MODULE

06R4 P

ELIZABETH R. ROXAS, RN, MSN

Change Management

FELY MARILYN E. LORENZO, RN, DrPh

INTRODUCTION

The only constant aspect of organizations is change. Change is necessary to adapt to the changing environment. Organizations must modify themselves all the time. Even large organizations must find ways to act like small, flexible organizations. Change management is critical to achieve and sustain competitiveness and responsiveness.

As Philippine nursing sector prepares to disseminate the 2012 National Nursing Core Competency Standards, master trainers need to be made aware of the change process and how it can be harnessed to bring about effective adoption and utilization of the new standards by the academe, practitioners and organizations where nurses work.

MODULE

3INTRODUCTION

1

MODULE OBJECTIVES

After going through the module, you, the Master Trainer, will be able to:

1. Define Change and Innovation2. Identify and discuss the process of Change3. Describe the actions required to set the stage for organizational change4. Identify ways to empower individuals to change5. Begin planning how to teach others about National Nursing Core Competencies

TOPIC OUTLINE

1. Change and Innovation 2. Process of Change 3. Types of Change 4. Managing and leading organizational change 5. Guidelines to empower individuals to change 6. Planning how to teach others about National Nursing Core Competency Standards

2 INTRODUCTION

MODULE CONTENT

WHAT IS CHANGE/INNOVATION?

Change is the only constant. Heraclitus, Greek philosopher

In any organization and in all of life, the only constant is change itself. Hence, in any work setting especially in health care, change has to be managed and led effectively.

Organizational change is a generic concept that constitutes any modification in operations, structure or goals of the organization. It is also adoption of a new idea (e.g. standards) or behavior by group or organization. Organizational innovation is a perceived to be new to an organization, work group or individual. It is also adoption of an idea (standards) or behavior that is new to the organizations industry, market or general environment. All innovation is considered change but not all change is innovation (Shortell and Kaluzny, 2001).

The introduction of the 2012 National Nursing Core Competency Standards (NNCCS) will bring about significant change within the whole nursing sector and within nursing units where the standards will be utilized to ensure quality nursing change.

The process of introducing the NNCCS effectively will necessarily go through several stages. These stages include: 1. Awareness of the need for change This is the initial stage of the change process where individuals realize that there is a discrepancy or gap between what they are currently doing and what they should be doing. This awareness may be stimulated internally by expectations of organizational participants or it may also be driven externally by community or regulatory pressures affecting the performance of the organization. 2. Identification of potential change strategies or solutions to the discrepancy or gap. This stage involves an attempt to address the discrepancies or performance gaps identified in the first stage. This may occur at various levels within the organization, and the critical challenge is to ensure that the identified solutions are quickly moved to implementation. 3. Implementation involves actual operations of the change within the organization at the specific work unit levels. 4. Institutionalization involves the integration of the change into ongoing activities and the prevailing culture of the organization. It is observed that while many changes are implemented, only few are successfully internalized within the organization. This an important stage that will ensure sustainability and successful change efforts if done well (Shortell and Kaluzny, 2002, Daft).

The aforementioned stages of the change process are interactive in nature in that Institutionalization is contingent on implementation, implementation is affected by identification and identification is dependent on awareness.

The process is also affected by a complex set of interacting factors. The prevailing organizational structure and processes, such as the degree of organizational complexity and formalization as well as levels of communication, coordination and availability of resource, all influence whether a change or innovation prospers through the different stages of the change process.

Change is a continuous and iterative process. The internal organizational environment is dynamic and evolving within which the organization functions. Changes are institutionalized and require continual assessment. Subsequent awareness of any discrepancy between what the individual or organization is currently doing vis--vis what it should be doing should stimulate the process once again.

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TYPES OF CHANGE

Health services organizations may undergo different types of change namely technical; product or service change; administrative, structural, or strategy change; or human resources change. Some individuals and organizations are able to better handle some types of change than others. Managers of change need to understand the types of changes, their interactions, and the factors which influence the successful implementation and institutionalization of the various types of change (Shortell and Kaluzny, 2002).

Technical Change is about changing the basic modalities that organizations use to deliver health services. This change may involve modifications in the practice patterns of nurses, changes in the flow of patients into or through the health facility, change in job assignments and responsibilities of professionals within the health care organization or change which results in the purchase of new equipment to provide existing services. For example, purchase of a new intravenous (IV) drip counter may change the speed by which nurses manage IV lines.

Product or Service Change is concerned with the introduction of new products or services in the health care facility. Teaching hospitals may provide new evidence in modalities of pain management that may prompt other health care facilities to utilize these new modalities that will improve patient care.

Administrative, Structural or Strategy Change consists of changes in the managerial or administrative activities of the health care organization. These may involve changes in organizational structure, human resource policies, organizational strategy, use of integrating mechanisms within the institution, management and clinical information systems, and financial systems. For example, many government hospitals now have private hospital components such as Philhealth beds or wards that are utilized to subsidize the care of charity or service in patients.

Human Resource Change may constitute efforts to influence attitudes, behaviors, skills and values of employees. For example, new standards such as NNCCS may specify new behaviors expected of beginning nurses in practice to conform to the new standards.

The types of change are not mutually exclusive and effective management of change may require considerable insight into the type of change and appropriate strategies to facilitate the change process.

MANAGING AND LEADING ORGANIZATIONAL CHANGE

There are many theories and approaches about how to accomplish change. Many originate with leadership and change management guru, John Kotter. A professor at Harvard Business School and world-renowned change expert, Kotter introduced his eight-step change process in his 1995 book, Leading Change. These are summarized in the following section and related to nursing organizational changes when feasible. Practical guidelines on how to accomplish each step are also discussed.

Step 1: Create Urgency

For change to happen, it helps if the whole organization really wants it. Develop a sense of urgency around the need for change. This may help you spark the initial motivation to get things moving.

This isnt simply a matter of showing people statistics of medication errors or patient accidents or talking about improving health facility performance. Open an honest and convincing dialogue about whats happening in the nursing and health care industries and trends your competitors or other health care organizations (HCOs) are exhibiting and why there is a need for change If many people start talking about the change you propose, the urgency can build and feed on itself.

4 INTRODUCTION

Guidelines: Identify potential threats, and develop scenarios showing what could happen in the future. Examine opportunities that should be, or could be, exploited. Start honest discussions, and give dynamic and convincing reasons to get people talking and thinking. Request support from clients/patients, outside stakeholders and nursing sector movers and shakers to strengthen your argument.

It should be noted that Kotter suggests that for change to be successful, 75 percent of an organizations management needs to buy into the change. In other words, one has to work really hard on Step 1, and spend significant time and energy building urgency, before moving onto the next steps. His advice is not to panic and jump in too fast because you dont want to risk further short-term losses if you act without proper preparation, you could be in for a very difficult change process.

Step 2: Form a Powerful Coalition

Convince people that change is necessary. This often takes strong leadership and visible support from key people within your organization. Managing change isnt enough you have to lead it. You can find effective change leaders throughout your organization they dont necessarily follow the traditional company hierarchy. To lead change, you need to bring together a coalition, or team, of influential people whose power comes from a variety of sources, including job title, status, expertise, and political importance.Once formed, your change coalition needs to work as a team, continuing to build urgency and momentum around the need for change.

Guidelines: Identify the true leaders in your organization. Ask for an emotional commitment from these key people. Work on team building within your change coalition. Check your team for weak areas, and ensure that you have a good mix of people from different departments and different levels within your company.

Step 3: Create a Vision for Change

When one first starts thinking about change, there will probably be many great ideas and solutions floating around. Link these concepts to an overall vision that people can grasp easily and remember.A clear vision can help everyone understand why youre asking them to do something. When people see for themselves what youre trying to achieve, then the directives theyre given tend to make more sense.

Guidelines: Determine the values that are central to the change. Develop a short summary (one or two sentences) that captures what you see as the future of your organization. Usually this is your change vision statement. Create a strategy to execute that vision. Ensure that your change coalition can describe the vision in five minutes or less. Dont just call special meetings to communicate your vision. Instead, talk about it every chance you get. Use the vision daily to make decisions and solve problems. When you keep it fresh on everyones minds, theyll remember it and respond to it. It is also important to walk the talk. What you do is far more important and believable than what you say. Demonstrate the kind of behavior that you want from others. Practice your vision speech often..

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Step 4: Communicate the Vision

What one does with your vision after you create it will determine your success. Your message will probably have strong competition from other day-to-day communications within the company, so you need to communicate it frequently and powerfully, and embed it within everything that you do.

Guidelines: Talk often about your change vision. Openly and honestly address peoples concerns and anxieties. Apply your vision to all aspects of operations from training to performance reviews. Tie everything back to the vision. Lead by example.

Step 5: Remove Obstacles

By now, youve been talking about your vision and building buy-in from all levels of the organization. Hopefully, your staff wants to get busy and achieve the benefits that youve been promoting.

But is anyone resisting the change? And are there processes or structures that are getting in the way of accomplishing change?

Put in place the structure for change, and continually check for barriers to it. Removing obstacles can empower the people you need to execute your vision, and it can help the change move forward.

Guidelines: Identify, or hire, change leaders whose main roles are to deliver the change. Look at your organizational structure, job descriptions, and performance and compensation systems to ensure theyre in line with your vision. Recognize and reward people for making change happen. Identify people who are resisting the change, and help them see whats needed. Take action to quickly remove barriers (human or otherwise).

Step 6: Create Short-term Wins

Nothing motivates more than success. Give your company a taste of victory early in the change process. Within a short time frame (this could be a month or a year, depending on the type of change), youll want to have results that your staff can see. Without this, critics and negative thinkers might hurt your progress.Create short-term targets not just one long-term goal. You want each smaller target to be achievable, with little room for failure. Your change team may have to work very hard to come up with these targets, but each win that you produce can further motivate the entire staff.

Guidelines: Look for sure-fire projects that you can implement without help from any strong critics of the change. Dont choose early targets that are expensive. You want to be able to justify the investment in each project. Thoroughly analyze the potential pros and cons of your targets. If you dont succeed with an early goal, it can hurt your entire change initiative. Reward the people who help you meet the targets.

6 INTRODUCTION

Step 7: Build on the Change

Kotter argues that many change projects fail because victory is declared too early. Real change runs deep. Quick wins are only the beginning of what needs to be done to achieve long-term change.

Launching one new product using a new system is great. But if you can launch 10 products, that means the new system is working. To reach that 10th success, you need to keep looking for improvements.

Each success provides an opportunity to build on what went right and identify what you can improve.

Guidelines: After every win, analyze what went right and what needs improving. Set goals to continue building on the momentum youve achieved. Learn about kaizen, or CQI, the idea of continuous improvement. Keep ideas fresh by bringing in new change agents and leaders for your change coalition.

Step 8: Anchor the Changes in Organizational Culture

Finally, to make any change stick, it should become part of the core of your organization. Your corporate culture often determines what gets done, so the values behind your vision must show in day-to-day work.

Make continuous efforts to ensure that the change is seen in every aspect of your organization. This will help give that change a solid place in your organizations culture.

Its also important that your companys leaders continue to support the change. This includes existing staff and new leaders who are brought in. If you lose the support of these people, you might end up back where you started.

Guidelines: Talk about progress every chance you get. Tell success stories about the change process, and repeat other stories that you hear. Include the change ideals and values when hiring and training new staff. Publicly recognize key members of your original change coalition, and make sure the rest of the staff new and old remember their contributions. Create plans to replace key leaders of change as they move on. This will help ensure that their legacy is not lost or forgotten.

KEY POINTS

You have to work hard to change an organization successfully. When you plan carefully and build the proper foundation, implementing change can be much easier, and youll improve the chances of success. If youre too impatient, and if you expect too many results too soon, your plans for change are more likely to fail.

Create a sense of urgency, recruit powerful change leaders, build a vision and effectively communicate it, remove obstacles, create quick wins, and build on your momentum. If you do these things, you can help make the change part of your organizational culture. Thats when you can declare a true victory. Then sit back and enjoy the change that you have envisioned so long ago.

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Figure 3.1 Spread and Embed Aspects of NNCCS process of Change (Borromeo, 2013)

DISCUSSION QUESTIONS

1. What are the types of change that the NNCCS development in each health care setting requires i,e, academe, community and practice? 2. How would you go about introducing and sustaining change? 3. What are the usual challenges or barriers that one would usually encounter in instituting change?

APPLICATION

Planning for Change at the Institutional Level