effective could be trainings, counseling, informal meetings with employees, etc.
The forth approach is about negotiation and agreement. Some people can lose out because of future change in this situation they can possess significant power to resist that change. Management can start the open fight with such people and tell them about what is good about change and that they should not resist it. This can be effective with some employees, and others can be just proposed to leave the company with some benefits, or retire. If such people do not want to experience change, they are not obliged to, and they are free to make the decision, which would correspond to their views and expectations. So, if it is possible to persuade the person or a group of people, it should be done. This approach can be effective when those who resist change are in the position of power.
The fifth approach is manipulation and co-optation. This approach is used in case when other tactics doesn’t work or on practice appear to be very expensive. Authors suggest another efficient manipulation technique that is to co-opt with those who resist change. This can be fulfilled by giving those people who resist the opportunity to participate actively in the activity of the change group.
Some of them can be even selected as leaders to participate in the decision-making process. Obviously those roles and decision-making power would be more symbolic and they should not pose threat to the general change process. And what is the most important with this approach, it that leaders or those people should not understand that they are being tricked, as if they realize that, they can push their resistance even further and it would be almost impossible to cope with it.
And the final approach concerns explicit and implicit coercion. In this approach speed is crucial factor, and this approach should be used only as the last resort. Management can implicitly and explicitly make employees to accept the coming change, by emphasizing that posing obstacles and resistance to change can result in dismissals, employee transfers, job losses, as well as absence of promotion.
5. Intervention
Well, I designed the form which included all the details needed, after consultation with everybody else a few changes were recommended, then the final version were accepted, and printed.
Then it was introduced to all the departments and colleagues and distributed to the wards, to be used instead of the normal endoscopy referral form.
It was planned to be uploaded to the intranet but it proved to be difficult and they are still working on it.
With my intervention I showed my vision of the change and made first steps towards its implementation. According to Richards Beckhard and Reuben T. Harris (1987) there is a change model or change equation that can give the fast first impression of the opportunities and conditions of change in organization. It was so historically developed that the Change Equation was envisioned as the main milestone for the sphere of Organizational Development. But the subject of Organizational Development is being constantly developed reacting to the needs and wants of employees. Such employees not just want to move their companies forward in terms of business goals, but also in terms of employees’ involvement in the process. And nowadays employers understand better the interconnection between success of the organization and employee involvement. To move employees to be involved in change, it is not necessary to force them, and even more- it will not work.
So, the formula of the change equation looks in the following manner: dissatisfaction multiplied with vision and first steps are greater than resistance to change. Therefore, obviously id any of three indices is zero or near zero, the final product will also be zero and change resistance will dominate.
6. Results
The form has speeded up the referral process, improved a better selection for the suitable patient for the PEG, although the pressure on the waiting lists has not made a creation of an empty slot possible, and still each consultant preferred to do the patient he assessed by himself. At the end more suitable patient and less inappropriate referrals were made.
7. Conclusion
In the conclusion I would like to summarize my practical experience and research findings regarding change management. First of all I must say that changes are undividable part of active business environment, which faces external, as well as internal challenges. Therefore employees and management should be ready not only to face those changes and implement appropriate programs, but also be ready for possible resistance and obstacles.
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