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Chapter 2
THE CHALLENGE OF CHANGE
Objectives 1. Identify the impact of change on organizational
life. 2. Identify the managers role as change agent. 3. Review examples of successful change. 4. Examine a major change having ongoing impact. 5. Describe the organizational change process. 6. Identify specific strategies for dealing with
resistance to change.
The Impact of Change
consumes financial and administrative resources
drains emotional and physical energy away from primary goals
adds a new function to managers role: change agent
Attributes of the Successful Manager
Communication Leadership Adaptability Relationship Building Develops Others Develops Themselves Observation and Awareness
As a Manager: OBSERVE
Successful managers: Are aware of the skills of their employees Know in advance who might resist change Maintain an Open Door policy to the staff
A successful manager observes the team without it being obvious.
Change: Everybody has an opinion..
The Change Curve
The Change Process for the Organization
The Change Process for Managers
The Change Process for Employees
The pyramid components depicted here must be established well in advance of a change project.
Employee Expectations
The Manager as Change Agent mediates imposed change by adjusting patterns of
practice, staffing, and administrative routines monitors horizon events through active
assessment of trends creates a change-ready environment takes the lead in accepting change
Gripes go up the chain of command!
Examples of Successful Change Y2K: change as opportunity Patient Self Determination Act of 1990 (PSDA) HIPAA: extensive change due to legislation Electronic health record: proactive change Economic and market forces: anticipatory
readiness restructuring Disruption in personal circumstances:
revitalization through career development
Change as Opportunity: Y2K
1. Carefully define the characteristics of the anticipated change
2. Compare approaches 3. Use the opportunity to make a major change
(new systems) all at once 4. Use the opportunity to assess and update
related plans
Change as Opportunity: Y2K Characteristics of this event: A definitive event with an exact timetable Given significant time to plan for Some unknowns and uncertainty with clearly
known technical dilemmas Funding for preparation readily available for
organizational survival (not stated in text) Catalyst in overall emergency preparedness and
disaster planning for healthcare institutions
The Routinization of Change: Patient Self Discrimination Act
outreach to educate re: living wills review and update DNR and related protocols review plan of care re: balance of life admission increase emphasis on spiritual and psychological considerations renew involvement of the Ethics Committee augment documentation and related administrative processes to
reflect the details of this sequence of care
**The changes stemming from this law were easily managed through systematic review and adjustment of existing, well established routines.**
HIPAA (1996): Extensive Change via Legislation
Major aspects: employee health insurance portability promote medical savings accounts set standards for covering long-term care administrative simplification, including privacy
** The initial intent of HIPAA was to enable workers to change jobs without fear of losing healthcare coverage.**
Title II of HIPAA: Administrative Simplification
Focus on the Privacy Rule An unanticipated, massive change
new policies and procedures re: patient information
training programs for all employees re: privacy
monitoring programs for compliance
Title II of HIPAA (contd)
maintaining documented proof of compliance setting up trust agreements with suppliers, etc. addressing physical layout to ensure privacy establishing position of Privacy Officer
** The term administrative simplification is misleading because it included several requirements designated for implementation at different times. The effects that HIPAA had on the healthcare industry were much more pronounced than initially anticipated.**
The Electronic Health Record: Proactive Change
a welcome change to enhance existing documentation practices
a change flowing from emerging technology an opportunity to link ongoing vision and
mission to new technology an opportunity for leadership
EHR: Five-Fold Strategy
1. individual initiative within the work place. 2. advocacy in the public arena 3. partnership with key stakeholders 4. outreach to clients/patients 5. continual adjustments to the information
system
Individual Workplace Initiative continual adoption of new technology gradual conversion of workflow and processes internal administrative systems as building
blocks for expansion of computerized systems to include the electronic
health record ** Workflow and processes have been gradually converted over time to automated systems.**
Advocacy in the Public Arena
Contribute professional knowledge to the debate
Assist lawmakers and regulatory agency officials with technical detail
Participate in work groups and task forces re: the issues
Partnership with Key Stakeholders
American Health Information Management Association
American Health Information Community (DHHS)
American Medical Informatics Association Medical Group Management Association National Library of Medicine Corporate Partner Industry Briefing
Outreach to Clients/Patients AHIMAs Community Education Campaign public
awareness AHIMA-created presentations at local level
Consumers are an important partner in the effective use of the electronic health record. Raising public awareness is important in establishing trust in the process of revealing personal information fully and truthfully during healthcare interactions
Health Information Exchanges
LIPIX / Healthix As a Regional Health Information Organization, or RHIO, provide technology and consulting services that connect health care providers and patients. With the patients consent, help medical care teams securely share records across organizations, making patient information available wherever and whenever its needed. https://services.lipixportal.org/HealthixPortal/
Getting back to the Challenge of Change.
Economic and Market Forces (preparing the organization to survive and thrive)
Anticipatory readiness through organizational restructuring emerging from hibernation (restructuring) anticipated changes in state law and
regulation reconfiguration of services being offered
The Individual: Revitalization Through Career Development
example of major change in personal circumstances
assessment of job prospects utilization of resources for career assessment additional formal study additional career experience
** Lifelong Learning**
Sources of Change
Management turnover Product or service lines added, dropped, or
altered Introduction of new technology Job restructuring Methods and procedures updated Organizational policies
Resistance To Change
Change is the only constant in life.- Heraclitus
Resistance To Change
Change is inevitable (for better or worse) Change can be chaotic and painful Change has the power to confuse and frustrate People expect constancy (Human nature) People strive to reach and maintain
equilibrium with their surroundings People equate security with constancy
Resistance to Change
Addressing Resistance with Employees
Tell them what to do (rarely successful) Convince them of what must be done
(always possible) Involve them in determining the nature of
the change (ideal, but not always possible)
Managing Resistance to Change
Five points for managing resistance: Do change management right the first time Expect it Address it formally Identify the root causes Engage the right resistance managers (this is
typically senior leadership of the organization.)
Consider the following change management activities:
Utilize a structured change management approach from the initiation of the project
Active and visible participation by senior leaders Advocacy by management levels including
middle managers and front-line supervisors Communications that describe the need for
change, the impact on employees and the benefits to the employee (answering "What's in it for me?)
Guidelines for Effective Management of Change
Plan thoroughly Communicate fully Convince employees Involve employees when possible Monitor implementation
Guidelines for Effective Management of Change
Plan thoroughly
Fully evaluate the potential change and examine all implications of its potential impact on the department and the organization.
Guidelines for Effective Management of Change
Communicate fully
Completely communicate the change, starting early, ensuring that the employees are not taken by surprise.
Guidelines for Effective Management of Change
Convince employees
Take steps to sell employees on the value and benefits of the proposed change.
This can be a difficult step when personnel downsizing is part of the change plan.
Guidelines for Effective Management of Change
Involve employees when possible
!Be aware of the value of employees as a source of job knowledge, and tap this source not only for the acceptance of change but for the development of improvements.
!Build teams of employees to help plan for change, implement change, and monitor change.
Guidelines for Effective Management of Change
Monitor implementation
!Monitor the implementation of change until it is established as part of the excepted work pattern.
!Initial enthusiasm often wears off and old habits return. New resistance may arise at this point.
A New and Current Challenge
The Patient Protections and Affordable Care Act of 2010
The Patient Protections and Affordable Care Act of 2010
major change affecting all levels of health care
gradual implementation over several years
necessity for having a process to monitor the facts
Tracking Changes Implementing PPACA
impact on the organizational setting patterns of care developments changes in practitioners roles effect on clients needs of employees systems impact
Take a break..
And then it is your turn.
Return in 15 minutes Please sit with your team!
Activity & Class Discussion (a real-world scenario)
You are an administrative staff specialist newly employed by the hospital to act as a management engineer and address a number of issues relating to operating efficiency. Your first assignment is to analyze work methods and staffing in the central sterile supply division of materials management. The department was singled out for study because:
Activity & Class Discussion (a real-world scenario)
The manager, a registered nurse who has held the job for more than 25 years, has requested two more processing aides although her staff is already one person larger than that of another area hospital of equivalent size.
There has been a recent, seemingly unexplainable, upturn in the consumption of disposables.
A number of storage shelves appear to be stocked to overflowing with infrequently used items.
The department issues frequent rush orders to obtain needed items that have completely run out.
Activity & Class Discussion (a real-world scenario)
On your initial visit to the department the first thing the manager says to you is: So youre the one whos going to tell us what were doing wrong? Her tone is none too friendly. Instructions:
Develop a proposed approach to a complete study of the department, including the sales pitch you would use to try winning the managers cooperation and support, specifying what should be done, why it should be done, and how you propose to address the inevitable resistance of both manager and staff.