Change managementis

Change managementis a structured approach to transitioningindividuals,teams, andorganizationsfrom a current state to a desired future state.

John P Kotter's 'eight steps to successful change'

Increase urgency-

inspire people to move, make objectives real and relevant.

The change agent had clearly defined problem and need for improvement. The change agent had personal experience, credibility and authority to direct the change. The leader shared the knowledge and views that he had about the situation. The leader formed a task force of champions to shape ideas into practical solutions.

The change agent did it in another way of mobilizing team’s commitment and arranged for the team to look outside the box. He took them on a tour of a leading organisation to see other ways of doing the same thing first hand. The team was very much impressed with the work and expressed more interest in knowing the further details. Besides this there were other financial incentives, security of job, better working, and opportunities to develop new skills and extend influence. Workshops were e very useful processes to develop collective understanding. This helped the team to reach the same conclusion that the change agent had arrived.

Staff surveys were also a helpful way to repair damage and mistrust among staff. Management training, empathy and facilitative capability were priority areas .The management was crucial to the change process; therefore they facilitated the process of learning.

Management empowered people to find their own solutions and responses, with facilitation and support from managers, and tolerance and compassion from the leaders and executives. Management’s leadership, and behavior were encouraging and employees had a firm trust in organization.

The objectives were real and relevant:

The change was necessary and urgent, and the benefits of change were explained: The present paper system was to be replaced with an electronic health record system. The top issues related to the change were, training and further familiarization with the E.H.R-System.

Business benefits EHR-System::

1. Reduce healthcare costs;

effective way to avoid duplicating expensive imaging procedures, and reduction of medical errors.

2. Improve the quality of care:

It is claimed to help reduce medical errors by providing healthcare workers with decision support. Fast access to medical literature and current best practices in medicine are hypothesized to enable the proliferation of ongoing improvements in healthcare efficacy.

Promote evidence-based medicine:

EHRs provide access to clinical data for research that can accelerate the level of knowledge of effective medical practices.
The reason for improvement was clear and benefits were measureable. Moreover the project was within clinic’s fund limits.

2. Build the guiding team-

Get the right people in place with the right emotional commitment, and the right mix of skills and levels.

Management hired a team of IT experts in healthcare whose roles were to deliver the change and assist the staff to execute the change. This assisted greatly to execute this type of change without greater resistance. The hired consultants had experience and reputation of managing Electronic Health record projects. The co-operation and pro-active support of stakeholder was important. Essential Stakeholders and sponsors were identified and their level of influence assessed and mapped through stakeholder analysis. Workshops were conducted to address the issues and stake holder agreed to support and commitment. There was a good communication and common understanding amongst the stakeholders about the degree and scope of change needed.

Get the vision right-

get the team to establish a simple vision and strategy focus on emotional and creative aspects necessary to drive service and efficiency.

Getting the vision right, this was the leadership, who was taking their team to where they cannot go on their own. At this step learning was kicked into play in this process of change. By having teams with new goals and accountabilities the leader facilitated learning through all members of the team. The changes in roles and responsibilities. Changed patterns of coordination increased employee participation, collaboration, and information sharing. This step helped agents of change to identify those who cannot fit in the new organisation.

There was a clear and detailed vision of the future. The change vision was aligned with the organization’s strategy of continuous improvement. It involved key stakeholders in defining and detailing the change vision. Again, workshops were conducted in developing the change strategy. High-level benchmarking was conducted to identify best practices, reference sites and competitor information.

The management team set out the "7 S" framework to help diagnose the current health of organisations and to help develop their visions for the future.10their research suggests that any intelligent approach to organizing should involve the following:

1. Structure (roles, responsibilities, organisation, structure)

2. Strategy (direction)

3. Staff (numbers and skills)

4. Management style (leadership and management approach)

5. Systems and procedures

6. Guiding concepts and shared values (ways of doing things, operating style)

7. Corporate strengths and skills (general competencies).

Developing and presenting a vision had a key role in motivating staff as well reassuring them about the journey and how they might be involved.

A vision can be expressed in different ways and these are important at different stages of change.

High level visions of achievement and outcomes.

High level visions play key roles at the start. They build on the problems and threats that provide the case for change, but address them positively. They can motivate staff by showing benefits.

Outline visions of service that helped move staff from finding problems to building solutions without involving detailed negotiation on changes.

A detailed vision of service and organisation: This allows staff to imagine how their work life will be in the future. Building on the details may allow them to have some influence on their destiny.

A vision of the journey

This provides a structure for communication during the change.

The service model was made for building support for change. That outlined the change and also the benefits at the end. The benefits were; improved outcomes for patients, and better futures for staff. The service model helped subsequent translation of change in terms of:

* Structure (new roles and responsibilities across professions)

* Staff (changes in skill mix)

* New skills (multidisciplinary working)

* Systems and procedures (new protocols for referrals)

* Management style (focus on outcomes as well as process)

* Shared values (the emphasis on assessing and responding to the full range of patient needs).

Communicate for buy-in- Involve as many people as possible, communicate the essentials, simply, and to appeal and respond to people's needs. De-clutter communications - make technology work for you rather than against.

The managed involved all stakeholder, medical societies, and NGOs in healthcare, and also some international hospitals. The essential of change were communicated. Simply:

* Electronic health records will become a "must-have" for healthcare organizations

* EHR adoption will be inevitable due to internal as well as external factors

* Improving the quality of care is a priority for healthcare organizations

* Other healthcare players will "encourage" late adopters to implement EHRs

* An overwhelming market is difficult for hospitals and physician offices to navigate

Change was communicated in a clear, concise way to capture the minds and hearts of the entire organization.

The co-operation and pro-active support of stakeholder was important. Workshops were conducted to address the issues and stake holder agreed to support and commitment. There was a good communication and common understanding amongst the stakeholders about the degree and scope of change needed.

The team had Coordination, Commitment, and Competence. These three components are essential for introducing change .Change is the external manifestation of transition .while Transition is the psychological aspect of change: how people feel towards change, their attitudes, their internal plans, and their personal vision of change.

Win Commitment to Change

Change was determined as its actions were consistent with the change vision. Therefore, effective Stakeholder Communications and Management are vital components of winning commitment to and delivering change. Ongoing effectiveness was traced through Staff Surveys.

* Stakeholders were managed on an on-going basis. Communication was established through weekend updates, emails, letters and also mobile phone msgs.

* A large part of winning commitment is also about managing change resistance. Understanding Human Responses, Change Resistance and Managing Conflict is vital.

Questionnaire and staff satisfaction surveys were quite effective in determining the views of employees and allowed people to voice their opinions about the change program.

* Role of change agent was vital.

Empower action

- Remove obstacles, enable constructive feedback and lots of support from leaders - reward and recognise progress and achievements.

Create short-term wins- Set aims that are easy to achieve - in bite-size chunks. Manageable numbers of initiatives. Finish current stages before starting new ones. Deliver Change delivering change is the crux of the change management program. Change is realised when it becomes the normal way of working, this requires proof that performance has improved and will continue in the future. Quick wins were identified in the forms of electronic health records being printed and stored in one location. That saved time and efforts that were used in compiling paper records.

Senior management communicated results delivered through quick wins to the organisation.

The quick wins increased the momentum and also early positive feedback was also t was very encouraging essential for the on-going success of a change management program.First milestone was celebrated after feedback was very positive.

2. Don't let up- Foster and encourage determination and persistence - ongoing change - encourage ongoing progress reporting - highlight achieved and future milestones.

3. Make change stick- Reinforce the value of successful change via recruitment, promotion, new change leaders. Weave change into culture.

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